The new international Diabetes Federation (IDF) definition According to the new IDF definition , for a person to be defined as having the metabolic syndrome he/she must have : Central Obesity ( defined as waist circumference * with ethnicity specific values ) plus any two of the following four factors : Raised triglycerides 150 mg/dL (1.7 mmol/L ) or specific treatment for this lipid abnormality . Reduced HDL Cholesterol 40 mg/dl ( 1.03 mmol/L ) in males 50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality Raised blood pressure Systolic BP 130 or diastolic BP 85 mmHg Or treatment of previously diagnosed hypertension Raised fasting ) FPG ( 100 mg/dL (5.6 mmol/L)
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The new international Diabetes Federation (IDF) definition According to the new IDF definition, for a person to be defined as having the metabolic syndrome.
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The new international Diabetes Federation (IDF) definitionAccording to the new IDF definition , for a person to be defined as having the
metabolic syndrome he/she must have: Central Obesity ( defined as waist circumference * with ethnicity specific values )
plus any two of the following four factors:
Raised triglycerides
150 mg/dL (1.7 mmol/L )
or specific treatment for this lipid abnormality.
Reduced HDL Cholesterol
40 mg/dl ( 1.03 mmol/L ) in males
50 mg/dL (1.29 mmol/L) in females
or specific treatment for this lipid abnormality
Raised blood pressure
Systolic BP 130 or diastolic BP 85 mmHg
Or treatment of previously diagnosed hypertension
Raised fasting plasma glucose
)FPG (100 mg/dL (5.6 mmol/L)
or previously diagnosed type 2 diabetes
Diabetes Mellitus and its state of control and complications in the
- The mean age in patients who developed DKA = 42.5 years
- The mean age in patients who never developed DKA = 53.1 years
Hypoglycemia- Occurrence of Hypoglycemic episodes in = 20.5%
------------------------------------------------------------------------ - The mean age of patients who developed hypoglycemic episodes at any time = 50.8 years
- The mean age of patients who did not experience hypoglyceamic episodes = 52.1 years
labour Abortion
Fertility and Abortions
Abortions : 21.5%
Fertility : 3.6 ch/m
The Socio economic Burden
Middle East Countries- economic statusper capitum incomes:
High Kuwait EmiratesQatarBahrainOmanSaudi ArabiaLibya
Low SyriaJordanTunisiaMoroccoEgyptYemenSudan
Middle
(Iraq)Iran
>5,000 US $
< 2,000 US $
Mean Health Expenditure /person with diabetes in different regions
180 233514 625 684
11881561
0
500
1000
1500
2000ID
<200200-600600 -1000 <1000
Afghanistan 56
Iraq 72
Pakistan 99
Sudan 103
Yemen 110
Syria 185
Alger 273
Morocco 285
Egypt 286
Libya 384
Oman 614
Tunisia 637
Jordan 711
Iran 744
Kuwait 806
Saudi Arabia 891
Emirates 929
Bahrain 1047
Lebanon 1050
Qatar 1198
MENA Countries according to The Mean Health Expenditure per person with diabetes in ID (international Dollar) : Diabetes Atlas, 3rd Ed.
100%120.80%
354% 346%
0%
50%
100%
150%
200%
250%
300%
350%
400%
DM +CVD +R.F. +Diab. Foot
Hospital Treatment 2001 Cost /Day
(Egyptian Study )
55% Medicine & Supp.
45% Basic( Food : 5%
H.C.Team 11%
Others: 29%)
Distribution of Hospital Cost
8.85%
EGYPT
1.9%
QATAR
3.1%
SAUDI ARABIA
Year Cost / percapit. Burden for Human Insulin (40 u /d)
EGYPT
29.9%
Cost Burden of Oral Treatment related to Percapitum
QATAR
4.2%
8.4%
SAUDI ARABIA
To promote diabetes care, prevention and a cure worldwide
For improving Diabetes Care and Prevention , Education of Health Care Providers should consider expertise in both: I- Clinical Diabetes , and
II- Educations skills
The Way to a National Diabetes Program
Minimal requirements : 1- Insulin and medications availability ( affordable) 2- Primary centers for diagnosis and care 3- wide distribution of services allover the country 4- Basic requirements to manage complications 5- Education : knowledge & skills to patients – Public orientation 6- National basic studies in epidemiology and socioeconomics . 7- Care for Diabetes in School children 8- Care for diabetes in pregnancy
Potential Adverse Factors 1- Economic :Poor Financial Res. /per capit. / Government expenditure/ House-hold expend. with High Prev. of diab.
2- Demographic Extensive areas with poor communications . High population density
3- Social : Illiteracy- Misconceptions – adverse habits and traditions.
1- Consider the specific needs in the country and available resources to decide priorities 2 - Define the role to be played by each one of the constituents of the community , and Identify Champions for projects .3- Seek partnerships with :
WHO , Twining ,WDF , Rotary , etc..
Obligations of Different Parties
The Government ( Ministry of Health)
1- Increase Investments in Health/Diabetes 2- provide Minimal Diabetes Care in Clinics & Hospitals 3- Insure Insulin & Medications Availability 4- provide Education :Patient, Health Care Team and Public
5- Coordinate with Health Care Syndicates 6- Coordinate with NGOs 7- attract International Aid programmes 8- promote National Research ( epidemiol.-socioeconomic)
Parliament (Legislation)
1- Budget planning to improve diabetes Care 2- Taxation Exemption for insulin & medical requirements 3- Put rules and regulations for NGO activities 4- Maintain and guard Patients’ Human Rights ( anti discrimination, working , children, women , elderly …etc) 5- Health Insurance Laws
The Non-Governmental Organizations (NGOs )
1- Advocacy 2- Education Programs for : -Patients and Families -Health Care Team -Community at large
3 - Rules & Regulations - legally recognized - non profitable - accountable and transparent - coordinated & complementary to government - no unhealthy competition, extravagance , business controlled ( by industries )
The Health Care TeamThe Physician 1- is Leader of the HC team 2- is the Final reference for his patient’s education 3- keep harmony with others in the HC team 4- requires continuous training courses and updates 5- acquire education skills
Nurses 1- Training courses , by whom ? 2- Knowledge + skills & attitude 3- skills in education 4- keep Team work 5- Continuous education , scientific meetings and workshops
Diabetes Care for Special Groups School Children - Registration at national level - Individual records in schools - basic equipments to manage emergencies - Education courses to school attendants. - protecting special rights : play- recreation - treatment .non discrimination …etc
Mothers with Diabetes of Pregnancy
- Screening for diabetes of pregnancy - Protocols for management of GD - Care for the N.B. - After-labour follow-up of mothers
The National Diabetes Registry - essential as source of information for planning public services - Central location - paper or computer recordings - contains individual patient data - complemented by local & peripheral registries (in schools - work – Health insurance, etc ) - network connections for exchange information
Diabetes Screening Programmes - Specifically to high risk groups - By central planning and organization - ensure unified criteria for diagnosis
- Screening for early detection of complications :
- Sending study groups to remote areas.
International Relations
The International Diabetes Federation
1- get moral support from IDF to National Associations & programs 2- use as source of information & educational material 3- Benefit from IDF Task forces’ activities and programs 4- Benefit from WDD events
The WHO
1- Government / collaborative programmes for promotion of diabetes Care2- NGO : collaboration in promoting diabetes care through training & education programmes
The Patient Obligations 1- Take active role: seek to be educated 2- follow proper life style 3- comply 4- not to accept misconceptions and deceptive propaganda