Prevention of Diabetes

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Prevention of Diabetes


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Presentation Overview
Definition
Classification of diabetes
The size of the problem
The costs of diabetes
Prevention of Diabetes
Recommendations

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What is diabetes
Diabetes mellitus is a chronic condition characterized by raised plasma glucose levels
Diabetes, results from the body’s inability to produce or use insulin properly, resulting in high levels of blood sugar.


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Classification of diabetes
Type 2 diabetes is caused by a combination of insulin resistance and some degree of insulin deficiency
In type 1 diabetes, the body produces no insulin
More than 80% of recognized diabetes is Type 2 and most of the remainder is Type 1

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Classification of diabetes- Cont
Gestational Diabetes Mellitus (GDM) developing during some cases of pregnancy but usually disappears after pregnancy
Impaired glucose tolerance/Impaired fasting glucose
Other rare forms include maturity-onset diabetes of the young (MODY), malnutrition-related diabetes.

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Diabetes: the size of the problem
WHO estimated prevalence of diabetes for all age- groups worldwide to be 2.8% in 2000 and 4.4% in 2030.
Estimated rise in number from 171 million in 2000 to 366 million in 2030.
150% rise in developing countries by 2030.
Number of deaths attributed to diabetes estimated at just over 800,000.

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Magnitude of the Problem
The number of people with diabetes will nearly double within the first quarter of this millennium.


World Health Report, 1997; Geneva: WHO.

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Developed Vs Developing

• Region
• 2000
• 2025
• Developed countries
• 6.2%
• 54.8 million
• 7.6%
• 72.2 million
• Developing countries
• 3.5%
• 99.6 million
• 4.9%
• 227.7 million

King et al, Diabetes Care 1998; 21: 1414-31

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The costs of diabetes
Direct costs:
Direct costs to individuals and their families: medical care, drugs, insulin and other supplies
Direct costs to the healthcare sector: hospital services, physician services, …
Overall, direct health care costs of diabetes range from 2.5% to 15% annual health care budgets, depending on local diabetes prevalence and the sophistication of the treatment available.

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The costs of diabetes- Cont
Indirect costs:
Sickness, absence, disability, premature retirement or premature mortality can cause loss of productivity.

Estimating the cost to society of loss of productivity is not easy. Pain, anxiety, inconvenience and other factors which decrease quality of life are intangible costs, which are just as heavy.

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Why should we prevent diabetes?
To reduce human suffering

To alleviate the economic burden

To prevent morbidity and mortality from diabetes-related CVD and other complications.


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Levels of prevention in diabetes
Primary: Includes activities aimed at preventing diabetes from occurring in susceptible populations or individuals
Secondary: Early diagnosis and effective control of diabetes in order to avoid or at least delay the progress of the disease
Tertiary: Includes measures taken to prevent complications and disabilities due to diabetes.

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Fact on Prevention of Diabetes

The heavy social and economic costs

of type 2 diabetes
(including its role in other diseases,
such as heart disease
and stroke) mean that primary
prevention must be a priority

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Prevention Strategies
Strategy: a set of essential preventive measures believed sufficient to control a health problem.
The word prevention embodies the goals of medicine: to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress.



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Primary preventive strategies: approaches
A population-based strategy, involving altering the lifestyle and environmental determinants of Type 2 diabetes.
A high-risk strategy applying preventive measures on individuals identified as high-risk for diabetes.

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Pre-diabetics can prevent the development of type 2 diabetes by making changes in their lifestyle

Effective prevention also means more cost-effective healthcare (?)

Facts on Primary Prevention of Diabetes

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Facts on Primary Prevention of Diabetes- Cont
Primary prevention protects susceptible individuals from developing diabetes

It reduces or delays both the need for diabetes care and the need to treat diabetes complications.

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Primary prevention
Primary prevention
Weight
Loss
Physical
Activity
Stop
Smoking


Healthy Diet

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Primary prevention- Cont
Lifestyle Changes Can Prevent Diabetes
Weight Loss is Accompanied by Considerable Lowering of the Risk of Diabetes
Physical Activity Can Prevent Diabetes
Smoking Predisposes to Type 2 Diabetes



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Weight Loss is Accompanied by Considerable Lowering of the Risk of Diabetes
• Body-Mass Index:
• Obesity in adults is assessed using the body-mass index . The higher the body-mass index, the higher the morbidity and mortality risks become.
• The risk of diabetes increases 15-fold as the body-mass index rises from 23 kg/m2 to 35 kg/m2.

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Weight Loss is Accompanied by Considerable Lowering of the Risk of Diabetes - Cont
2. Waist Circumference
The body-mass index does not indicate the distribution of body fat; waist circumference is therefore also used as a measure of obesity and the associated health risks.


