Diabetes is a metabolic disease that results from Diabetes has many potential health complications, Type 2 diabetes, which accounts for 85 percent to …
wwwdcp2org
November 2006
The Growing Diabetes Pandemic
One Million Deaths Globally Every Year
Diabetes is a metabolic disease that results from defects in the secretion or activity of insulin within a persons body Diabetes has many potential health complications, including coronary heart disease, stroke, peripheral vascular disease, blindness, kidney disease, and lower-extremity amputation There are three basic types of diabetes Type 1 diabetes, which most often strikes children and young adults, occurs when the destruction of pancreatic cells causes insulin deficiency Type 2 diabetes, which accounts for 85 percent to 95 percent of all cases, is usually characterized by insulin resistance when the body no longer uses insulin properly A third type is gestational diabetes, which appears only during pregnancy
More than 80 percent of the global disability adjusted life years DALYs in 2001 resulting from diabetes were in developing countries, with the largest burden in East Asia and the Pacific Between 1990 and 2001, the proportion of DALYs resulting from diabetes increased by 250 percent worldwide, and by 266 percent in low- and middle-income countries The economic burden of
diabetes is felt acutely by national health care systems, which incur most of the treatment costs, and by individuals and families, who suffer indirect costs from lost productivity caused by sickness, disability, and premature death from the disease The direct health care costs of diabetes range from 25 percent to 150 percent of the annual health care budgets in developing countries But
Burden of Disease
In 2003, diabetes prevalence worldwide was estimated at 51 percent among people ages 20 to 79 Although diabetes is still more common in developed countries, it is rapidly increasing in developing countries By 2025, the worldwide prevalence is projected to be 63 percent, a 24-percent increase over the 2003 rate, largely due to greater food availability and increased consumption of sugar and fats Diabetes causes significant morbidity and mortality The World Health Organization WHO estimates that 1 million deaths were caused by diabetes in 2001 Almost two-thirds of these deaths occurred in developing countries, where four-fifths of the world population lives The death rate for men with diabetes is almost twice that of men without it For women with the disease, the death rate is two
and a half times higher than that of women without diabetes Diabetes is a major risk factor for cardiovascular disease CVD, which causes up to 65 percent of all deaths of people with diabetes in developed countries
the indirect costs are even higher, and, because diabetes is projected to increase most among people in their productive years ages 20 to 64 over the next 30 years, the future indirect costs will be even higher
Risk Factors
The risk factors for type 2 diabetes include obesity, physical inactivity, pregnancy, improper diet, and certain socioeconomic characteristics The risks begin before birth: Retarded intrauterine growth and low birth weight increase the risk of developing diabetes After birth, however, breastfeeding reduces the risk of developing obesity, insulin resistance, and diabetes Obesity and weight gain are key risk factors for diabetes Both are caused by a disproportionate intake of energy as food compared with the amount of energy expended through physical exercise Each unit increase in the body mass index, a common measure of body weight, boosts the risk of diabetes by 12 percent Central obesity, or disproportionate build-up of fat in the bodys trunk
region, is
Fogarty International Center of the US National Institutes of Health The World Bank
World Health Organization
Population Reference Bureau
|
Bill Melinda Gates Foundation
another leading risk factor, as is a sedentary lifestyle Diet plays a strong role–a high intake of sugar-sweetened beverages, saturated fats, and trans fatty acids increases the risk of diabetes In contrast, regular physical activity and diets including polyunsaturated fats, long-chain omega-3 fatty acids found in fish oils and rich in fiber and vegetables may reduce the risk of diabetes Likewise, socioeconomic status appears to influence the risk of developing diabetes, but the relationship operates differently in developed than in developing countries In developing economies, diabetes is linked to increased affluence and Westernization, especially among indigenous populations But in developed countries, people in lower socioeconomic groups have a higher risk of obesity and type 2 diabetes
education programs for health care professionals and patients can cover foot hygiene, treatment of calluses, awareness of functional infections, care for skin injuries, and access to appropriate footwear
Other diabetes interventions that provide good value for money in some settings may not be feasible in others, depending on the resources needed, the difficulty in reaching the target population, the expertise required, or a countrys ability to deliver the intervention within its health care system Proven interventions include care for women of reproductive age before they become pregnant; lifestyle interventions; influenza vaccinations; annual eye examinations; smoking cessation programs; and blood pressure control through medication Other interventions that would not be cost-effective or feasible in many low-resource settings include specific high-cost drugs, cholesterol and/or intensive glucose control, and screening for undiagnosed diabetes A polypill–a combination pill that includes three or four drugs tha 
