Are we ready for the Diabetes tsunami?

1. Dr Nancy Ngugi Consultant Physician , Endocrinologist Are we ready for the Diabetes tsunami?

2. Diabetes Mellitus Diabetes is a chronic metabolic condition characterized by hyperglycemia, that occurs as a result of lack of insulin or insulin sensitivity.

3. Types of Diabetes Mellitus (DM) • Type 1 Diabetes • Type 2 Diabetes • Gestational Diabetes • Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)

4. Predisposing factors to type 2 DM • Physical inactivity • Obesity • Unhealthy diet • Increasing age • Family history of diabetes • Ethnicity • Poor nutrition during pregnancy affecting the developing child

5. Symptoms of Diabetes Type 2 diabetes is often without symptoms in its early stages. That’s the reason there are 50% of people with Type 2 diabetes are unaware of their disease. • feeling tired and weak • Polyuria, nocturia • recurrent infections • blurred vision • weight-loss • excessive hunger and thirst • symptoms of peripheral neuropathy • slow healing wounds

6. Diagnosis • Diabetes: -RBS >11.1 mmol/ l -FBS > 7.0 mmol/l -HbA1c >6.5% • If the RBS is > 5.6 mmol/l and < 11.1 then do the FBS or OGTT • OGTT- 75 g CHO in 250mls of water

7. OGTT Interpretation

8. Diabetes: Complications Macrovascular Microvascular Diabetic eye disease (retinopathy and cataracts) Stroke Heart disease and hypertension 2-4 X increased risk Renal disease Peripheral vascular disease Erectile Dysfunction Peripheral Neuropathy Foot problems Meltzer et al. CMAJ 1998;20(Suppl 8):S1-S29.

9. Management • The primary treatment for type 2 diabetes is exercise and diet. • The aim of pharmacological management is to reduce the risks of complications from diabetes through; • Glycemic control: • Insulins • Oral agents • BP control • Cholesterol control • Aspirin • Smoking cessation • Moderate alcohol intake

10. Prevention    • Screening for type 2 diabetes and people with no symptoms is recommended for: • Overweight children who have other risk factors for diabetes, starting at age 10 and repeating every 2 years • Overweight adults (BMI greater than 25) who have other risk factors • Adults over 45, repeated every 3 years • Those with a history of gestational diabetes • Maintain a healthy body weight and keep an active lifestyle to help prevent type 2 diabetes.

12. Africa Eastern Mediterraneanand Middle East Europe North America South and Central America South-East Asia Western Pacific Diabetes is an increasing healthcare epidemic throughout the world 52.6 64.0 +22% 37.7 51.2 +36% 131.9 187.9 +42% 32.8 59.7 +83% 71.4 120.9 +69% 14.7 28.0 +90% 25.1 39.9 +59% Worldwide: 366 million people in 2011 552 million projected for 2030 51% increase IDF. Diabetes Atlas 5rd Edition – 2011

13. Global situation • Type 2 DM is increasing in every country • 80% of people with DM live in low and middle income countries • Most people with DM are between 40 to 59 years of age • 183 million people (50%) with DM are undiagnosed • DM caused 4.6 million deaths in 2011 • 78,000 children develop type 1 diabetes every year • 280 million people with IGT in 2011, will increase to 398 million in 2030

14. Situation in Kenya • Prevalence of diabetes • 2.7% in rural areas • 10.7% in urban areas • Prevalence of IGT/IFG • 8.8 % in rural areas • 14.4 % in urban areas • 53% of all hospital admissions are due to Non Communicable Diseases of which 28% due to Diabetes • Increasing cases of childhood diabetes • Increasing cases of gestational Diabetes

15. Situation in KNH Adult diabetic clinic attendance in 2011 (Jan- Dec) new ptsrevisits Main clinic (Fri) 448 2530 Mini clinic ( Mon-Fri) 153 5190 Pead diabetic/ endo 178 683 (Tue clinic)

16. What are we doing as the diabetes fraternity in Kenya? • Kenya national diabetes strategy 2010-2015 • National clinical guidelines for management of diabetes • National diabetes educators manual • Diabetes comprehensive care manual • Diabetes prevention and management: A guide for community health workers • Kenya Diabetes Study group (KDSG)- Diabetes Manual

17. Diabetes Projects • MoMS and MoPHS in conjunction with DMI (NGO) with funding from WDF -diabetes education and awareness project (2005-2008) -diabetes comprehensive care project-DCC (2009-2013) -mobile foot clinic project-MFC (2009-2012) -changing diabetes in children-CDIC (2010-2015) • National diabetes registers • National insulin registers • Rockefeller foundation- DMI - diabetes awareness and screening project • Others projects by CDC, APHRC, Diabetes Kenya.

18. Diabetes programs • Diabetes medical camps –by Safaricom-DMI, Diabetes Kenya, Pharmaceuticals companies , hospitals • Diabetes children's camps-Safaricom, Johnson and Johnson • Diabetes training-Diabetes Kenya, Handicap international • Patient support groups • Diabetes educators programs • Nutrition-diabetes programs • Diabetes education through audio, radio and print • SMS web portal diabetes support programs-Tuzungumziekisukari (DMI-WDF) English - SMS “subscribe” to - 0710 840 337, Swahili “jisajili” to - 0710 840 337

19. What are we doing in KNH? • The diabetes fraternity has invested a lot in setting up structures for the national diabetes care centers country wide • Over 70 diabetes comprehensive care centers (provincial, district and sub district hospitals • UoN and KNH diabetologists have improved the curriculum in diabetes medical training • Diabetes education training programs, diabetic foot training, diabetes awareness and screening-world diabetes day (14th November) • Diabetes and Endocrinology center

20. Thank You