Educating and inspiring policy makers – driving change

1. Educating and inspiring policy makers – driving change

2. Diabetes • Currently affects 246 million people worldwide and 380 million cases predicted by 20251 • 7 million new cases each year1 • Increase in diabetes is linked to the obesity epidemic2 • Diabetes can cause serious complications, including loss of vision, kidney failure and stroke1 • Every year ~ 4 million deaths are attributable to diabetes1 1. International Diabetes Federation. Did You Know?http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A 2. Mokdad AH et al. JAMA 2003;289: 76–79.

3. Type 2 diabetes: a global epidemic Type 2 diabetes accounts for 85–95% of diabetes cases 2025> 380 million 400 350 2007246 million 300 2000150 million 250 Global prevalence of diabetes (millions) 200 150 198530 million 100 50 0 1985 1990 1995 2000 2005 2010 2015 2020 2025 Year http://www.idf.org/home/index.cfm?node=264

4. The UN Resolution on Diabetes UN Resolution 61/225 passed on 20 December 2006 “Diabetes joins AIDS as the only other disease with its own UN resolution and a designated world day.” Professor Martin Silink Silink M. Int J Clin Pract 2007; 61 (s157): 5–8. “The challenge now is to convert fine words into real action.” Sir George AlbertiAlberti KGMM et al. Int J Clin Pract 2007; 61 (s157): 38–46.

5. The 1st UN World Diabetes Day • Over 400 global events….with 246 monuments lit • Worldwide media coverage http://www.worlddiabetesday.org/

6. Diabetes is a public health challenge

7. Type 2 diabetes affects the most productive • Almost half of diabetes deaths occur in people under the age of 70 years • Economic consequences of premature death may be severe • Substantial productivity is lost from diabetes, primarily from premature death Increased lifetime risk of developing diabetes for individuals born in 2000 (US) Men Women 1 in 3 2 in 5 www.who.int/mediacentre/factsheets/fs312/en/ www.idf.org/home/index.cfm?node=41 Narayan KM et al. J Am Med Assoc 2003; 290:1884–1890.

8. India China Brazil Russia Accounting for disability might double or triple these figures Economic consequences of premature death due to diabetes Predicted lost income over next 10 years ($ bn) www.idf.org/home/index.cfm?node=41

9. The burden of premature mortality Estimated diabetes deaths and DALYs* lost among people aged 20–79 years, by region, 2001 Disease Control Priorities in Developing Countries, second edition, 2006. http://www.dcp2.org/file_fs/302/2.ppt#1 * Disability Adjusted Life Years

10. $174 180 160 $132 140 120 $98 $92 100 80 60 40 $20 20 0 20075 20024 19861 19922 19973 Diabetes: the total cost of care Estimated US costs Direct costs breakdown5 Indirect costs Hospitalinpatient care 50% <1%Other supplies Cost per year (US$ billion) 20% Direct costs Outpatient care 5% Insulin/diabeticsupplies 6% 7% 11% Nursing/residential care Non-diabeticprescriptions Anti-diabetic drugs Year 1Huse DM, et al. JAMA 1989; 262:2708–2713. 2Ray NF, et al. Direct and indirect costs of diabetes in the United States in 1992. ADA; 1993. 3ADA. Diabetes Care 1998; 21:296–309. 4ADA. Diabetes Care 2003; 26:917–932. 5ADA. Diabetes Care 2008; 31:1–20.

11. Serious health risks from complications • Every 10 seconds a person dies from diabetes-related causes • 3 out of 5 have a serious complication • Largest cause of kidney failure in developed countries • Leading cause of vision loss in 20–65 year olds in industrialised countries • People with type 2 diabetes: • die 5–10 years before people without diabetes • 2x more likely to have heart attack or stroke than people without diabetes Number of serious complications affecting people with type 2 diabetes Four or More Complications 7.6% No Complications 42.1% Three Complications 6.7% Two Complications 10.3% One Complication 33.3% http://www.idf.org/home/index.cfm?node=37 American Association of Clinical Endocrinologists. State of Diabetes Complications. 2007. www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf.

12. The major cost of diabetes lies in the management of avoidable complications • Annual healthcare costs with diabetes and complications 3x cost without diabetes • Total yearly expenditure with complications ~$10,000 per person $9,797 $10,000 Total Costs Out-of-Pocket Costs $8,039 $8,000 $6,000 $4,000 $2,848 $1,566 $2,000 $1,429 $541 $0 No Diabetes with Average Complication Rates Diabetes with Average Complication Rates Diabetes with Diabetic Complication Rates Annual Per-Capita Healthcare Costs American Association of Clinical Endocrinologists. State of Diabetes Complications. 2007. www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf.

