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Global and National Burden of Diabetes

Global and National Burden of Diabetes. Diabetes Mellitus: classification New (WHO) Screening and Diagnostic Criteria Diabetes, Impaired Glucose Homeostasis , Impaired Fasting Glucose, Impaired Glucose Tolerance Epidemiological Perspectives Measurement Worldwide incidence and prevalence

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Global and National Burden of Diabetes

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  1. Global and National Burden of Diabetes • Diabetes Mellitus: classification • New (WHO) Screening and Diagnostic Criteria • Diabetes, Impaired Glucose Homeostasis, Impaired Fasting Glucose, Impaired Glucose Tolerance • Epidemiological Perspectives • Measurement • Worldwide incidence and prevalence • National incidence and prevalence • Perspectives on Cost

  2. Diabetes Mellitus - Classification • Type 1 Diabetes (5-10%) • Juvenile Onset, IDDM, type I • Auto-immune disease • Pancreas is unable to produce insulin (beta-cell destruction) • Generally diagnosed from birth to age 30, highest incidence between 12-18 years of age. Estimated to be present in 0.3% of the U.S. adult population (>30 years)* • Type 2 Diabetes (90-95%) • Adult Onset, NIDDM, type II • Deficiency in insulin secretion coupled with insulin resistance • Disorder associated with obesity and the aging process • Generally diagnosed after age 40, may be diagnosed as early as 5 years of age *Diabetes in America, 1995

  3. Diabetes Mellitus - Classification (continued) • Gestational Diabetes Mellitus (5% of all births) • Also known as GDM -- hyperglycemia first diagnosed in pregnancy (not to be confused with pre-gestational diabetes in which diabetes exists prior to pregnancy) • Pancreas is unable to produce adequate insulin to overcome insulin resistance which is primarily due to three factors: human placental lactogen, genetic predisposition to insulin resistance, weight gain in pregnancy • Generally diagnosed after age 25, may be diagnosed at any age of pregnancy • Other Specific Types • Maturity-Onset Diabetes of the Young* (<1%) • Pancreatic disease • Drug • etc. *Hattersley, Diabetic Med, 1998

  4. Diabetes Mellitus - Classification (continued) • Slow Onset of Insulin Dependent Diabetes (SIDDM) or Latent Autoimmune Diabetes in Adults (LADA)* • antibodies to glutamic acid decarboxylase (anti-GAD) proposed as an early differentiating marker of type 1 diabetes in those individuals for whom there is a question of whether they have type 1 or type 2 diabetes • a correlation has been found between individuals originally classified as type 2 requiring insulin and anti-GAD • possible early test to identify those with type 2 diabetes who will eventually require insulin *Zimmet, Diabetes Care, 1999

  5. Overview of Type 2: Screening and Diagnosis Patient w. Risk Factors and/or Symptoms of Diabetes May screen using capillary blood: FCG>110 mg/dL (6.1 mmol/L) or CCG>160 mg/dL (8.9 mmol/L) then proceed to diagnostic test Fasting Plasma Glucose (FPG) or Casual Plasma Glucose (CPG) FPG < 110 mg/dL (6.1 mmol/L) CPG< 140 mg/dL (7.8 mmol/L) FPG 110-125 mg/dL (6.1 - 6.9 mmol/L) CPG 140-199 mg/dL (7.8 - 11.0 mmol/L) FPG > 126 mg/dL (7.0 mmol/L) CPG> 200 mg/dL (11.1 mmol/L) No Diabetes Repeat FPG within 7 days If only FPG criteria then: Impaired Fasting Glucose If CPG criteria then: Impaired Glucose Homeostasis Diagnosis of Diabetes if FPG > 126 mg/dL (7.0 mmol/L) Type 1 or Type 2 Diabetes dependent upon age and ketones

  6. Risk Factors for Diabetes • Obesity • Asian: > 120% DBW or BMI >24 kg/m2 • Western: > 120% DBW or BMI > 27 kg/m2 • Family history (1st degree relative with diabetes)* • High risk ethnicity (any indigenous peoples) • Previous GDM or baby > 9 pounds (4000 g) • Hypertension (BP > 140/90 mm Hg) • HDL < 35 mg/dL, TG > 250 mg/dL • Previous IGT or IFG = Impaired Glucose Homeostasis *Rich, Diabetes 1990

  7. Global Epidemic Of Diabetes • More than 135 million people worldwide had diabetes in 1995 (4.0%) • 300 million people are expected to have the disease by 2025 (5.4%)42% increase in developed countries170% increase in developing countries • Urban dwellers more likely to have the disease than rural inhabitants *King, et. al., Diabetes Care, 1998

  8. Population of Thailand is approximately 62 million 1.4 million people have diabetes 46,000 have Type 1 diabetes 1.4 million have Type 2 diabetes Prevalence: 1.4 million / 62 million in 1999 (2.3%) Fair access to diabetes medications The Burden of Diabetes in Thailand Source: A National Health Interview and Examination Survey 1991

  9. Add Thai Epidemiology

  10. Cost of Diabetes Care : Worldwide and the US (in billions dollars)

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