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

1

Subjects

Definition

Diagnosis

Epidemiology

Associated factors

Complications

Management

Costs

Prevention

25/08/13 Dra. Lehdía Mohamed Dafa 2

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


Diagnosis


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)


Epidemiology

25/08/13 Dra. Lehdía Mohamed Dafa

IDF 2012

Arab World


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


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


Associated factors in the Arab World


Westernisation


Physical Inactivity


The Growing Epidemic of T2DM in relation to Obesity


Female Obesity


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


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


Malnutrition in Women and Children Western Sahara Refugee Camps


Consanguinity


Complications



Common Complications in the Arab Word

25/08/13 Dra. Lehdía Mohamed DafaSaudi Medical Journal

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


Management

1. Glycaemic control

2. Lifestyle Intervention

3. Other Factors Control


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


ADA/EASD Algorithm 2012


7

Glycaemic Targets

. MICR

OANGIO

PATIC

COMPLI

C


Patient-Centered Approach



Antiglycaemic Agents 1


Antiglycaemic Agents 2


Anti-Hyperglycemic Therapy


Other Factors

•Blood pressure <140/80 mmHg

•Lipids: LDL <100 mg/dl

•Primary prevention


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)


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)


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


Health Expenditures for DM in 2010 by Region (IDF)


Costs

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Arab Human Development Report 2009

Prevention


Lifestyle Change


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


Diet


Physical Activity


Global Diabetes Plan 2011-2021 (IDF)


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


Conclusions


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



But, is there hope?



Thank youGracias

شكرا


Iima2013 diabetes arab_world_lehdia

Health & Medicine

lehda mohamed dafa idf

bajas diabetes

patient values

associated factors

arab world

definition diabetes

patientcentered approach

female obesity