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Weight Loss is Accompanied by Considerable Lowering of the Risk of Diabetes - Cont
Central obesity has been found to strongly predict risks of type 2 diabetes

Treatment of obesity will prevent illness development in individuals at risk, and in those already affected improve quality of life and prevent late complications.

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Physical Activity and Diabetes Prevention
Physical activity can reduce the risk of non-insulin-dependent diabetes by up to 50 percent
Physical activity decreases insulin resistance and aid in both preventing type 2 diabetes mellitus and managing the disease
Physical activity has an insulin-like effect – it help lower blood sugar levels.

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EXERCICE and DIABETES
Exercise also helps:
People feel better (less stressed)
Keep the body in good shape
Keep blood fat levels normal
Keep blood pressure normal
Increase insulin sensitivity
Maintain normal blood circulation to the feet.


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Physical Activity Preventing Weight Gain and Diabetes




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Smoking Predisposes to Type 2 Diabetes
Studies have shown correlation between smoking and the risk of developing type 2 diabetes among middle-aged and elderly men and women.

The risk is dose-dependent: the longer you smoke, the higher the risk.

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One of the possible mechanisms
Insulin action

Smoking

Oxidative stress

Diabetes mellitus

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Quitting Smoking





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Etiology and primary prevention of type 1 diabetes (IDDM)
Destruction of beta cells by autoimmune process
Length of latency period varies, often very long
Disease develops in a genetically susceptible individual after environmental insults
Viral infections, e.g., Coxsackievirus, cytomegalovirus
Several dietary factors suggested to be involved in the pathogenic process, e.g., cow milk, Vitamin D Nicotinamide
A number of possibilities for prevention have been raised but have yet to lead to a worthwhile population approach.

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Secondary Prevention of Diabetes
Secondary prevention includes early detection (screening) and prompt treatment
Appropriate action taken at the right time is beneficial in terms of quality of life, and is cost-effective, especially if it prevent hospital admission.


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Secondary Prevention of Diabetes: Screening approaches
Population screening

Selective screening

Opportunistic screening

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Secondary Prevention of Diabetes: Selective Screening for Diabetes
All subjects age > 45
Subjects age< 45:
Family history
Obesity: BMI>27
Habitual physical activity low
Hypertension (BP>140/90)
HDL<35 mg/dl and/or triglyceride>250 mg/dl
History of GDM
Polycystic ovary syndrome

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Diagnostic Criteria
Random glucose > 11mmol


Fasting glucose > 7mmol

2 hours after 75g glucose orally > 11mmol

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Tertiary prevention
Actions taken to prevent and delay the development of acute or chronic complications
Acute complications, e.g. hypoglycemia, severe hyperglycemia and infections
Chronic complications, e.g. atherosclerosis, retinopathy, nephropathy, neuropathy and foot problems.

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Effective interventions for 20 and 30 prevention
Strict metabolic control, education and effective treatment

Screening for complications in their early stages when intervention is more effective.

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Why Patient Education is necessary
Knowledge is power
Lifelong disease
3 times more likely to die prematurely
Lifestyle changes are needed


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Patient Education should be
An on-going process
More information is given as/and when patient can use it
Specialist health education material and specialist education teams are needed
Partnership with health professionals.

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Aim of patient education
Patient takes practical responsibility for his/her own health

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Obstacles and barriers for prevention
Economic problems: unavailability of needed resources

Lack of data, knowledge and skills

Socio-cultural problems


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Examples of socio-cultural barriers for prevention:
Obesity is not considered abnormal
No value given to physical exercise
Changing diet is very difficult
No time or place is granted to do physical exercise at work
Fatalism.


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Central issues in diabetes prevention
Diabetes prevention must be integrated in a major program for the prevention of other lifestyle related disorders like CVD and cancer

Primary prevention is essential especially in resource-constrained countries

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Central issues in diabetes prevention - Cont
Diabetes prevention is an inter-sectoral effort requiring cooperation and coordination of sectors other than health
Culturally appropriate and economically feasible interventions should be adopted. Imposing unacceptable or unaffordable interventions will have a negative impact.

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Recommendations
Change will come more easily if everyone is involved

Prevention of diabetes should be on different levels; individuals, community, local government and national levels

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The government should work to reduce health inequality and improve environmental factor by improving the deprived areas and making the streets safe for walking or cycling to school or the workplace, promoting and improving access to sport and leisure facilities, as well as encouraging physical activity and healthy diet

Recommendations - Cont

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Recommendation - Cont
Parents of overweight children should be helped to take responsibility and encourage healthy eating and physical activity
Anti- smoking behaviour should be promoted by implementing legal action.



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Questions?