Diabetes mellitus, plague of the century

Diabetes Mellitus
the plague of the century
Prof. Dr. Faisal Abdul Latif Alnasir FPC, FRCGP, MICGP, FFPH, PhD
Chairman; Dept. of Family & Community Medicine
Arabian Gulf University. Bahrain
President; Scientific Council Family & Com. Medicine
Arab Board for Medical Specializations
General Secretary; Int. Society for the History of Islamic Medicine

Faisal Alnasir 2014 3
Content:
• Definition
• History
• Incidence
• Economic Impact
• Prevention

 Diabetes mellitus
(diabetes) is a non-
communicable
chronic disease.
 It occurs when the
pancreas does not
produce enough
insulin, or when the
body cannot
effectively use the
insulin it produces.

Diabetes name is from a Greek
physician, Aretus the Cappadocian
(around the first century B.C.E), he
called it diabainein, meaning "a
siphon," or "to pass through,"
referring to the excessive urination.
The Greek word mellitus, meaning
“like honey,” reflect the sweet smell
and taste of the urine.

Discovery
In views of some;
Diabetes has been discovered in the fifth century
BC.
An Indian doctor observed the gathering of ants
around the urine of patients who were suffering
from certain diseases.
He was surprised and asked: What could attract
ants to urine?
Scientific curiosity led him to taste that the urine.
And discovered that the urine was sweet .
He then knew that these patients suffer from a
strange disease arises when the sugar is present
in the urine

Old Egyptian 1550 BC

Diabetes, is an old disease
since early mankind.
Anciently people noticed its
symptoms and tried to invent
a treatment.
It took many many years of
attempts to uncover its
mysteries and its causes.

‫ساهم‬‫في‬‫اكتشاف‬‫مرض‬‫السكر‬‫و‬‫وصف‬‫أعراض‬‫ه‬‫ف‬‫ي‬
‫كثرة‬‫التبول‬‫و‬‫شرب‬‫الماء‬‫وضعف‬‫البنية‬‫الجسدي‬‫ة‬
‫وضعف‬‫القوى‬‫البدني‬‫ة‬.
‫عالج‬‫ال‬‫مرض‬‫بتنظيم‬‫الغذاء‬‫والنباتات‬‫الطبي‬‫ة‬.‫ث‬‫م‬
‫نصح‬‫األطباء‬‫في‬‫رسالته‬‫التوجيهية‬‫إلى‬‫الطبي‬‫ب‬‫ب‬‫أن‬
‫المقابلة‬‫نصف‬‫العالج‬‫وذلك‬‫دعوة‬‫للكشف‬‫السري‬‫ري‬
‫الدقيق‬‫على‬‫المريض‬.
‫د‬‫عبدالناصر‬‫كععدان‬ISHIM
‫الرازي‬ ‫زكريا‬ ‫بن‬ ‫يحيى‬ ‫بن‬ ‫محمد‬ ‫بكر‬ ‫أبو‬
(256–313‫هـ‬)‫افق‬‫و‬‫الم‬(865–925‫م‬:)

‫وصف‬‫ابن‬‫سينا‬‫مرض‬‫السكر‬:
•‫بكثرة‬،‫التبول‬‫وله‬‫عالقة‬‫بغرغري‬‫نا‬
‫القدم‬.
•‫كما‬‫وصف‬‫بعض‬‫مضاعفات‬‫السكر‬
‫األخرى‬‫مثل‬(‫العنه‬)‫الضعف‬
‫الجنسي‬‫أو‬‫ضعف‬‫االنتصاب‬.
•‫وعالج‬‫المرضى‬‫بتنظيم‬
‫الغذاء‬‫والنباتات‬‫الطبيه‬‫والحجامه‬
‫وأوصى‬‫بالتمارين‬‫الرياضية‬‫وخاص‬‫ة‬
‫على‬‫ظهر‬‫الحصان‬.
•‫وأوصي‬‫إلى‬‫أهمية‬‫العالج‬‫النفسي‬.
‫سيناء‬ ‫ابن‬
‫ب‬ ‫علي‬ ‫بن‬ ‫الحسن‬ ‫بن‬ ‫هللا‬ ‫عبد‬ ‫بن‬ ‫الحسين‬ ‫علي‬ ‫أبو‬‫ن‬،‫سينا‬
]370-427‫ه‬980-1037‫م‬[

