This document discusses diabetes prevention and control strategies in Pakistan. It recommends taking an integrated population and high-risk approach. The population approach involves reducing risks for all ages through school health initiatives and keeping obesity levels low. The high-risk approach focuses on intensified screening of high-risk groups and education on risk reduction and management. Key strategies proposed include lifestyle changes like healthy diet, exercise and weight control; early diagnosis through affordable testing; treatment through blood sugar and risk factor control; and multilevel prevention programs targeting all sectors.

1. Dr. Gulzar Usman
MBBS, DFHC, MPH, PhD
Associate Professor

2. Scheme

3. Diabetes
3
Diabetes is a chronic disease that
occurs when the pancreas does not
produce enough insulin (a hormone
that regulates blood sugar) or
alternatively, when the body cannot
effectively use the insulin it
produces. The overall risk of dying
among people with diabetes is at
least double the risk of their peers
without diabetes.

4. Classification
• The WHO recognises several
types of diabetes
• Type 1
• Type 2
• Gestational diabetes
• Other types
4

5. What do these images say to you about diabetes?
5
Silent Killer…

6. EPIDEMIOLOGY

7. Global Prevalence of
Diabetes
Diabetes is a growing global
health concern

9. Diabetes: Quick facts and figures
9
About 347 million people
worldwide have diabetes.
75% of these people will hail from the
developing countries.
There is an emerging global epidemic
of diabetes that can be traced back to
rapid increases in overweight,
obesity and physical inactivity.

10. Diabetes: Quick facts and figures
10
80% of diabetes deaths occur in
low- and middle-income countries.
In developed countries most people with
diabetes are above the age of retirement,
whereas in developing countries those most
frequently affected are aged between 35 and 64.

11. Global diabetes epidemic
International Diabetes Federation
Estimated
number
of
people
with
diabetes
worldwide
(millions)
Year
30
150
246
380
0
50
100
150
200
250
300
350
400
1980 1990 2000 2010 2020 2030

12. Global impact…
• Diabetes accounts for estimated 5.2%
all world mortality
• 80% deaths occur in low & middle
income countries
• Prevalence increasing fastest in these
countries
Source: WHO
12

13.  Hypertension 40-50%
 Hyperlipidemia 30-35%
 Central Obesity 46-53%
 Diabetes 07-12%
 7.0 million have diabetes
 14.5 million will have diabetes by 2025
Burden of Diabetes in Pakistan
1-Pakistan medical research council. National health survey of Pakistan – health profile of the people of Pakistan.
Islamabad, Pakistan: Federal bureau of statistics and Pakistan medical research council;
2- Data from M Phil June 2007, “Metabolic Syndrome and Insulin Resistance in Pakistan: a population based study in
adults 25 years and above in Karachi, University of Oslo
3-Jafer TH, et al. Heart disease Epidemic in Pakistan: Women and Men at Equal Risk. Am Heart J 2005;150:221-6
4-Heart file. Population-based surveillance o Non- communicable disease 1st round, 2005. Islamabad, Pakistan: heart file,
ministry of health and world health organization; 2006
5.Prevalence of diabetes in Pakistan. Diabetes Research and Clinical Practice, Volume 76, Issue 2, May 2007, Pages 219-
222 A. Shera, F. Jawad, A. Maqsood

14. Diabetes: Health implications
14
Elevated blood sugar is a common effect of
uncontrolled diabetes, and over time can
damage the heart, blood vessels, eyes, kidneys,
and nerves.
Some health complications from diabetes include:
• Diabetic retinopathy
• Diabetic neuropathy
• Diabetes is among the leading causes of kidney
failure; 10-20% of people with diabetes die of
kidney failure.
• Diabetes increases the risk of heart disease and
stroke; 50% of people with diabetes die of
cardiovascular disease (primarily heart disease
and stroke).

