fahid malik

8/6/2019 fahid malik

http://slidepdf.com/reader/full/fahid-malik 1/20

Diabetes – the condition

• What is it?

• How is it caused?

• Who gets it?• Risk factors



What is diabetes?

• A condition in which the amount of glucose

(sugar) in the blood is too high because the body

cannot use it properly

• This happens because the body does not produce

or properly use insulin, which is needed to convert

sugar and starchy foods from the diet into energy

needed for daily life



Types of diabetes

• Type 1 (5-10%) – sudden onsetabsolute deficiency in insulin. Usuallyaffects younger age group (not always)

• Type 2 (90 - 95%) – gradual onset of

relative insulin insensitivity. Usuallyolder age group (not always)

• Pre-diabetes – T2DM

Impaired glucose toleranceMay remain undiagnosed for years; risk of complications same as for T2DM



Diagnosis of diabetes

Symptoms• Thirst

• Passing lots of urine

• Malaise

• Infections (thrush)

• Weight loss

BUT – many years of pre-diabetes

(type 2) before these symptomsappear!

Biochemical tests • Random plasma glucose

• Fasting plasma glucose

• Oral glucose tolerance test – 2hglucose

WHO criteria

ADA criteria



Why is diabetes so important?

The burden to patients, carers, NHS

– Complications• Cardiovascular

• Eyes

• Renal - Hypertension, renal failure• Feet

• Skin, infections, sexual, psycho-sexual, depression

• Quality of life

• Premature mortality

– Cost

DIABETES NSF



Diabetic complications



Epidemiology of diabetes

• Prevalence worldwide is increasing*• 2.8% in 2000; 4.4% in 2030 worldwide

• 171 million in 2000; 366 million in 2030

• Greatest rise in developing world

• Prevalence in England• 1.4 million people, HSE ’98/99

• 2-3% of England population

• “Missing million” campaign

• Prevalence in your area? PCT/LA

*Wild S et al; Diabetes Care, May 2004. Vol 24, pg 1047-53



Epidemiology of diabetes – Risk

factors

• Increasing age

• Ethnic origin

• ObesityPhysical (in)activity

Diet (calorie intake)

• Family history

• Social deprivation

• Maternal/foetal factorsGENES OR ENVIRONMENT?



Why do we need to know diabetes

prevalence?

Diabetes NSF

• Standards – Dec 01

• Delivery Strategy – Jan 03

•Service provision, monitor outcomes, identify individuals at high risk of

diabetes

• Establish diabetes registers

• Offer retinal screening to 100% of diabetic population by year 2007 (80%

by 2006)

New GMS contract

• Report and verify patients with diabetes• Compare expected prevalence with reported/recorded prevalence



Do we know our diabetes prevalence?

ENGLAND

Prevalence (%) of self-reported diabetes

Health survey for England 1999

HSE-Diabetes prevalence: Men

0

10

20

30

40

50

16-34 35-54 55+

Age group

Prevalen

cerate(%)

HSE- Diabetes prevalence: Women

16-34 35-54 55+

Age group

White

Black-C

Indian

Pakistani

Bangladesh

Chinese

Prevalence by age/sex/ethnicity



Do we know our diabetes

prevalence?

What is the prevalence

• In a health sector (StHA level)?• In a PCT?

• In a ward?

• In a practice?

• In a geographic area – eg London?



Estimating prevalence - Where do we

start?

Sources of information on prevalence in a

PCT – e.g. Brent

• Primary care register

• Chronic disease management payment

• Hospital attendance, other clinics, retinal screening

database

• Ask each practice • Audit

• Capture-recapture



Epidemiological prevalence

modelling - principles

•National surveys/databases – Known diabetes

eg: HSE’99, GPRD (Key health statistics), MSGP-4, Oxford & Poole, DARTS, others

•Research studies – known and undiagnosed disease

Apply reference prevalence rates by age, sex, ethnicgroup to local population (by age, sex, ethnic group)



Obesity – what is it?

• Body mass index = BMI• An index derived by the formula [Weight in kg / (height)2 in

metres]

• Not very good for defining fat levels in an individual, but very

good for monitoring trends over time, and across populations –

thus a very important public health statistic

WHO definitions

Normal weight BMI<25 kg/m2

Overweight BMI 25 – 30 kg/m2

Obese BMI >30 kg/m2



Obesity – what is it?

• Other measures of obesity are percentage body fat and central obesity – waist

circumference or waist/hip ratio

• Ethnic differences in obesity – BMI cut off points adopted by WHO may not applyuniformly across different populations

» South Asians have higher central adiposity for a given level of BMI compared with

European Whites

» While cut-off of 30 kg/m2 defines obesity in European groups, a cut-off of 27.5 may be

equivalent in South Asians in defining associated risks

• Despite its limitations, BMI remains the most robust marker of obesity that is available



Trend in obesity in USA – 1990/2001



Obesity: What is the fuss about?Crude mortality associated with obesity



Obesity: what is the fOCUS about?



Public Health message

•

Obesity prevalence is increasing

•

Diabetes prevalence is increasing

fahid malik

Documents