what is diabetes, its prevalance acc to data from 2021 and what can be done to manage it globally

1. DIABETES MELLITUS
NONCOMMUNICABLE DISEASES

2. • Diabetes is a chronic disease that occurs either when the pancreas does not
produce enough insulin or when the body cannot effectively use the insulin it
produces. Insulin is a hormone that regulates blood glucose. Hyperglycaemia,
also called raised blood glucose or raised blood sugar, is a common effect of
uncontrolled diabetes and over time leads to serious damage to many of the
body's systems, especially the nerves and blood vessels. (WHO, 2023)
HOW DOES INSULIN WORK?
• Glucose uptake
• Pancreatic response
• Cellular uptake
• Blood glucose regulation
• Negative feedback loop

3. In a nutshell
• If your pancreas are not adequately producing insulin, Type 1.
• If the insulin receptors on the cells in your body are desensitized and cannot
effectively use the insulin it produces, Type 2.
• Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-
onset) is characterized by deficient insulin production and requires daily
administration of insulin.
Moreover…
• Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are
intermediate conditions in the transition between normality and diabetes.
People with IGT or IFG are at high risk of progressing to type 2 diabetes,
although this is not inevitable

5. Gestational Diabetes

6. • Gestational diabetes is hyperglycaemia with blood glucose
values above normal but below those diagnostic of diabetes.
Gestational diabetes occurs during pregnancy.
• Women with gestational diabetes are at an increased risk of
complications during pregnancy and at delivery. These
women and possibly their children are also at increased risk
of type 2 diabetes in the future.
• Gestational diabetes is diagnosed through prenatal
screening, rather than through reported symptoms
(WHO, April 2023)

7. Symptoms include
• Feeling very thirsty
• Needing to urinate more often than usual
• Blurred vision
• Feeling very tired
• Losing weight unintentionally
(WHO, April 2023)
Patients diagnosed with type 2 diabetes often approach
their treatment via medicines to help manage their
blood sugar levels. These include insulin injections or
other medicines. Some examples include:
• metformin
• Sulfonylureas sul-fony-lureas
• sodium-glucose co-transporters type 2 (SGLT-2)
inhibitors.

8. Factors Responsible for the Causes of Diabetes Mellitus
Genetic
Predisposition:
• Family history of diabetes is a significant risk factor (Smith et al., 2018).
• Certain genetic mutations can increase susceptibility to diabetes (Jones & Williams, 2016).
Obesity and
Sedentary Lifestyle
• Obesity contributes to insulin resistance and type 2 diabetes (Gupta et al., 2019).
• Lack of physical activity is associated with higher diabetes risk (Brown & Smith, 2017).
Insulin Resistance • Insulin resistance disrupts glucose regulation, leading to diabetes (Kahn, 2020).
• Adipose tissue inflammation can contribute to insulin resistance (Xu et al., 2015).
Dietary Factors • High sugar and refined carbohydrate intake contribute to diabetes (Johnson et al., 2017).
• Mediterranean diet may lower diabetes risk due to its nutrient composition (Martinez-Gonzalez et al.,
2019).
Ethnic and
Socioeconomic
Factors
• Certain ethnic groups have higher diabetes prevalence (Tan et al., 2018).
• Socioeconomic disparities impact access to healthy foods and healthcare (Adler et al., 2016).
Imbalance of gut
microbiome and
Inflammation
• Gut microbiota composition can influence diabetes risk (Wu et al., 2021).
• Chronic inflammation may contribute to insulin resistance and type 2 diabetes (Hotamisligil, 2017).