15. RISK FACTORS

16. The wide spread determinants of health
Source: Dahlgreen and Whitehead, G and
Whitehead M (1991)
16 LTPHN/JS © 2010

17. Relative risks of type 2 diabetes
• Non-Modifiable risk
factors:
• Family history;
• Age;
• Ethnicity
• Modifiable risk factors
• Obesity;
• Exercise;
• Smoking
• Socioeconomic
circumstances;
(life style)
0 5 10 15 20 25
OBESITY
age
ethnicity
socioeconomic
factors
SMOKING
Risk
factor
RR
17 LTPHN/JS © 2010

18. The challenge for public health
18 LTPHN/JS © 2010

19. Luckovich, Atlanta Journal Constitution

20. Prevention and control of
diabetes in Pakistan
Diabetes prevention and control is
particularly relevant in Pakistan;
Increased inherent predisposition,
younger age of onset, lack of
capacity to effectively treat the
condition at the primary healthcare
level and lack of equitable access
to healthcare for possible
complications makes a strong case
for investment in diabetes
prevention and control.
Life style.

21. Diabetes: Prevention
21
Without urgent action, diabetes-related deaths will
increase by more than 50% in the next 10 years.
To help prevent type 2 diabetes and its
complications, people should:
• Achieve and maintain healthy body weight.
• Be physically active - at least 30 minutes of
regular, moderate-intensity activity on most
days.
• Early diagnosis can be accomplished through
relatively inexpensive blood testing.
• Treatment of diabetes involves lowering blood
sugar and the levels of other known risk factors
that damage blood vessels.
• Tobacco cessation is also important to avoid
complications.

22. Prevention and control of
diabetes in Pakistan…cont
Complications are known to increase
with age, duration of diabetes and
severity of uncontrolled diabetes.
In an urban facility-based setting in
Pakistan, 19.8% of the diabetics were
shown to be suffering from CAD,
6.2% had suffered a major
cerebrovascular event whereas 2.1%
had a diabetic foot.

23. Integrated Framework for Action
(IFA)

24. Approaches to prevention of
diabetes
Strategies for preventing diabetes fall within the
primary and secondary prevention domains and
can be grouped into population and high-risk
approaches.
The population approach focuses on mitigating
risks whereas the high-risk approach involves
intensified case-finding in high-risk groups and
provision of guidance to patients relating to risk
reduction and effective control

25. Population approach:
Young people of all ages need to be targeted to
keep their risks at low levels.
School health initiatives, therefore, provide an
opportunity to identify obese and overweight
children

26. High-risk approach:
Focuses on addressing risks and
intensified case-finding in high-risk
groups, management and patient
education

27. Diabetes: Control
27
People with type 1 diabetes require insulin;
people with type 2 diabetes can be treated with
oral medication, but may also require insulin.
Blood pressure control
Foot care
Other cost saving interventions include:
Screening and treatment for retinopathy (which
causes blindness);
Blood lipid control (to regulate cholesterol
levels);
Screening for early signs of diabetes-related
kidney disease and treatment.
These measures should be supported by a healthy
diet, regular physical activity, maintaining a
normal body weight and avoiding tobacco use.

28. Exercise
• Chief Medical officer
Report 2004: ‘5 a
week’ call
for action
• At least 30 minutes
exercise 5 times a
week can improve
health, prevent
diabetes and reduce
overweight
28 LTPHN/JS © 2010

29. Preventive
Strategies
Diet &
Education
Public
Awareness
Diabetes
Educators
Course
Foot Clinic
Diploma in Diabetology
for Family Physicians
8 Batches completed
151 Diploma holders
Peripheral Diabetes
Centers
National Health
Network for Diabetes
Control and Prevention
IT
HCMS
Website
Network
Multi
centered
Data base
Research
& Audit Papers
Presentations
National
multicentered
data
Future
Podiatry
Course
National
Foot
Program

30. Summary:Prevention and control
strategies of diabetes in Pakistan
Prevention and control of diabetes
needs to be structured at all levels of
prevention – primary and secondary.
Evidence suggests that there is a
clear potential in reducing diabetes-
related mortality and morbidity by
addressing

31. Thought of the day