13. 4 8 4 1 3 7 1 9 , , 2 0 Costs of diabetes in Europe could approach $100 billion by 2025…. 3 2 1 4 5 Number of Diabetes Patients in Europe = 100 $94.3 billion$1,609/patient 80 Annual cost of diabetes care (International dollars, billions) 60 40 20 2003 2015 2025 Year Based on data available at the International Diabetes Federation. E-Atlas. 2005; www.eatlas.idf.org/

14. ….Although, costs could be more than halved by 2025 if action is taken NOW 100 $94.3 billion$1,609/patient 80 Annual cost of diabetes care (International dollars, billions) 60 $38.9 billion$664/patient 40 20 2003 2015 2025 Year Based on data available at the International Diabetes Federation. E-Atlas. 2005. www.eatlas.idf.org/ Menzin J, et al. Diabetes Care 2001;24:51–55 Saydah SH, et al. JAMA 2004; 291:335–342. Liebl A, et al. Diabetologia 2002; 45:S23–S28.

15. = Short-term complications = Long-term complications 9000 8000 7000 6000 –69% 5000 Per-patient costs (US$) 4000 3000 –68% 2000 1000 0 Poor blood glucose control Good blood glucose control Improved blood glucose control = fewer complications = reduced costs Per-patient costs reduced by more than half in 3 years with better blood glucose control Significant cost reductions Menzin J, et al. Diabetes Care 2001; 24: 51–55.

16. The urgent need for unified policies

17. Governments must respond now • Governments and healthcare systems can be better prepared • E.g. only 12 out of 25 EU countries currently have a national diabetes framework • If the situation continues, governments will need to spend up to 13% of healthcare budgets on diabetes by 20251 • Effective action plans must be developed and implemented NOW • Prevent costs spiralling and patients continuing to suffer devastating complications 1www.eatlas.idf.org/

18. Case Study The quest for the UN Resolution: Unite for Diabetes • International Diabetes Federation campaign • Largest ever diabetes coalition • Patient organisations from >150 countries • Most of world’s professional diabetes societies plus charities, service organisations, industry • A partnership that generated international change

19. Together, wecan achieve change Government initiatives + Sustained, united effort from all interested parties Integrated approach to global, regional and local projects Sustained improvement in public health worldwide

20. We can improve diabetes care and improve outcomes

21. Case Study Health Disparities Collaboratives • US public health partnership • Pools healthcare resources at state, local and community level • Diabetes care and prevention programmes: • improved training • technical assistance with clinical care and patient education • links with other diabetes organisations • assisting with data collection and analysis

22. Case Study Developing unified policy initiatives: the European example FEND and IDF call for EU Council recommendation on diabetes and screening EU Health Council’s Conclusions on Healthy Lifestyles and Prevention of Type 2 Diabetes urges states to develop national diabetes frameworks Written EU parliamentary declaration adopted by absolute majority Portuguese EU presidency’s Health Strategies in Europe meeting towards European Health Strategy National action plans in 14 states Need for unified policy initiatives Formal recommendations from Portuguese Presidency due June 2008 July 2007 June 2006 Feb 2006 April 2006

23. Case Study Local and national programmes: The Finnish example • Partnership between government and Finnish Diabetes Association • Screening of at-risk patients; lifestyle counselling • Obesity prevention in general population • Quality assurance of care • Study assessing cost-effectiveness • Aim to reduce CV complications by one-third • Now serving as model for other countries First EU state to roll out diabetes prevention strategy http://www.diabetes.fi/sivu.php?artikkeli_id=831

24. Case Study Local and national programmes: Council of Australian Governments • 10-year reform plan • Multifaceted approach to primary prevention • Targeting modifiable risk factors • Improving cost-effective early detection and intervention • Enhanced healthcare • $137 million from government of Victoria and $548 from Commonwealth Government over next 4 years • Drawing on Finnish example: national hotline, website and risk assessment tool Plan to address the growing impact of obesity and type 2 diabetes

25. Guidelines are not being implemented in everyday practice Despite reminders of A1C goal below 7%, physicians remain complacent

26. Case Study Developing countries: World Diabetes Foundation • Links people and resources • Educates and advocates globally for prevention and treatment of diabetes in developing countries • Supporting Sudanese project to improve capacity for diabetes care • 12-week training programmes for physicians; training diabetes educators • Regional summit in Kenya to build support for similar projects and showcase successful examples

27.     Rising to the challenge Prioritisediabetes as a public health challenge Governments respond to the UN resolution Practical, sustainable models of diabetes care and prevention require working closely with diabetes organisations, healthcare professionals and patients Case studies around the world serve as leadership models Continued efforts will enable improved, earlier and more intensive diabetes care and a healthier public Alberti KGMM et al. Int J Clin Pract2007; 61 (s157): 38–46. www.blackwell-synergy.com/toc/ijcp/61/s157