9. Stress and Hormonal Factors • Chronic stress can impact insulin sensitivity and glucose
regulation (Kyrou & Tsigos, 2017).
• Hormones like cortisol and glucagon play a role in diabetes
development (Stentz et al., 2019).
Gestational Diabetes and Pregnancy • Gestational diabetes increases the risk of type 2 diabetes
later in life (Bellamy et al., 2009).
• Pregnancy-related hormonal changes can affect glucose
metabolism (Lowe et al., 2018)
Environmental Toxins • Exposure to certain environmental pollutants may
contribute to diabetes risk (Lee et al., 2020).
• Endocrine-disrupting chemicals can affect insulin signaling
(La Merrill & Lind, 2021).
Sleep Disruption • Poor sleep patterns and sleep disorders are linked to insulin
resistance (Morselli et al., 2019).
• Sleep deprivation can affect glucose tolerance (Tasali et al.,
2016)

10. Consequences
Microvascular Complications
(Brownlee, 2001) (Molitch et al., 2003) (Cheung et al., 2010)
Economic Burden
(American Diabetes Association, 2018) (Zhuo et
al., 2014)
Macrovascular Complications
(Seshasai et al., 2011) (Forbes & Cooper, 2013).
Cardiovascular Health and Mortality
(Sarwar et al., 2010) (Selvin et al., 2014)
Lower Extremity Amputations
(Wukich & Hobizal, 2016) (Lavery et al., 2008)
Psychological and Quality of Life Impact
(Nouwen et al., 2010) (Fisher et al., 2012)
Cognitive Function and Dementia
Biessels & Despa, 2018) (Janson et al., 2004).
Pregnancy Complications
(Hod et al., 2017) (Lowe et al., 2018)

11. HIGHLIGHTS
1 in 2
Adults are undiagnosed
240 million people
11.5%
Of global health expenditure spent
on diabetes (USD 966 billion)
1 in 10
Adults (20-79 years)
has diabetes
537 million people
1 in 6
Live births (21 million) affected
by hyperglycaemia in pregnancy,
80% have mothers with GDM
6.7 million
Deaths attributed to diabetes
1 in 18
Adults (20-79 years) has
impaired fasting glucose
319 million people
1 in 9
Adults (20-79 years) has
impaired glucose tolerance
541 million people
1.2 million
Children and adolescents below
20 years have type 1 diabetes
3 in 4
People with diabetes live in
low and middle-income countries

12. HIGHLIGHTS
7.8 million
More adults with diabetes
undiagnosed
1.67 million
More adults with impaired
glucose tolerance
US$206 billion
More USD spent on diabetes
700,000
More pregnancies affected
by hyperglycaemia
2.5 million
More deaths caused by diabetes
149,500
More children and adolescents
with type 1 diabetes
73.6 million
More adults with diabetes

13. Prevalence and Incidence
prevalence and incidence of disease wrt world, regions, and Pakistan

14. Number of people with diabetes
Aged 20–79 years globally and by IDF region

15. 30.8
24.9
23.4
23.4
22.6
20.9
19.8
19.5
0 5 10 15 20 25 30 35
Pakistan
Kuwait
Austrailia
France
Mauritius
Egypt
Solomon Islands
Qatar
Highest
Prevalence

16. • Approximately 463
million adults
worldwide have
diabetes, and 90% of
these people suffer from
type 2 diabetes mellitus
• Pakistan is one of the 21
countries and territories
of the IDF Middle east
north africa region. 537
million people have
diabetes in the world and
73 million people in the
MENA Region; by 2045
this will rise to 135.7
million.
Affected Unaffected

17. Hence, Pakistan has around 27.4 million people >20 years of age suffering with diabetes
compared to previous estimation of having around 7 million diabetic patients based on a survey done in 1994–1998,
the figures are disturbingly alarming
Studies reported that diabetes incidence increased during the COVID-19 pandemic

18. Disparities among Gender in Pakistan
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Punjab Sindh Balochistan KPK
Axis
Title
Axis Title
Chart Title
Males Females

19. Socioeconomic Factors include
Urbanization and Lifestyle Changes (Ghaffar et al., 2019), (Shera & Jawad, 2017).
Gender Disparities (Basit et al., 2017), (Fawwad et al., 2017)
Age Distribution (Imran et al., 2020)
Rural-Urban Divide (Shera et al., 2016)
Ethnic and Regional Variations (Bakhtawar et al., 2018)
Healthcare Infrastructure Challenges (Khattak et al., 2018)
Undiagnosed Cases (Khattak et al., 2018)
Economic Burden (Riaz et al., 2017)

