iima2013 diabetes arab_world_lehdia

Diabetes Mellitus in the Arab World. A challenge for the 21st Century

IIMA 10th International ConferenceMadrid – Malaga 2013

Dra. Lehdía Mohamed Dafa

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Subjects

Definition

Diagnosis

Epidemiology

Associated factors

Complications

Management

Costs

Prevention

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Definition

Diabetes Mellitus is a metabolic disorder of multiple etiologies characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism that results from defects in insulin secretion, insulin action or both

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Diagnosis

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Criteria for the Diagnosis

A1C ≥ 6.5%or

Fasting plasma glucose (FPG)≥ 126 mg/dL (7.0 mmol/L)

or2-h plasma glucose ≥ 200 mg/dL

(11.1 mmol/L during an OGTTor

In patient with classic symptoms, A random plasma glucose ≥ 200 mg/dL (11.1 mmol/L)

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Epidemiology

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IDF 2012

Arab World

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Top 10 Countries/Territories for Prevalence of DM (%) (20-79 years) IDF 2012

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Associated Risk Facords (IDF)

• Family history of Diabetes• Overweight• Unhealthy diet• Physical inactivity• Increasing age• High blood pressure• Ethnicity• Impaired glucose tolerance (IGT)• History of gestational diabetes• Poor nutrition during pregnacy

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Associated factors in the Arab World

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Westernisation

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Physical Inactivity

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The Growing Epidemic of T2DM in relation to Obesity

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Female Obesity

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Prevalence of Obesity. Male and Female. Aged between 15 and 100 years, using WHO estimates for 2010.

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Prevalence of Obesity Males and females. Children and adults aged between 2 and 19.

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Malnutrition in Women and Children Western Sahara Refugee Camps

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Consanguinity

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Complications

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Common Complications in the Arab Word

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Macrovascular Complications are a Major Cause of Death in People with Diabetes

0

100

200

300

400

500

Cardiopatías

e ictus

Cáncer Accidentes Enfermedades

crónicas de las

vías resp. bajas

Diabetes

0

5

10

15

20

25

30

35

Nº de fallecidos (miles)

Hombre

Mujer

% fallecidos(eje derecho)

Nº fallecidos(eje izquierdo)

% fallecidos (hombres y mujeres)

Centro Nacional de Estadística de la Salud 2004 USA

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Management

1. Glycaemic control

2. Lifestyle Intervention

3. Other Factors Control

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Patient-Centered Approach“…to providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” ADA/EASD 2012

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ADA/EASD Algorithm 2012

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Glycaemic Targets

. MICR

OANGIO

PATIC

COMPLI

C

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Patient-Centered Approach

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Antiglycaemic Agents 1

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Antiglycaemic Agents 2

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Anti-Hyperglycemic Therapy

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Other Factors

•Blood pressure <140/80 mmHg

•Lipids: LDL <100 mg/dl

•Primary prevention

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Key Points. Diabetes Care 1

• Care should be aligned with components of the chronic Care Model to ensure productive interactions between a prepared proactive practice team and an informed activated patient (A)

• When feasible, care systems should support team-based care, community involvement, patient registries and embedded decision support tools to meet patient needs (B)

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Key Points. Diabetes Care 2

• Treatment decisions should be timely and based on evidence-based guidelines that are tailored to individual patient preferences, prognoses, and comorbidities (B)

• A patient –centered communication style should be employed that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care (B)

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Cost of DiabetesDeaths Attributable to DM by Age (20-79 years) IDF 2012

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Health Expenditures for DM in 2010 by Region (IDF)

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Costs

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Arab Human Development Report 2009

Prevention

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Lifestyle Change

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Support Patient Behavior Change• Implement a systematic approach to support

patient behavior change effortsA) Healthy lifestyle: physical activity, healty eating, non use of tobacco, weight management, effective copingB) Disease self-management: medication taking and management, self monitoring of glucose and blood pressure when clinicaly appropriateC) Prevention of Diabetes complications: self-monitoring of foot health, active participation in screening for eye, foot, and renal complications and immunizations

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Diet

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Physical Activity

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Global Diabetes Plan 2011-2021 (IDF)

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The Key Strategy

• Implement National Diabetes Programmes or action plans OR implement NCDs programmes

• Or action plans of which diabetes is a discrete component

• Well designed and actively implemented national diabetes plans or NCD plans of which diabetes is a discrete component are an effective way of organising, structuring the policy and practice response and

• Engaging policy makers, funders, service providers, and civil society organisations in collective action to

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Conclusions

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Because

• The prevalence and incidence of type II diabetes are increasing dramatically in the Arab World

• Type 2 Diabetes is a prevantable non comunicable disease, but

• Marginalized on the public health and development strategies in many countires of our region

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But, is there hope?

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Thank youGracias

شكرا

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