Diabetes - WHO

1 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWorld Health OrganizationGojka RoglicDiabetesWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWhat is Diabetes ? Diabetes mellitus is a metabolic disorder of multiple aetiology, characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or , 1999 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionThree major types of Diabetes Type 1 (5-15%) Type 2 (85-95%)

2 Gestational diabetesWHO, 1999 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionCauses of diabetesLargely Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionCauses of diabetesGenetic susceptibility+Environmental factorsWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionType 1 Diabetes risk factors: Viral infections?

3 Maternal nutrition in pregnancy? Infant nutrition? Environmental toxins? Protective effect of intestinal parasites?No known means for preventionWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionType 2 risk factors: Overweight, obesity Physical inactivity Smoking?Potentially preventableNumber of persons with Diabetes in the world 2010(IDF Atlas, 4th ed) 285 million in 2010 ( million type 1) 438 million in 2030 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionAge distribution of persons with Diabetes in Europe, 2010 (IDF Atlas, 4th ed) group (years)MillionsWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionAge distribution of persons with Diabetes in South- East Asia, 2010 (IDF Atlas, 4th ed) group (years)

4 MillionsHealth Statistics and InformaticsDeaths attributed to 19 leading factors, by country income level, 2004 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionThe rising global prevalence of Diabetes (millions)050100150200250300 WHO 2000 IDF 2003 IDF 2007 IDF 2010 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionRISING PREVALENCE OF Diabetes IN URBAN INDIA(Mohan, 2006)1989 - [%]1989199520002004 YEARSW ithin a span of 14 years, the prevalence of Diabetes increased by World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWorld Health OrganizationIs there a Diabetes epidemic?

5 World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionPossible causes of increasing type 2 Diabetes prevalence Ageing of the population Younger age at onset Decreasing mortality Increasing incidenceWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionPossible causes of increasing type 2 Diabetes prevalence(Colagiuri et al, 2005) Ageing of the population Younger age at onset Decreasing mortalityExplain only 20-25% increase in prevalenceWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionPossible causes of increasing type 2 Diabetes prevalence(from Colagiuri et al, 2005) Ageing of the population Younger age at onset Decreasing mortality Increasing incidence!

6 Explain only 20-25% increase in prevalenceWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWHO Global Strategy for the Prevention and Control of Noncommunicable Diseases, 2000 TobaccoUseUnhealthy dietsPhysical InactivityHarmfulUse of AlcoholCardio- vascularDiabetesCancerChronicRespiratory Determinants outside the health sector, including: Ministries of Finance, Trade, Education, Social Affairs Development donors International Financial Institutions Intergovernmental OrganizationsDeterminants outside the health sector, including: Ministries of Finance, Trade, Education, Social Affairs Development donors International Financial Institutions Intergovernmental OrganizationsFour diseases and four risk factorsFour diseases and four risk factorsWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionPrevalence of overweight and obesity in 10 year old boys and girls in selected countries (IOTF, 2005) Prevalence of overweight and obesity in 10 year old boys and girls in selected countries (IOTF, 2005)

7 MaltaItaly USAC hileAustraliaGermany VenezuelaJapanSingaporeFranceUKHungarySl ovakiaSwedenHong KongBrazilNetherlandsOverweight girlsObese girlsOverweight boysObese boys30201001020304040%MaltaItaly USAC hileAustraliaGermany VenezuelaJapanSingaporeFranceUKHungarySl ovakiaSwedenHong KongBrazilNetherlandsOverweight girlsObese girlsOverweight boysObese boys30201001020304040%World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWorld Health OrganizationIs type 2 Diabetes In the population?

8 In people at high risk?World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionPrimary prevention of type 2 Diabetes in the population Intuitively appealing, but few tries and little evidence Finnish Diabetes Programme Singapore National Healthy Lifestyle Programme (Bhalla, 2006) (Un)natural experiments Japan (Goto, 1958) Netherlands (Hermanides, 2008) Cuba (Franco, 2007) Paris (anecdotal) England (anecdotal)World Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionPrimary prevention of type 2 Diabetes in the populationEconomic crisis in Cuba, 1990's (Franco, 2007) CHD mortality reduced Diabetes mortality levels offWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionStudyNIGT PopAgeFUYrs FU %Rx RRR Finnish DPS522 BMI > 58%DPP2161 BMI > 24 FPG > 58%DaQing259 Groups45692 Diet/Ex 38%Kosaka458 Men.

9 BMI = 24~55492 Diet/Ex 67%India DPP269 Any 29%Prevention of Diabetes in people at high risk, by lifestyle modificationWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionCumulative incidence of Diabetes in Da Qing Follow-up Study (Li et al, Lancet 2008)01020304050607080901000123456789101 1121314151617181920 Follow-up (years)% with diabetesControl groupIntervention groupWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionCan complications of Diabetes be prevented/delayed ? Yes, convincing evidence from rigorous trials However, great inequities in access to quality treatmentWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionProposed actions for.

10 Member States WHO Secretariat WHO Headquarters WHO Regional Office for Africa (AFRO) WHO Regional Office for the Americas (AMRO) WHO Regional Office for the Eastern Mediterranean (EMRO) WHO Regional Office for Europe (EURO) WHO Regional Office for South-East Asia (SEARO) WHO Regional Office for the Western Pacific (WPRO) International partnersWorld Health OrganizationDepartment of Chronic Diseases and Health PromotionDepartment of Chronic Diseases and Health PromotionReducing the level of exposure of individuals and populations to unhealthy diet and physical inactivity:- Population salt reduction platforms & strategies Population prevention strategies for childhood obesity Recommendations on the marketing of foods and non-alcoholic beverages to children Global Recommendations on physical activity and health NCD Prevention through Diet and Physical Activity in Schools and Worksites The WHO STEP wise Approach to Chronic Disease Risk Factor Surveillance (STEPS) From Surveillance-to-Policy workshops Technical support package (next slide)Why are the poorest people in low- and middle-income countries affected the most?