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ScopeofthereportBurdenofdiabetesPreventingdiabetesManagingdiabetesNationalresponseRecommendations
BURDENOFDIABETESDiabetes
isaserious,chronicdiseasecharacterizedbyelevatedblood glucoseoccurseitherwhenthepancreas doesnotproduceenoughinsulin (type1)orthebodycannoteffectivelyuse theinsulinitproduces(type2).CausativeriskfactorsTobaccouseUnhealthydietsPhysicalinactivityHarmfuluseofalcoholNon-communicablediseasesHeartdiseaseandstroke
Diabetes
Cancer
Chroniclungdisease
DiabetesisoneofthefourmajorNCDsRiskfactorsType1Exactcausesareunknown.Type2Riskisdeterminedbygeneticand metabolicfactorsOverweight/obesityandphysical inactivityarethestrongestriskfactorsFetal&earlychildhoodnutritionaffect futureriskComplicationsofdiabetes108million422millionRiseindiabetes19802014Riseisfasterinlow-and
middle-incomecountriesIncreaseindiabetesismostmarkedintheWHOEasternMediterraneanRegionMortalityfromdiabetes43%ofdeathsoccurredundertheageof70yearsEconomicimpactofdiabetesCatastrophicmedicalexpendituresignificantlyhigherinpeoplewithdiabetes.Directannualcostofdiabetesglobally>US$827billion.LossesinGDPworldwideestimatedtobeUS$1.7trillionfrom2010to2030DiabetesandtheglobalNCDagendaPREVENTINGDIABETESOverweightandobesityincreasing
20141in3overweight1in10obesePreventingtype2diabetesatthepopulationlevelMultisectoralapproachestoreducetheprevalenceofmodifiablediabetesriskfactorsAcombinationoffiscalpolicies,legislation,changestotheenvironmentandraisingawarenessofhealthriskscanpromotehealthierdiets andphysicalactivity.HealthyworkplacesSchool-basedapproachPreventingtype2diabetesinpeopleathighriskDiabetescanbedelayedorpreventedinpeoplewhoareoverweightandhaveimpairedglucosetolerance(IGT).Dietandphysicalactivityaremoreeffectivethanmedication.Thehigh-riskapproachneedstobeimplementedinaccordancewithavailableresources.MANAGINGDIABETESDiagnosingdiabetesDiabetesisdiagnosedby
measuringglucoseinbloodFasting2hoursaftera75goralloadofglucosemeasuringglycatedhaemoglobin(HbA1c)Highproportionoftype2diabetesisundiagnosed.ManagementofdiabetesGoodmanagementcanpreventcomplicationsandprematuredeathusing:standardguidelinesandprotocols(WHOPackageofEssentialNCDinterventions)smallsetofgenericmedicinesdietandphysicalactivitypatienteducationaboutself-careregularscreeningforearlydetectionandtreatmentofcomplications.AccesstoaffordableinsulinPeoplewithtype1diabetesrequireinsulinforsurvival.Peoplewithtype2diabetesoftenneedinsulinLow-incomecountriesgenerallypaymostforinsulinwhilehigh-andmiddle-incomecountriespayleast.Only23%oflow-incomecountriesreportthatinsulinisgenerallyavailable.EarlydetectionandtreatmentofcomplicationsEnd-stagerenaldiseaseMeasurementofurineproteinprogressiontokidneyfailurecanbeslowedbyessentialdrugsCardiovasculardiseasesMeasureandcontrolcardiovascularriskfactorsBlindnessPeriodiceyeexaminationsandtimelylaserphotocoagulationLowerlimbamputationProperfootwearandregularexaminationoffeetProviderehabilitationIntegratedmanagementofdiabetesandotherchronichealthconditionsDiabetesmanagementshouldbeintegratedwithmanagementofotherNCDs,andinsomesettingswithtuberculosisandHIV/AIDS.NATIONALRESPONSENationalcapacityforpreventionandcontrolofdiabetes(NCDCCS2015-177countries)156countrieshaveanationaldiabetespolicy,planorstrategy,only127arefundedandoperational.68%ofcountrieshaveoperationalpoliciesfordietandphysicalactivity.<50%ofcountrieshaveconductedanational,population-basedsurveywithmeasurementofbloodglucosestatuswithinthepast5years.Only47%ofcountriesreportfullimplementationofguidelinesformanagementofdiabetes.Only1/3oflow-andlower-middleincomecountrieshaveallthreebasictechnologiesinPHCbloodglucoseurinestripforglucose/ketoneandheightandweightmeasurement
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