世界卫生组织全球糖尿病报告

1、第1页Scope of the report Burden of diabetes Preventing diabetes Managing diabetes National response Recommendations 第2页BURDEN OF DIABETES第3页Diabetes is a serious, chronic disease characterized by elevated blood glucose occurs either when the pancreas does not produce enough insulin (type 1) or the bod

2、y cannot effectively use the insulin it produces (type 2).第4页Causative risk factorsTobacco useUnhealthy dietsPhysical inactivityHarmful use of alcoholNon-communicable diseasesHeart disease and strokeDiabetesCancerChronic lung diseaseDiabetes is one of the four major NCDs第5页Risk factorsType 1 Exact c

3、auses are unknown. Type 2 Risk is determined by genetic and metabolic factors Overweight/obesity and physical inactivity are the strongest risk factors Fetal & early childhood nutrition affect future risk第6页Complications of diabetes第7页108 million422 millionRise in diabetes1980第8页Rise is faster in lo

4、w- and middle - income countries第9页Increase in diabetes is most marked in the WHO Eastern Mediterranean Region第10页Deaths due to high blood glucose 3.7 MillionDeaths due to diabetes1.5 MillionMortality from diabetes43% of deaths occurred under the age of 70 years第11页Economic impact of diabetesCatastr

5、ophic medical expenditure significantly higher in people with diabetes.Direct annual cost of diabetes globally US$ 827 billion.Losses in GDP worldwide estimated to be US$ 1.7 trillion from to 2030第12页Diabetes and the global NCD agenda2011 UN Political Declaration on NCDsNCD Global Action Plan 2013-2

6、020NCD Targets for 2025 Halt the rise in DiabetesSDG target- One third reduction in premature mortality from NCDs (including Diabetes) 第13页PREVENTING DIABETES第14页Overweight and obesity increasing1 in 3 overweight1 in 10 obese第15页Preventing type 2 diabetes at the population levelMultisectoral approac

7、hes to reduce the prevalence of modifiable diabetes risk factorsA combination of fiscal policies, legislation, changes to the environment and raising awareness of health risks can promote healthier diets and physical activity.第16页Healthy work places第17页School-based approach第18页Preventing type 2 diab

8、etes in people at high riskDiabetes can be delayed or prevented in people who are overweight and have impaired glucose tolerance (IGT). Diet and physical activity are more effective than medication.The high-risk approach needs to be implemented in accordance with available resources. 第19页MANAGING DI

9、ABETES第20页Diagnosing diabetesDiabetes is diagnosed by measuring glucose in bloodFasting2 hours after a 75g oral load of glucosemeasuring glycated haemoglobin (HbA1c) High proportion of type 2 diabetes is undiagnosed.第21页Management of diabetesGood management can prevent complications and premature de

10、ath using: standard guidelines and protocols (WHO Package of Essential NCD interventions) small set of generic medicines diet and physical activity patient education about self-care regular screening for early detection and treatment of complications.第22页Access to affordable insulinPeople with type

11、1 diabetes require insulin for survival. People with type 2 diabetes often need insulinLow-income countries generally pay most for insulin while high- and middle-income countries pay least. Only 23% of low-income countries report that insulin is generally available.第23页Early detection and treatment

12、of complicationsEnd-stage renal disease Measurement of urine protein progression to kidney failure can be slowed by essential drugsCardiovascular diseases Measure and control cardiovascular risk factorsBlindness Periodic eye examinations and timely laser photocoagulation Lower limb amputation Proper

13、 footwear and regular examination of feet Provide rehabilitation第24页Integrated management of diabetes and other chronic health conditionsDiabetes management should be integrated with management of other NCDs, and in some settings with tuberculosis and HIV/AIDS.第25页NATIONAL RESPONSE第26页National capac

14、ity for prevention and control of diabetes (NCD CCS - 177 countries)156 countries have a national diabetes policy, plan or strategy, only 127 are funded and operational.68% of countries have operational policies for diet and physical activity. 50% of countries have conducted a national, population-b

15、ased survey with measurement of blood glucose status within the past 5 years.第27页Only 47% of countries report full implementation of guidelines for management of diabetes.Only 1/3 of low- and lower-middle income countries have all three basic technologies in PHC blood glucose urine strip for glucose

16、/ketone and height and weight measurementBlood glucose measurement is generally available in primary care in 50% of low-income countries.National capacity for prevention and control of diabetes (NCD CCS - 177 countries)第28页RECOMMENDATIONS第29页RecommendationsNational mechanismsEstablish high-level mul

17、tisectoral commissionsBuild capacity of health ministriesStrategic leadership, engagement of stakeholders, implement policies and foster accountabilityPrioritize prevention of overweight and obesityLife-course approach, create supportive environments, use fiscal policies and legislationStrengthen he

18、alth systems Enhance capacity of primary health care, national protocols for management, improve access to affordable medicines.Address gaps in knowledge baseOutcome evaluations, operational researchSurveillance and monitoringCollect, analyse and use representative data, develop and strengthen diabetes registries if feasible.第30页WHO responsePreventionEnding childhood obesityFiscal policies, legislation Setti