‫له‬‫رسالة‬‫خاصة‬‫مفصلة‬‫عن‬‫مرض‬‫السكري‬‫بها‬‫ثالثة‬‫أجزاء‬:
‫الجزء‬‫األول‬:‫تكلم‬‫عن‬‫أعراض‬‫المرض‬‫وخاصة‬‫فرط‬‫إدرار‬‫البول‬‫مع‬‫العطش‬‫الشديد‬‫وكثرة‬‫شرب‬‫الماء‬.
‫وضعف‬‫الجسم‬‫والهزال‬‫الشديد‬‫ومرض‬‫الكلي‬‫المصاحب‬‫لداء‬‫السكري‬.
‫الجزء‬‫الثاني‬:‫ذكر‬‫فيه‬‫آراء‬‫المتقدمين‬‫عن‬‫مرض‬‫السكري‬،‫وعلل‬‫أسباب‬‫المرض‬‫مثل‬‫تأثير‬‫بعض‬‫المواد‬
‫التي‬‫تفرز‬‫من‬‫الكبد‬‫والتي‬‫ال‬‫تحتملها‬‫الكلي‬‫فتتأثر‬‫بذلك‬‫وتدر‬‫البول‬‫بكثرة‬.‫وأن‬‫ضياع‬‫رطوبة‬
‫الجسم‬‫يعد‬‫سببا‬ً‫من‬‫أسباب‬،‫المرض‬‫وعرف‬‫الرطوبة‬‫أنها‬‫خليط‬‫في‬‫الجسم‬‫من‬‫الماء‬‫وال‬‫نار‬
‫ثم‬‫مزيج‬‫من‬،‫االثنين‬‫واختالط‬‫هذه‬‫النسب‬‫يؤدي‬‫إلى‬‫مرض‬‫السكري‬‫والكلي‬.
‫الجزء‬‫الثالث‬:‫تطرق‬‫فيه‬‫إلى‬‫ال‬،‫عالج‬‫في‬‫وصي‬‫بتنظيم‬‫الغذاء‬‫وزيادة‬‫األلياف‬‫فيه‬‫حيث‬‫وصى‬‫ف‬‫الخ‬‫يار‬
‫والفواكه‬‫والمواد‬‫القابضة‬‫التي‬‫تقلل‬‫من‬‫إدرار‬‫البول‬.‫وأوصى‬‫بالتمارين‬‫والرياضية‬‫وببعض‬
‫األقراص‬‫التي‬‫اكتشفها‬‫وقام‬،‫بتركيبها‬‫مثل‬‫خليط‬‫من‬‫الطباشير‬‫وبرباريس‬‫وورد‬‫وبزر‬
‫قطونا‬،‫تعجن‬‫بماء‬‫الخيار‬‫أو‬‫بماء‬‫سويق‬‫الشعير‬.‫وأوصى‬‫كذلك‬‫بنبات‬‫السفرجل‬.
‫البغدادي‬ ‫اللطيف‬ ‫عبد‬
(‫ولد‬‫عام‬ ‫ببغداد‬1162‫م‬)

Diabetes is plague of the century which
is pandemic and a ticking time bomb

Diabetes Can Be Silent:
Diabetes can go silently
undetected for a long time
without symptoms.
Many people first become
aware that they have
diabetes when they develop
one of its potentially life-
threatening complications,
such as heart disease,
blindness or nerve disease.

Types:
 Type 1 diabetes: insulin-dependent diabetes or juvenile-onset diabetes.
It develops when the body's immune system destroys pancreatic beta
cells.
 Type 2 diabetes: non-insulin-dependent diabetes mellitus or adult-onset
diabetes. It usually begins as insulin resistance, a disorder in which the
cells do not use insulin properly. It accounts for about 90 to 95 percent of
all diagnosed cases of diabetes.
 Gestational diabetes is a form of glucose intolerance diagnosed during
pregnancy.
 Other types result from specific genetic conditions, such as maturity-
onset diabetes of youth; surgery; medications; infections; pancreatic
disease; and other illnesses.
National Diabetes Information Clearinghouse (7)Faisal Alnasir 2014 15


Prevalence and Facts:
 About 347 million people worldwide have diabetes
 Diabetes is predicted to become the seventh leading cause of
death in the world by the year 2030
www.who.int/features/factfiles/diabetes/en/index.html(11)
 Of 57 million deaths occurred in the world during 2008; 36
million (63%) were due to NCDs, principally cardiovascular
diseases, diabetes, cancer and chronic respiratory diseases.
 80% of these NCD deaths (29 million) occurred in low- and
middle-income countries NCD.
 Deaths are projected to increase by 15% globally between
2010 and 2020 (to 44 million deaths).
www.who.int/nmh/publications/ncd_report_chapter1.pdf?ua(1)

