Diabetes management: lessons from around the globe MENA J. Belkhadir (Morocco)
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 www.lmlcd.com jamalbelkhadir@yahoo.fr
Managing diabetes: Challenges faced in the MENA Region and strategies developed What is the current situation of diabetes globally and in Mena Region?
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..
Diabetes today Diabetes fact
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
Top 10 countries for Prevalence IDF ALTLAS 2014
7 8 4 1 4 Tunisia Algeria 3 Moroco 1988 2001 2003 Libya 2001 <10% Mauritania 1998 1 3 9 16 5 1 2 10-20%Syria 3 Lebanon 1999 1997 4 Iraq 1979 Jordan 2004 Egypt 1997 3 Sudan 1996 1 9 1 5 >20% 26 1 6 Saudi Bahrain Qatar Arabia7 UAE 2006 2004 Oman 200 Yemen 2002
Prevalence of diabetes in Mena Region
Mena Region : 48 % are undiagnosed
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. 2013 Sep)
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)
Prevalence of Diabetes in Mena Region) World J Diabetes. 2015 Mar 15; 6(2): 304 311.
Labor force in Mena Region World J Diabetes. 2015 Mar 15; 6(2): 304 311.
The relationship between BMI and the risk of developing type 2 diabetes
The socially disadvantaged in any country are especially vulnerable to diabetes
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
Chronic Complications in Arab Countries
Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review Hassanein and al, JRSM Short Rep. 2012
Dialysis Centers 1971-2012 SCOT, 2012
Dialysis in the Kingdom of Saudi Arabia Dialysis Population Current and Projected 1993-2020 Average Net Annual Increase = 366 Patients Average Percentage of Annual Increase = 7.8% SCOT, 2012
Mena Region - Average age 10-15 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: 937-952
Prevalence of retinopathy IDF ALTLAS 2014
WHO : Stepwise data from some EMRO countries Country Year of field work Smoking % Low physical activity % Iraq 2006 21.6 56.7 Jordan 2007 29 5.2 Saudi Arabia 2005 12.9 33.8 Syria 2003 24.7 32.9 Kuwait 2005 15.7 91.5 Egypt 2005 21.8 50.4 Sudan 2005 12 86.8
Mortality < 60 years
Increasing development and wealth is correlated with decreasing early mortality due to diabetes
Health expenditure (USD) due to diabetes (20 79 years). 2013
Clinical and Economic Burden of Diabetes Mellitus in Middle East Countries: A Mini Systematic Review - March 2014
Clinical and Economic Burden of Diabetes Mellitus in Middle East Countries: A Mini Systematic Review - March 2014
"...healthcare costs relating to diabetes are escalating rapidly..."
Projection of population with diagnosed diabetes and their healthcare expenditure in Saoudi Arabia (in USA dollars) J Family Community Med. 2013 Jan-Apr; 20(1): 1 7.
32.6 million people, or 9.1% of the adult population, suffer from diabetes in 2011. 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 2030. 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
Just over 10% of adult deaths in the region are attributable to diabetes. This represents nearly 280 000 deaths in 2011. Deaths from diabetes are divided equally between men (139 600) and women (136 800). 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
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
November 4, 2009
Diabetes fact Diabetes today Undiagnosed Diabetes and IGT Complications Prevention
Mena Region and arabe countries in Gulf - 2009 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 2001 2002 - Resolution 8/52 (Riyadh, 8-9 January 2002) - Resolution 5, conference 58 HMC (Muscat, 14-15 february 2005 - 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)..
IDF-WHO MENA-EMRO agreement 2013 1. 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.
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
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.
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
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