Diabetes management: lessons from around the globe MENA. J. Belkhadir (Morocco)

Transcription

1 Diabetes management: lessons from around the globe MENA J. Belkhadir (Morocco)

2 Managing Diabetes: challenges faced in the MENA Region and strategies developed Jamal Belkhadir Diabetologist, Endocrinologist President of the Moroccan League for the Fight against Diabetes

3 Managing diabetes: Challenges faced in the MENA Region and strategies developed What is the current situation of diabetes globally and in Mena Region?

4 Why Diabetes is a challenge today? Chronic and epidemic disease Prevalence increases rapidly Complications are very common Main cause of death before the age of 60 A lot of people worldwide have no access to adequate health care Very costly disease No efficient method to cure or prevent completely diabetes..

5 Diabetes today Diabetes fact

6 Diabetes is a huge and growing problem, and the costs to society are high and escalating 382 million people have diabetes (2013) By 2035, this number will rise to 592 million

7

8 Top 10 countries for Prevalence IDF ALTLAS 2014

9 Tunisia Algeria 3 Moroco Libya 2001 <10% Mauritania %Syria 3 Lebanon Iraq 1979 Jordan 2004 Egypt Sudan >20% Saudi Bahrain Qatar Arabia7 UAE Oman 200 Yemen 2002

10 Prevalence of diabetes in Mena Region

11 Mena Region : 48 % are undiagnosed

12 The yearly total number of registered cases of diabetes according to gender (G) and type (T) of diabetes from the start of registry in 2000 to 2012 (Alrubeaan.etal, J Med Internet Res Sep)

13 Gestational Diabetes Mellitus in Mena Region Country GDM Prevalence Reference Saudi Arabia 12.5% (el-hazmi and Warsy 2000) Bahrain 15.5% (Al Mahroos, Nagalla et al. 2005) United Arab Emirates 9.2% (Ezimokhai, Joseph et al. 2006) Iran 4.7% (Hossain, Kawar et al. 2007) Global Average 2-5% (Scobie 2007)

14

15 Prevalence of Diabetes in Mena Region) World J Diabetes Mar 15; 6(2):

16 Labor force in Mena Region World J Diabetes Mar 15; 6(2):

17 The relationship between BMI and the risk of developing type 2 diabetes

18 The socially disadvantaged in any country are especially vulnerable to diabetes

19 Factors that increases the prevalence of DM Lifestyle modifications: - Obesity - Low physical activity - Rapid urbanisation - Smoking - Stress of modern life Sudden modification of nutritional habits: - The abandon of Mediterranean nutrition - The spread of fast food and high-calorie dietary intake Marriage among relatives with family history of DM

20 Chronic Complications in Arab Countries

21 Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review Hassanein and al, JRSM Short Rep. 2012

22 Dialysis Centers SCOT, 2012

23 Dialysis in the Kingdom of Saudi Arabia Dialysis Population Current and Projected Average Net Annual Increase = 366 Patients Average Percentage of Annual Increase = 7.8% SCOT, 2012

24 Mena Region - Average age years lower than developped countries - Mean age of first AMI 10 years lower compared to other regions of the world WHO 2011 The Interheart study, Lancet 2004; 364:

25 Prevalence of retinopathy IDF ALTLAS 2014

26 WHO : Stepwise data from some EMRO countries Country Year of field work Smoking % Low physical activity % Iraq Jordan Saudi Arabia Syria Kuwait Egypt Sudan

27 Mortality < 60 years

28 Increasing development and wealth is correlated with decreasing early mortality due to diabetes

29 Health expenditure (USD) due to diabetes (20 79 years). 2013

30 Clinical and Economic Burden of Diabetes Mellitus in Middle East Countries: A Mini Systematic Review - March 2014

31 Clinical and Economic Burden of Diabetes Mellitus in Middle East Countries: A Mini Systematic Review - March 2014

32 "...healthcare costs relating to diabetes are escalating rapidly..."

