Educating and inspiring policy makers driving change

1
Educating and inspiring policy makers driving
change
The Global Partnership for Effective Diabetes
Management, including the development of this
slide set, is supported by GlaxoSmithKline
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?unode3B96
906B-C026-2FD3-87B73F80BC22682A 2. Mokdad AH et
al. JAMA 2003 289 7679.
3
Type 2 diabetes a global epidemic
Type 2 diabetes accounts for 8595 of diabetes
cases
2025gt 380 million
400
350
2007246 million
300
2000150 million
250
Global prevalence of
diabetes (millions)
200
150
198530 million
100
50
0
1985
2000
1990
1995
2005
2010
2015
2020
2025
Year

http//www.idf.org/home/index.cfm?node264
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) 58.
The challenge now is to convert fine words into
real action. Sir George AlbertiAlberti KGMM et
al. Int J Clin Pract 2007 61 (s157) 3846.
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.i
df.org/home/index.cfm?node41 Narayan KM et al. J
Am Med Assoc 2003 29018841890.
8
Economic consequences of premature death due to
diabetes
Predicted lost income over next 10 years ( bn)
www.idf.org/home/index.cfm?node41
9
The burden of premature mortality
Estimated diabetes deaths and DALYs lost among
people aged 2079 years, by region, 2001
Disease Control Priorities in Developing
Countries, second edition, 2006. http//www.dcp2.o
rg/file_fs/302/2.ppt1
Disability Adjusted Life Years
10
Diabetes the total cost of care
Estimated US costs
Direct costs breakdown5
Indirect costs
Hospitalinpatient care
50
lt1 Other supplies
Cost per year (US billion)
20
Direct costs
Outpatient care
5
Insulin/diabeticsupplies
6
11
7
Nursing/residential care
Non-diabeticprescriptions
Anti-diabetic drugs
Year
1Huse DM, et al. JAMA 1989 26227082713. 2Ray
NF, et al. Direct and indirect costs of diabetes
in the United States in 1992. ADA 1993. 3ADA.
Diabetes Care 1998 21296309. 4ADA. Diabetes
Care 2003 26917932. 5ADA. Diabetes Care 2008
31120.
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 2065 year olds
  in industrialised countries
• People with type 2 diabetes
• die 510 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?node37
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
Diabetes with Diabetic Complication Rates
Diabetes with Average Complication Rates
No Diabetes with Average 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
Costs of diabetes in Europe could approach 100
billion by 2025.
1
2
3
4
5
Number of Diabetes Patients in Europe
100
94.3 billion1,609/patient
80
Annual cost of diabetes care (International
dollars, billions)
60
40
20
2003
2025
2015
Year
Based on data available at the International
Diabetes Federation. E-Atlas. 2005
www.eatlas.idf.org/
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.Although, costs could be more than halved by
2025 if action is taken NOW
100
94.3 billion1,609/patient
80
Annual cost of diabetes care (International
dollars, billions)
60
38.9 billion664/patient
40
20
2003
2025
2015
Year
Based on data available at the International
Diabetes Federation. E-Atlas. 2005.
www.eatlas.idf.org/ Menzin J, et al. Diabetes
Care 2001245155 Saydah SH, et al. JAMA 2004
291335342. Liebl A, et al. Diabetologia 2002
45S23S28.
15
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 5155.
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The urgent need for unified policies
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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/
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The quest for the UN Resolution Unite for
Diabetes

• International Diabetes Federation campaign
• Largest ever diabetes coalition
• Patient organisations from gt150 countries
• Most of worlds professional diabetes societies
  plus charities, service organisations, industry
• A partnership that generated international change

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Together, we can 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
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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
Developing unified policy initiatives the
European example
EU Health Councils Conclusions on Healthy
Lifestyles and Prevention of Type 2 Diabetes
urges states to develop national diabetes
frameworks

• FEND and IDF call for EU Council recommendation
  on diabetes and screening

Written EU parliamentary declaration adopted by
absolute majority
Portuguese EU presidencys Health Strategies in
Europe meeting towards European Health Strategy
Formal recommendations from Portuguese Presidency
due June 2008
National action plans in 14 states Need for
unified policy initiatives
July 2007
June 2006
Feb 2006
April 2006
23
Local and national programmes The Finnish
example
First EU state to roll out diabetes prevention
strategy

• 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

http//www.diabetes.fi/sivu.php?artikkeli_id831
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Local and national programmes Council of
Australian Governments
Plan to address the growing impact of obesity and
type 2 diabetes

• 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

25
Guidelines are not being implemented in everyday
practice
Despite reminders of A1C goal below 7,
physicians remain complacent
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Meeting the challenge by changing policy

• APPGD key recommendations
• Treat to HbA1c target of 6.5
• Reward physicians for the number of patients
  achieving a 1 drop in HbA1c
• Encourage continued vigilance and better glycemic
  control
• Incentives for GPs to educate patients

All Party Group on Diabetes Current Qualities and
Outcomes Framework Renegotiations and the Impact
on Diabetes Care A Parliamentary Stakeholder
Investigation. November 2007
27
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

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Rising to the challenge
Prioritise diabetes 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 Pract 2007 61
(s157) 3846. www.blackwell-synergy.com/toc/ijcp/
61/s157