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1、第一页，共32页。Scope of the report Burden of diabetes Preventing diabetes Managing diabetes National response Recommendations 第二页，共32页。BURDEN OF DIABETES第三页，共32页。Diabetes is a serious, chronic disease characterized by elevated blood glucose occurs either when the pancreas does not produce enough insulin (
2、type 1) or the body cannot effectively use the insulin it produces (type 2).第四页，共32页。Causative risk factorsTobacco useUnhealthy dietsPhysical inactivityHarmful use of alcoholNon-communicable diseasesHeart disease and stroke Diabetes Cancer Chronic lung disease Diabetes is one of the four major NCDs第
3、五页，共32页。Risk factorsType 1 Exact causes 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第六页，共32页。Complications of diabetes第七页，共32页。108 million422 mill
4、ionRise in diabetes19802014第八页，共32页。Rise is faster in low- and middle - income countries第九页，共32页。Increase in diabetes is most marked in the WHO Eastern Mediterranean Region第十页，共32页。Deaths due to high blood glucose 3.7 MillionDeaths due to diabetes1.5 MillionMortality from diabetes43% of deaths occur
5、red under the age of 70 years第十一页，共32页。Economic impact of diabetesCatastrophic 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 2010 to 2030第十二页，共32页。Diabetes and the
6、 global NCD agenda2011 UN Political Declaration on NCDsNCD Global Action Plan 2013-2020NCD Targets for 2025 Halt the rise in DiabetesSDG target- One third reduction in premature mortality from NCDs (including Diabetes) 第十三页，共32页。PREVENTING DIABETES第十四页，共32页。Overweight and obesity increasing20141 in
7、3 overweight1 in 10 obese第十五页，共32页。Preventing type 2 diabetes at the population levelMultisectoral approaches 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 health
8、ier diets and physical activity.第十六页，共32页。Healthy work places第十七页，共32页。School-based approach第十八页，共32页。Preventing type 2 diabetes 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 effe
9、ctive than medication.The high-risk approach needs to be implemented in accordance with available resources. 第十九页，共32页。MANAGING DIABETES第二十页，共32页。Diagnosing diabetesDiabetes is diagnosed by measuring glucose in bloodFasting2 hours after a 75g oral load of glucosemeasuring glycated haemoglobin (HbA1c
10、) High proportion of type 2 diabetes is undiagnosed.第二十一页，共32页。Management of diabetesGood management can prevent complications and premature death using: standard guidelines and protocols (WHO Package of Essential NCD interventions) small set of generic medicines diet and physical activity patient e
11、ducation about self-care regular screening for early detection and treatment of complications.第二十二页，共32页。Access to affordable insulinPeople with type 1 diabetes require insulin for survival. People with type 2 diabetes often need insulinLow-income countries generally pay most for insulin while high-
12、 and middle-income countries pay least. Only 23% of low-income countries report that insulin is generally available.第二十三页，共32页。Early detection and treatment of complicationsEnd-stage renal disease Measurement of urine protein progression to kidney failure can be slowed by essential drugsCardiovascul
13、ar diseases Measure and control cardiovascular risk factorsBlindness Periodic eye examinations and timely laser photocoagulation Lower limb amputation Proper footwear and regular examination of feet Provide rehabilitation第二十四页，共32页。Integrated management of diabetes and other chronic health condition
14、sDiabetes management should be integrated with management of other NCDs, and in some settings with tuberculosis and HIV/AIDS.第二十五页，共32页。NATIONAL RESPONSE第二十六页，共32页。National capacity for prevention and control of diabetes (NCD CCS 2015- 177 countries)156 countries have a national diabetes policy, pla
15、n 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-based survey with measurement of blood glucose status within the past 5 years.第二十七页，共32页。Only 47% of countries report f
16、ull 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/ketone and height and weight measurementBlood glucose measurement is generally available in primary care in 50
17、% of low-income countries.National capacity for prevention and control of diabetes (NCD CCS 2015- 177 countries)第二十八页，共32页。RECOMMENDATIONS第二十九页，共32页。RecommendationsEstablish high-level multisectoral commissionsStrategic leadership, engagement of stakeholders, implement policies and foster accountabi
18、lityNational mechanismsLife-course approach, create supportive environments, use fiscal policies and legislationBuild capacity of health ministriesEnhance capacity of primary health care, national protocols for management, improve access to affordable medicines.Prioritize prevention of overweight an
19、d obesityOutcome evaluations, operational researchStrengthen health systems Collect, analyse and use representative data, develop and strengthen diabetes registries if feasible.Address gaps in knowledge baseSurveillance and monitoring第三十页，共32页。WHO responsePreventionEnding childhood obesityFiscal pol
20、icies, legislation Settings- based approachesManagementClinical guidelinesUpdate of diagnostic criteriaDiabetes registriesAccess to essential medicinesMonitor availability and priceStrategic procurementReview and update WHO EMLSurveillanceRisk factor surveysCountry capacity and responseMortality estimates第三十一页，共32页。第三十二页，共32页。
