世界卫生组织全球糖尿病报告-PPT.ppt

Scope of the report Burden of diabetes Preventing diabetes Managing diabetes National response Recommendations BURDEN OF DIABETESDiabetes is a serious,chronic disease characterized by elevated blood glucose occurs either when the pancreas does not produce enough insulin(type 1)or the body cannot effectively use the insulin it produces(type 2).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 NCDsRisk 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 riskComplications of diabetes108 million422 millionRise in diabetes19802014Rise is faster in low-and middle-income countriesPrevalence1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 20140%2%4%6%8%10%Low-incomeLower middle-incomeUpper middle-incomeHigh-incomeIncrease in diabetes is most marked in the WHO Eastern Mediterranean RegionDeaths due to high blood glucose 3.7 MillionDeaths due to diabetes1.5 MillionMortality from diabetes43%of deaths occurred under the age of 70 yearsEconomic 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 2030Diabetes and the 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)PREVENTING DIABETESOverweight and obesity increasing20141 in 3 overweight1 in 10 obesePreventing 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 healthier diets and physical activity.Healthy work placesSchool-based approachPreventing 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 effective than medication.The high-risk approach needs to be implemented in accordance with available resources.MANAGING DIABETESDiagnosing 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.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 education about self-care regular screening for early detection and treatment of complications.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-and middle-income countries pay least.Only 23%of low-income countries report that insulin is generally available.Early detection and treatment 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 footwear and regular examination of feet Provide rehabilitationIntegrated 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.NATIONAL RESPONSENational capacity for prevention and control of diabetes(NCD CCS 2015-177 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-based survey with measurement of blood glucose status within the past 5 years.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/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 2015-177 countries)RECOMMENDATIONSRecommendationsEstablish high-level multisectoral commissionsStrategic leadership,engagement of stakeholders,implement policies and foster accountabilityNational 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 and 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 monitoringWHO responsePreventionEnding childhood obesityFiscal policies,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