33 Projection of population with diagnosed diabetes and their healthcare expenditure in Saoudi Arabia (in USA dollars) J Family Community Med Jan-Apr; 20(1): 1 7.

34 32.6 million people, or 9.1% of the adult population, suffer from diabetes in This figure is expected to almost double, reaching the 59.7 million mark in less than 20 years. The explosion of diabetes in the region is mainly due to type 2 diabetes. Prevalence (%) of diabetes in the region within the younger age groups is considerably higher than the global average. 24 million more people, or 6.7% of the population at high risk of developing diabetes because of impaired glucose tolerance (IGT). This number is also expected to almost double by It's Saudi Arabia that by far the largest contributor to the total number of children with type 1 diabetes, with almost a quarter of the 64,900 counted cases. IDF ALTLAS 2014

35 Just over 10% of adult deaths in the region are attributable to diabetes. This represents nearly deaths in Deaths from diabetes are divided equally between men ( ) and women ( ). Slightly less than half of deaths attributable to diabetes in the region occur in people under 60 years. Premature deaths from diabetes could be a consequence of environments and lifestyles rapidly evolving in the region, a late diagnosis and health systems are not equipped to deal with this growing burden. IDF ALTLAS 2014

36 Socioeconomic/cultural change Globalization Urbanization Aging Poverty Stress Behavioral risk factors «80%» Unhealthy Diet Physical inactivity Tobacco use Metabolic changes Obesity Diabetes mellitus Hypertension WHO 2011 Dyslipidemia

37

38

39 November 4, 2009

40 Diabetes fact Diabetes today Undiagnosed Diabetes and IGT Complications Prevention

41 Mena Region and arabe countries in Gulf MENA plan - National Progams - Many Health Resolutions and Declarations were Issued : - Resolution 3/50 (Kuwait, January 8-10, 2001) - Resolution 2/51 (Geneva, May 2001) - Gulf Plan of Action Resolution 8/52 (Riyadh, 8-9 January 2002) - Resolution 5, conference 58 HMC (Muscat, february Resolution 4 Conference 60 (February 2006) - Declaration 2013 of Rabat on the Fight against Diabetes in the MENA Region - Call from Rabat 2014 (Rabat, 6-7 juin 2014)..

42 IDF-WHO MENA-EMRO agreement Establish joint task forces IDF and EMRO to coordinate the insulin supply and accessibility for needed individuals among country in crisis. 2. IDF/MENA to assist in lobbying for implementation of the UN Political Declaration. 3. EMRO will prepare and celebrate the WDD jointly with IDF/MENA.

43 Difficulties and Obstacles Policy makers don t believe in prevention and prefer spend money on treating diseases and their complications Doctors and health care systems are oriented more to treating than preventing The national budgets for health care are very variable and limited from country to country in the same region Diabetes cost: health insurance unavailable in many areas Lack of medical infrastructures in rural areas Weight of tradition and culture

44 Conclusion In Region Mena Diabetes inflicts unacceptable costs in human, social and economic impacts on all countries of the region and this whatever income levels. The rapid growth of economic development and the adoption of a western lifestyle and the emergence of physically undemanding job sectors on the manual workload is largely the cause of the increase in prevalence diabetes in the population independent of other lifestyle habits. Diabetes is a public health problem. It requires the involvement of all stakeholders and partners: public and political authorities, civil society, media,.. with regional and international collaboration to address the specificities and the diversity of the population in the MENA region, which requires changes in current economic policies. This strategy will have direct beneficial effects on health with lower health costs and improved quality of life on the entire population.

45 Conclusions Urgent Need To Develop more the local Strategies 1. Act now, to face the challenges today to avoid a catastrophic situation on the next decades 2. Have your own country plan, adapted and implementable 3. Increase public awareness regarding the risk factors particularly among high risk people 4. Screen diabetes: more than 1/3 of DM undiagnosed 5. Utilize the UN-IDF declaration and IDF-WHO to engage policy makers and the media in our fight against diabetes 6. Collaborate actively with local and regional partners to implement your plans 7. Create your country task force

46 Thank you And welcome to Marrakech