20. Diabetes Management
Initiatives in Pakistan
• Risk Assessment
(Basit et al., 2016)
• Diabetes Awareness Campaigns
(Zaman et al., 2020)
• Diabetes Screening and Early Detection
(Fawad et al., 2018)
• Access to Diabetes Care
(Shera et al., 2019)
• Diabetes Education and Training self-management training (Bailey
et al., 2019)
• Public-Private Partnerships National DPP
(Zafar et al., 2020)
• Research and Surveillance
(Khuwaja et al., 2015)

21. WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of
diabetes and its complications, particularly in low- and middle-income countries. To this end, WHO:
 provides scientific guidelines for the prevention of major noncommunicable diseases including diabetes;
 develops norms and standards for diabetes diagnosis and care;
 builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14 November); and
 conducts surveillance of diabetes and its risk factors.
 In April 2021 WHO launched the Global Diabetes Compact, a global initiative aiming for sustained improvements in
diabetes prevention and care, with a particular focus on supporting low- and middle-income countries.
 In May 2021, the World Health Assembly agreed a Resolution on strengthening prevention and control of diabetes. In
May 2022 the World Health Assembly endorsed five global diabetes coverage and treatment targets to be achieved by
2030

22. • Diabetic foot guidelines will be developed by Pakistan Working Group on Diabetic Foot (PWGDF) in accordance
with the International Working Group on the Diabetic Foot (IWGDF) guidance document which has been
developed in May 2015 with active participation of faculty of BIDE, Karachi, Pakistan.
• Gestational diabetes mellitus (GDM) guidelines are being developed by the GDM advocacy board, after the
completion of two major projects screening around 25000 pregnant women, the outcomes of these projects are
expected to be available by 2018.

23. They are aligned with SDG 3, which focuses on ensuring good health and well-being for all
Namely :
3.1 Reduce maternal mortality
3.4 Reduce mortality from non-communicable diseases and promote mental health
3.7 Universal access to sexual and reproductive care, family planning and education
3.8 Achieve universal health coverage
3B Support Research, develpoment and universal access to affordable vaccines and medicines
3D Improve early warning systems for global health risks

24. Recommendations
• Early Life Interventions anti-obesity drug to protect metabolism in USA
(Hanson & Gluckman, 2015)
• Community-Based Programs
1. promoting primary prevention and awareness all over Pakistan using screening methods such as Risk
Assessment of Pakistani Individuals for Diabetes (RAPID); 3) defining strategies for the management and
prevention of diabetes and its complication through forums such as the Pakistan Diabetes Leadership Forum
(PDLF)
2. creating multidisciplinary teams through capacity building of the health care professionals (HCPs), including
doctors, dieticians, diabetes educators, diabetes foot assistants, and program managers in standardized
evidence-based protocols, enhancing their knowledge and skills in managing diabetes and their related
comorbidities (Philis-Tsimikas et al., 2017)
• Policy Advocacy
• Future priority areas and interventional strategies shall include the following: implementing a diabetes
health care service model in both rural and urban population using evidence-based clinical guidelines along
with lifestyle modifications (LSMs) and prevention policies
(Hawkes et al., 2015)
• Leveraging Technology and Big Data (Ali et al., 2020) wearable deavices such as
Continuous glucose monitors (CGMs)

25. Digital Health Solutions
Continuous glucose monitors (CGMs) transmit
data to softwares to supervise Blood sugar
(Rodbard, 2018)
Long-term Follow-up and Maintenance
(Kidd et al., 2016)

26. Using mass media for Public Service Messages to deliver awareness at a much greater extent

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• https://www.who.int/news-room/fact-sheets/detail/diabetes
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