Source www.who.int/nmh/publications/ncd (12)

www.who.int/nmh/publications/ncd_report_chapter1.pdf?ua=1

In the USA
 In 2005–2008, based on fasting glucose or
hemoglobin A1C (A1C) levels, 35% of adults ages
<20 years and 50% of adults ages <65 years are
prediabetic
 8.3% of the population have DM of whom:
18.8 million people are DIAGNOSED
 7.0 million people are UNDIAGNOSED
National Diabetes Information Clearing house (7)

Source: 2007–2009 National Health Interview Survey estimates projected to the year 2010

www.who.int/nmh/publications/ncd_report_chapter1.pdf?ua=1(30)

In MENA, GCC
It is particularly dangerous for the Middle
East and GCC countries where the world’s
highest prevalence of diabetes exists. It
threatens both individuals and the society
as a whole.
gulfbusiness.com/2013

 Its prevalence in the Middle East ranges from 4%
in the Islamic Republic of Iran to 19% in Sudan
however it may reach up to 30%.
www.cdc.gov/diabetes(14)
 Six of the 10 countries with the highest
prevalence of diabetes in the world are from the
Region: Bahrain, Kuwait, Lebanon, Oman, Saudi
Arabia and United Arab Emirates.

•According to the International Diabetes Federation:
 32.8 million people diagnosed with diabetes in
2011 in the MENA region.
 expected to increase by 83% to 59.7 million by
2030.
IDF
• By 2025, the number of people with diabetes will be
more than double in Africa, Eastern Mediterranean
and South-East Asia regions.

Faisal Alnasir 2014 26Dr. Tawfik A. M. Khoja 26

It is anticipated that by 2030 in the
Middle East
The increase will reach to 60 million
from 32.6 million (in 2011) people with
diabetes
IDF

Without intervention, the spread of
diabetes leads to devastating social
and fiscal consequences, including
threats to the region’s economic
progress and investment stability.
http://www.boozallen.com

WHY?
•Rapid economic development that has
negative side effects: less physical activity,
unhealthy diets and, eventually, obesity.
• The GCC is witnessing in the last few
years huge changes in the health needs
of its population. MANY countries are
suffering from the effects of the double
burden due to infectious and non-
communicable diseases.

• NCDs forms the main causes of premature
deaths and disability. It forms around 60%
of the overall mortality and 47% of the
global burden of diseases.
• These two rates are expected to jump
into 73% and 62% respectively by the
year 2020.

Diabetes
Hypertension
Smoking
Obesity
Dyslipidaemia
Physical Inactivity
EMRO & NCD RISK FACTORS
Diabetes 1.5 -2 in 10
Hypertension 1 in 4
Smoking 1 in 3
Obesity 1 in 2
Dyslipidaemia 1 in 2
Physical
Inactivity
8 in 10
31
Dr. Tawfik A. M. Khoja

Awareness of Diabetes Mellitus

Faisal Alnasir 2014
33
Awareness of Diabetes Mellitus
Faisal Alnasir, 2008

In Pakistan
43% adults had any awareness of DM.
14% awareness of risk factors
22% awareness of the complications associated
with the disease
77% reported never going for regular checkups
to any clinic or hospital
Osman Saleem Ulvi, 2009

In Gambia
The majority of diabetic patients have poor
knowledge of DM.
47% only knew what DM is.
53% had no knowledge of the causes of DM
50% were not aware of the methods of
prevention.
Mafomekong etal, 2013

37Faisal Alnasir
Economic Impact
The economic burden of NCDs can be analyzed on
two levels.
• First, the effects of macroeconomic policies on
opportunities for prevention in different population
groups
• Second, the cost and overall efficiency of interventions
must be evaluated in terms of effectiveness and health
gains for the population at large

Economic burden
DM Imposes large economic burden on individuals,
national healthcare system and economy.
• In the world; 80% of the countries are predicted to
spend between 5% to 13% of their total healthcare
expenditure on diabetes.
• In 2010 diabetes accounted for 11.6% of the total
healthcare expenditure which was around USD376
billion and projected to exceed USD490 billion by
2030.
Int. Diabetic Federation

Diabetes Costs in the United States,
2007
Medical expenses for diabetic people
TWO times higher than for people
without diabetes
Approximately $1 of $5 (20%) health
care dollars in the USA is spent caring
for someone with diagnosed diabetes.
www.cdc.gov/diabetes/consumer/research.htm (14)