t combat hypertension and elevated cholesterol–might become available that would reduce the risk of cardiovascular disease among people with diabetes Although the benefits and side effects of a polypill have yet to be established, computer modeling suggests cost-effectiveness from US560 to US1,280 per quality adjusted life year QALY gained Diabetes education is an integral
part of diabetes care because it helps people with diabetes learn about and understand their disease, recognize emergency health problems, and adhere to self-care practices and lifestyle changes A review of literature suggests that self-managed diabetes education may reduce medical costs in developing countries A study in Latin America showed that a low-cost education program reduced the cost of drugs by 62 percent The quality of diabetes care generally remains poor worldwide, regardless of a countrys level of development, health care system, or population size Yet, the growing diabetes pandemic warrants greater attention and rapid action An array of effective interventions to prevent diabetes and its complications is available, with varying degrees of implementation feasibility Diabetes education and organized care delivery are perhaps the most essential interventions today: It reaps substantial benefits at a low cost Over the long-term, other interventions such as the polypill, that have yet to be proven, may be the most cost-effective way to address this pandemic
Cost-Effective Interventions
Efforts to prevent type 2 diabetes involve lifestyle interventions –changes in diet
and increased physical activity among people at high risk–and medications Lifestyle interventions reduced the incidence of type 2 diabetes by almost 60 percent in a major study Other interventions include screening to detect diabetes in its early stages, and managing the disease to reduce its complications There is not enough evidence to show that type 1 diabetes can be prevented Three interventions have proven especially cost-effective and feasible in low-resource settings The first involves glycemic control through diet and physical activity, oral medications to reduce glucose, and insulin injections, combined with patient education to foster compliance with medication and diet and exercise regimens see table Glucose is usually poorly controlled among people with diabetes in developing countries because of lack of access to insulin and other diabetes treatment supplies Hence, an important aspect of these interventions in developing countries is to guarantee these supplies A second highly cost-effective and feasible intervention is the use of medication to control blood pressure Even in the United States, moderate blood-pressure control costs less than US250 per patient per year,
with even lower costs in developing countries because most of the drugs are generic and therefore less expensive A third cost-effective intervention is low-cost foot care to reduce the risk of foot ulceration and amputation Foot-care
PA G E 2
| The Growing Diabetes Pandemic | Disease Control Priorities Project
Key Cost-Effective Interventions for Preventing and Treating Diabetes and Its Complications
INTERvENTION
lEvEl 1A
DESCRIPTION
FEASIBIlITy C
Glycemic control in people with poor control
Insulin, oral glucose-lowering agents, diet, and exercise
Blood pressure control
Blood pressure control medications
Foot care
lEvEl 2 B
Patient and provider education, foot examination, foot hygiene, and appropriate footwear
Care for women of reproductive age before they become pregnant Lifestyle intervention to prevent diabetes
Patient self-management Behavioral change, including diet and physical activity, to reduce bodyweight Vaccination
Influenza vaccination
Detection and treatment of eye diseases
Eye examination to screen for and treat eye diseases
ACE inhibitors
Angiotensin-converting enzyme medication
Smoking cessation
a Level 1 interventions are cost saving
and highly feasible
Physician counseling and nicotine replacement therapy
b Level 2 interventions are cost saving or cost less than US1,500 per quality-adjusted life year but pose feasibility challenges c Feasibility was assessed based on difficulty of reaching the intervention population the capacity of the health care system to deliver an intervention to the targeted population, technical complexity the level of medical technologies or expertise needed for implementing an intervention, capital intensity the amount of capital required for an intervention, and cultural acceptability appropriatenessof an intervention in terms of social norms and/or religious beliefs indicates feasible for all four aspects, indicates feasible for three of the four, indicates feasible for two of the four, and indicates feasible for one of the four
Source: K M Venkat Narayan et al 2006 Diabetes: The Pandemic and Potential Solutions In Disease Control Priorities in Development Countries, 2nd ed D T Jamison, J G Breman, A G Measham, G Alleyne, M Claeson, D B Evans, P Jha, A Mills, and P Musgrove tables 303 and 304 New York: Oxford University Press
The Growing Diabetes Pandemic |
Disease Control
Priorities Project |
PA G E 3
References
KM Venkat Narayan et al 2006 Diabetes: The Pandemic and Potential Solutions In Disease Control Priorities in Development Countries, 2nd ed D T Jamison, J G Breman, A G Measham, G Alleyne, M Claeson, D B Evans, P Jha, A Mills, and P Musgrove, 591-603 New York: Oxford University Press
wwwdcp2org
Source:pediatricnursing.net
