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In The name of God

In The name of God. Diabetes epidemiology: Reflecting your clinic?. Question #1. Approximately what percentage of your T2 diabetes patients are obese (>30 kg/m 2 ) * ? <10% 25% 50% 75% >90%. *WHO Diabetes Fact Sheet No. 311. September 2006.

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In The name of God

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  1. In The name of God

  2. Diabetes epidemiology: Reflecting your clinic?

  3. Question #1 Approximately what percentage of your T2 diabetes patients are obese(>30 kg/m2)*? <10% 25% 50% 75% >90% *WHO Diabetes Fact Sheet No. 311. September 2006

  4. Epidemiological transition” in newly industrialised nations Aging population Unhealthy lifestyle choices Urbanisation Reduced physical activity Dietary changes Adapted from IDF Diabetes Atlas 4th ed., 2009 Cockram CS 2000. HKMJ; 6 (1): 43-52 Mohan et al 2007. Indian J Med Res; 125: 217-230

  5. Urbanisation, Western dietary habits linked to obesity rates Emergence of obesity linked to lifestyle changes associated with urbanisation, modernisation Population adopts Western dietary habits, decreased physical activity etc. 1970 2000 Chiarelli and Marcovecchio 2008. EJE; 159: S67-S74 Yach et al 2006. Nature Medicine; 12(1): 62-66

  6. Prevalence of Diabetes and its risk factors in Iran • Methods: • Conducted in 2007 • 5,287 Iranian citizens included • Sample size aged 15–64 years • Results: • Diabetes 8.7% • Hypertension 26.6% • Obesity 22.3% • Central obesity 53.6% Female Male 2.5 million Iranian Esteghamati A, et al. Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health. 2009 May 29;9:167

  7. Obesity contributes to increase in prevalence of T2DM Obesity 2-fold increase in the odds of developing diabetes for 40-55 yr age group over a 30 year period Physical inactivity Increase in the number of individuals > 65 years 20 15 8 year rate (%) 10 5 0 1970s 1980s 1990s Normal weight Overweight Obese Fox CS et al. The Framingham Offspring Study.Circulation 2006;113:2914–8

  8. Diabetes epidemic: 54% increase in diabetes from 2010 to 2030 Europe North America 55.266.220% 37.453.242% Middle East and North Africa Western Pacific 26.651.7 94% 76.7 112.8 47% Southeast Asia Africa 58.7 101.0 72% 12.123.998% South and Central America 18.029.665% World 2010 = 285 million 2030 = 439 million Increase 54% Adapted from IDF Diabetes Atlas 4th ed., 2009

  9. Diabetes: from the globe to your clinic Assume you are a physician in the Asia/Western Pacific region, where the diabetes prevalence level is approximately 5-7% If you oversee a group of 200 patients, then: 14 will have diabetes (7%) 11 of these 14 remain undiagnosed (75%) Screen for high risk groups Only 2 of these people are undergoing optimal treatment Only 1 of these people have their diabetes properly controlled IDF Diabetes Atlas 4th ed., 2009 Asia-Pacific Type 2 Diabetes Policy Group. Practical Targets and Treatments 4th Ed. 2005.

  10. Poor glucose control is associated with increased risk of complications Stroke Retinopathy and blindness Heart disease Kidney disease Erectile dysfunction Neuropathy Peripheral vascular disease Diabetic foot disease International Diabetes Federation. Diabetes Atlas,2006

  11. Prevalence of Retinopathy and Neuropathy in Type 2 diabetic patients in Iran compared to other countries Diabetes Atlas, 3rd edition, International diabetes federation, 2006

  12. How well are diabetic risk factors controlled in Iran? Measured in the previous year Patients at goal 6.4% 1.1% HbA1c 25.7% NA Lipids Delaveri A.,Archives of Iranian Med 2009;12:492-495

  13. Question #3 What do you think is the greatest obstacle to improving diabetes care in Iran? Lack of infrastructure/healthcare training Patient compliance towards diet and exercise Physician attitude Resistance of patients to medication Difficulty managing diabetic complications Other

  14. Question #4 Approximately what percentage of patients do you treat with insulin? 5% 10% 15% 20% >20%

  15. Antidiabetic treatment use: OHA’s favoured, insulin used infrequently International Diabetes Federation. Diabetes Atlas. 2006: 273-287.

  16. Suboptimal care results in diabetic complications Assume you are a physician overseeing a group of approximately 50 patients diagnosed with diabetes If your clinic is in Iran: 38 patients will have suboptimal control of HbA1c Approximately 4 patients (8%) will be treated with insulin; 28 patients will be treated with OADs only and 18 patients will be treated with diet only 6 patients (11.3%) will suffer from renal failure as a complication of their diabetes IDF Diabetes Atlas 4th ed., 2009 Novo Nordisk. Changing Diabetes Barometer. 2009 International Diabetes Federation. Diabetes Atlas. 2006: 273-287.

  17. Local insulin usage: human insulin preferred vs. analogues in Iran 1% • Prevalence of Diabetes in Iran in 2007 was 8.7%* • In Iran, insulin is prescribed to less than 7.5% of diabetic patients • Uncontrolled blood sugar = increased risk of complications 99% Insulin Usage (%) ** *Esteghamati A, et al. Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and Dyslipidemia. BMC Public Health 2009, 9:167 ** National Pharmaceutics Statistics, Ministry of Health, 2009,Iran

  18. Question #5 Which of the following factors do you feel is most important to improving diabetes care in your region in the future? Diabetes prevention via education programmes Patient lifestyle changes (diet and exercise) Treatment advances/new drugs Improved training for clinicians Political will/government investment in diabetes care Other

  19. Better treatment extends and improves lives First minorcomplications Baseline (HbA1c = 7.0%) Earlier Diagnosis + Enhanced Treatment 52 65-68 69-71 71 ”Mr. Lee" Age at diabetes diagnosis 52 Age at diagnosis First majorcomplications 52 60-62 66-68 Baseline (HbA1c = 9.1%) 68 years ”Mr. Kim" Age at diabetes diagnosis 52 25-40%* 25-65%* 71 years *Average risk reduction UKPDS Risk Engine: modelled data based on newly diagnosed cohort at age 52

  20. Taking action now can have a positive impact UKPDS Risk Engine: modelled data based on newly diagnosed cohort at age 52

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