Fighting Diabetes

1
Fighting Diabetes

• The need for a systems
• approach in Nepal

by Dr. Netra Khadka
2
Diabetes Rising Globally

• The prevalence of diabetes worldwide 2.8 in
  2000 and 4.4 in 2030.
• The total number of people with diabetes171
  million in 2000 and 366 million in 2030.
• The prevalence of diabetes is higher in men than
  women, and more in urban than rural areas .
• The urban population in developing countries is
  projected to double between 2000 and 2030.
• In the US, from 1980 through 2002, the number of
  Americans diagnosed with diabetes more than
  doubled -- from 5.8 million to 13.3 million .
• In 2002 in Australia, about 1 million
  Australian (7.5 of Australians aged 25 years an
  over) were diabetic.

3
Diabetes Rising globally

• In 2000, 31.7 million people were diabetic in
  India and this figure will increase by more than
  double at 79.4 million in 2030.
• India ranks first in diabetes followed by China,
  USA, Indonesia, Japan, Pakistan, Russia, Brazil,
  Italia, and Bangladesh.
• No reported national survey of diabetes in India
  as yet, but it is believed that diabetes in urban
  India is in the rise.
• A study carried out in six major cities of India
  in 2001 indicated age standardised prevalence of
  diabetes and impaired glucose tolerance as 12.1
  and 14.0 respectively. Subjects under 40 years
  of age had a higher prevalence of impaired
  glucose tolerance than diabetes (12.8 vs 4.6
  ). Diabetes showed a positive and independent
  association with age, BMI, WHR, family history of
  diabetes, monthly income and sedentary physical
  activity. Age, BMI and family history of diabetes
  showed associations with impaired glucose
  tolerance.

4
Diabetes Rising Globally

• Nepal no exception for diabetes, and diabetes is
  on the rise in Nepal. Although there has been no
  national level survey on diabetes, some ad hoc
  research studies suggest a high prevalence
  diabetes, especially in the urban areas of the
  country ( cf.Karki et.al, 20006 Mehta et al,
  20057 Shrestha et.al, 20068 ) and that type 2
  diabetes among the urban adults is very common
  these days.
• For example In a seven urban population
  studies, Shrestha et. al (20068) report 19 per
  cent of the study sample of 1012 people aged 40
  as diabetic. Similarly, another urban-based
  study showed almost one third of the study
  population aged 40 as having diabetic tendency (
  Singh Bhattarai, 2003).

5
Diabetes Management A phase-wise matrix
Phase I
6
Phase II
7
Phase II
8
Phase III
Specifically it found that lowering and
maintaining more constant blood sugar levels
reduced the risk of eye disease by 76, kidney
disease by 50, nerve disease by 60 and
cardiovascular disease by 35.10
9
The need for a systems approach

• In the context of diabetes, the systems
  approach is meant to maximise the standards for
  good diabetes care in routine practice. Hence, in
  order to use a system approach, we need a model
  of diabetes management and care that may include
• a systematic screening process to identify people
  at risk of diabetes
• a systematic process for treating diabetic
  people with appropriate referrals, and
• a systematic development for self monitoring and
  management of diabetes

10
The need for a systems approach
The main objectives of the systems approach may
be

• To test the effectiveness of screening in
  identifying people at risks. Such screening may
  help identify vulnerable groups to diabetes
  problems.
• To promote partnerships among health
  professionals by using referral system of care
  (eg. referral to nutritionist/dietitian, diabetes
  educator, podiatrist, endocrinologist,
  neurologist, cardiologist, and ophthalmologist)
• To promote self-monitoring and management skills
  among diabetic people, and ensure that they have
  maintained a diabetes control target with proper
  action, reflection, and action or
  plan-do-study-act process.
• To establish a clinical information system to
  make proactive recall and review of individual
  diabetic patients and population

11
The need for a systems approach
The expected outcome of the system may be

• Protection of people from early on-set of
  diabetes
• Protection of diabetic people from diabetes
  complications, and provision of a longer and
  healthier life.
• Substantial reduction in the cost of
  hospitalisation and traumatic conditions and pain.

12
Summary

• A systems approach can be summarised in a
  diagram as

13
Questions

• ?