Type 2 diabetes: An Epidemic
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Transcript Type 2 diabetes: An Epidemic
ARE WE READY FOR THE DIABETES
TSUNAMI?
Dr Nancy Ngugi
Consultant Physician , Endocrinologist
Diabetes Mellitus
Diabetes is a chronic metabolic condition
characterized by hyperglycemia, that occurs
as a result of lack of insulin or insulin
sensitivity.
Types of Diabetes Mellitus (DM)
Type
1 Diabetes
Type
2 Diabetes
Gestational Diabetes
Impaired glucose tolerance (IGT) and
impaired fasting glucose (IFG)
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
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
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
OGTT Interpretation
FBS (Mmol/l)
2 hrs post prandial
(mmol/l)
Normal
<6.1
<7.8
IFG
6.1-6.9
<7.8
IGT
<6.1
7.8-11.1
Diabetes
>7.0
>11.1
Diabetes: Complications
Macrovascular
Stroke
Microvascular
Diabetic eye disease
(retinopathy and cataracts)
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.
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
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.
Diabetes is an increasing
healthcare epidemic throughout
the world
Africa
52.6
64.0
+22%
37.7
51.2
+36%
Eastern Mediterranean
and Middle East
Europe
32.8
59.7
+83%
North America
South and Central America
South-East Asia
Western Pacific
IDF. Diabetes Atlas 5rd Edition – 2011
25.1
39.9
+59%
14.7
28.0
+90%
131.9
187.9
+42%
71.4
120.9
+69%
Worldwide:
366 million people in 2011
552 million projected for 2030
51% increase
12
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
13
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
14
Situation in KNH
Adult diabetic clinic attendance in 2011 (Jan- Dec)
new pts
revisits
Main clinic (Fri)
448
2530
Mini clinic ( Mon-Fri)
153
5190
Pead diabetic/ endo
(Tue clinic)
178
683
15
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
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.
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-Tuzungumzie
kisukari (DMI-WDF) English - SMS “subscribe” to - 0710 840
337, Swahili “jisajili” to - 0710 840 337
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
Thank You