Direct medical costs
Indirect cost
•In USA $116 Billion
•In UK £10 Billion (in 2011) predicted
to increase to £17 Billion in 2036
Disability, work days loss, premature
mortality, Lower of Productivity
•In USA $58 Billion
•In UK £14 Billion predicted to increase
to £23 Billion in 2036
NHS

• More money is expected to be spent on diabetes
care for women than for men.
Disparities
• More than 80% of the estimated global expenditures
on diabetes are made in the world’s economically
richest countries, not in the low- and middle-income
countries where over 70% of people with diabetes
live.
• USA, spent USD198 billion or 52.7% of global
expenditure in 2010 on DM, while India, the country
with the largest population of people living with
diabetes, spent an estimated USD2.8 billion.
IDF

In UAE
The disease reached pandemic
proportions, with 31 percent of all deaths
in the UAE caused by diabetes and its
complications.
• Medical expenditures for those with
diabetes are on average 2.3 times
higher than for those without the
disease
www.boozallen.com

• In 2011, total diabetes-related costs
amounted to $6.6 billion, or 1.8 percent of
the nation’s GDP, higher than any other
country in the GCC
• Treatment of diabetes accounts for
approximately 40% of the nation’s overall
healthcare expenditures
www.boozallen.com

Obesity

Children
who were overweight when entering
kindergarten in 1998 in USA were 4 times
as likely as their normal-weight classmates
to become obese by age 14 years,
45.3% of obesity cases that developed
between kindergarten and eighth grade
occurred among the 14.9% of children who
were overweight when entering
kindergarten
Solveig A. etal 2014 (28)

who.int/nmh/publications/ncd (12)

Faisal Alnasir 49
In less affluent countries
Sudan
Of 6-12y children:
14.8% were overweight; 10.5%
were obese
Slaman et al 2010

Prevalence of overweight and obesity among
some countries of the Eastern Mediterranean
Region (WHO.2004)
Overweight/obesity (%)
Males Females
Country
70.064.0Saudi Arabia
53.060.0Lebanon
67.757.0Islamic Republic of Iran
79.056.4Bahrain
43.746.0Jordan
41.043.8Egypt
74.942.5Libyan Arab Jamahiriya
43.540.5Oman
21.737.2Morocco
39.925.5United Arab Emirates
41.913.1Tunisia
Kuwait 72.5
WHO,2004

51Faisal Alnasir
In Bahrain
MOH,UNDP 2010

53Faisal Alnasir 53
53
Life style Modification
• Physical activity
MOH,UNDP 2010

 58% Diabetes Mellitus
 21% Ischemic heart diseases
 4-42% of certain cancer were
attributable to BMI above 21
kg/m2
Global effect of Over weight & Obesity
on developing NCDs WHO analysis:

Diabetes & other disease
Intimate relationship between DM and
hypertension. It is estimated that if
diabetic patients live long enough,
approximately 75% will develop
hypertension.
Clarke ,2005
In the US 73% of diabetics have high
blood pressure.
National Diabetes Statistics Fact Sheet, NIDDK, 2003

Diabetic Control

Effect of reduction of HbA1c:
• Every 1% drop in HbA1c reduces the risk of microvascular
complications by 40%, and death by 21%.
• Over 6 years an HbA1c level of 8% instead of 7% predicted
92% greater risk of retinopathy.
University of Gothenburg Sweden, 2009 (25,1,3)
• 21% decrease in death rate per each 1% reduction in HbA1C
National resource center for academic detailing (26)

The key to understanding the gravity of diabetes and
managing it is through:
Education, Awareness, Prevention
It is provided through public health policy intervention.
It is the prim responsbility of the:
FAMILY PHYSICIAN

80% of money spent on
managing avoidable
complications
Diabetes UK

TEN facts about DM:
1. 347 million people worldwide have diabetes
2. seventh leading cause of death in the world in 2030
3. Type 2 is much more common than type 1 diabetes
4. Type 2 accounts for around 90% of all diabetes worldwide
5. Type 2 in children (previously rare) have increased worldwide. In some
countries, it accounts for almost half of newly diagnosed cases in children
and adolescents
6. Cardiovascular disease is responsible for 50% to 80% of deaths in people
with diabetes
7. Diabetes is a leading cause of blindness, amputation and kidney failure
8. In 2004, an estimated 3.4 million people died from consequences of high
FBS
9. 80% of diabetes deaths occur in low- and middle-income countries
10. Type 2 diabetes can be prevented
www.who.int/features/factfiles/diabetes(11)

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Diabetes mellitus, plague of the century

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