Educating and inspiring policy makers – driving change

This slideset was developed in 2007 with support from GlaxoSmithKline

Diabetes

• Currently affects 246 million people worldwide and 380 million cases predicted by 20251

• 7 million new cases each year1

• Increase in diabetes is linked to the obesity epidemic2

• Diabetes can cause serious complications, including loss of vision, kidney failure and stroke1

• Every year ~ 4 million deaths are attributable to diabetes1

1. International Diabetes Federation. Did You Know?http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A

2. Mokdad AH et al. JAMA 2003; 289: 76–79.

Type 2 diabetes: a global epidemic

Type 2 diabetes accounts for 85–95% of diabetes cases

0

50

100

150

200

250

300

350

1985

Glo

bal

pre

vale

nce

of

dia

bet

es (

mill

ion

s)

http://www.idf.org/home/index.cfm?node=264

400

2025> 380 million

2000

Year

1990 1995 2005 2010 2015 2020 2025

2007246 million

198530 million

2000150 million

The UN Resolution on Diabetes

UN Resolution 61/225 passed on 20 December 2006

“Diabetes joins AIDS as the only other disease with its own UN resolution and a designated world day.” Professor Martin SilinkSilink M. Int J Clin Pract 2007;

61 (s157): 5–8.

“The challenge now is to convert fine words into real action.” Sir George Alberti

Alberti KGMM et al. Int J Clin Pract 2007; 61 (s157): 38–46.

The 1st UN World Diabetes Day

http://www.worlddiabetesday.org/

• Over 400 global events….with 246 monuments lit• Worldwide media coverage

Diabetes is a public health challenge

Type 2 diabetes affects the most productive

• Almost half of diabetes deaths occur in people under the age of 70 years

• Economic consequences of premature death may be severe

• Substantial productivity is lost from diabetes, primarily from premature death

www.who.int/mediacentre/factsheets/fs312/en/

www.idf.org/home/index.cfm?node=41

Narayan KM et al. J Am Med Assoc 2003; 290:1884–1890.

1 in 3 2 in 5

Increased lifetime risk of developing diabetes for

individuals born in 2000 (US)

Men Women

Economic consequences of premature death due to diabetes

0

100

200

300

400

500

600

Pre

dic

ted

lo

st i

nco

me

ove

r n

ext

10 y

ears

($

bn

)

Brazil Russia India China

www.idf.org/home/index.cfm?node=41

Accounting for disability might double or triple these figures

The burden of premature mortality

Region DALYs (thousands)

Developing countries 15,804

East Asia and the Pacific 4,930

East Europe and Central Asia 1,375

Latin America and the Caribbean 2,775

Middle East and North Africa 843

South Asia 4,433

Sub-Saharan Africa 1,448

Developed countries 4,192

World 19,996

Estimated diabetes deaths and DALYs* lost among people aged 20–79 years, by region, 2001

Disease Control Priorities in Developing Countries, second edition, 2006.

http://www.dcp2.org/file_fs/302/2.ppt#1* Disability Adjusted Life Years

Estimated US costs

Year

Co

st p

er y

ear

(US

$ b

illio

n)

Indirect costs

Direct costs

Direct costs breakdown5

Hospitalinpatient care

Nursing/residential care

Outpatient care

Insulin/diabeticsupplies

Non-diabeticprescriptions

50%

20%

11%7%

5%6%

Anti-diabetic drugs

1Huse DM, et al. JAMA 1989; 262:2708–2713. 2Ray NF, et al. Direct and indirect costs of diabetes in the United States in 1992. ADA; 1993. 3ADA. Diabetes Care 1998; 21:296–309. 4ADA. Diabetes Care 2003; 26:917–932. 5ADA. Diabetes Care 2008; 31:1–20.

Diabetes: the total cost of care

0

20

40

60

80

100

120

19861 19922 19973

$98$92

$20

20024

$132140

20075

$174

160

180

<1% Other

supplies

Serious health risks from complications

• Every 10 seconds a person dies from diabetes-related causes

• 3 out of 5 have a serious complication

• Largest cause of kidney failure in developed countries

• Leading cause of vision loss in 20–65 year olds in industrialised countries

• People with type 2 diabetes:– die 5–10 years before people without

diabetes– 2x more likely to have heart attack or

stroke than people without diabetes

http://www.idf.org/home/index.cfm?node=37

American Association of Clinical Endocrinologists. State of Diabetes Complications. 2007. www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf.

Number of serious complications affecting people with type 2 diabetes

Four or MoreComplications

7.6%

ThreeComplications

6.7%

TwoComplications

10.3%

One Complication33.3%

No Complications42.1%

The major cost of diabetes lies in the management of avoidable complications

• Annual healthcare costs with diabetes and complications 3x cost without diabetes

• Total yearly expenditure with complications ~$10,000 per person

American Association of Clinical Endocrinologists. State of Diabetes Complications. 2007. www.aace.com/newsroom/press/2007/images/DiabetesComplicationsReport_FINAL.pdf.

$10,000

$8,000

$6,000

$4,000

$2,000

$0

$2,848

$541

$8,039

$1,429

$9,797

$1,566

Diabetes with DiabeticComplication Rates

Diabetes with AverageComplication Rates

No Diabetes with Average Complication Rates

Annual Per-Capita Healthcare Costs

Total Costs

Out-of-PocketCosts

Costs of diabetes in Europe could approach $100 billion by 2025….

Based on data available at the International Diabetes Federation. E-Atlas. 2005; www.eatlas.idf.org/

Ann

ual c

ost o

f dia

bete

s ca

re

(Int

erna

tiona

l dol

lars

, bill

ions

)

2003 2025201520

60

100

80

40

$94.3 billion$1,609/patient

Number of Diabetes Patients in Europe = 3 71199, ,1484 22001122334455

Year

….Although, costs could be more than halved by 2025 if action is taken NOW

Ann

ual c

ost o

f dia

bete

s ca

re

(Int

erna

tiona

l dol

lars

, bill

ions

)

2003 2025201520

60

100

80

40

$94.3 billion$1,609/patient

$38.9 billion$664/patient

Based on data available at the International Diabetes Federation. E-Atlas. 2005. www.eatlas.idf.org/ Menzin J, et al. Diabetes Care 2001;24:51–55Saydah SH, et al. JAMA 2004; 291:335–342.

Liebl A, et al. Diabetologia 2002; 45:S23–S28.

Year

Improved blood glucose control = fewer complications = reduced costsPer-patient costs reduced by more than half in 3 years with better blood glucose control

Significant cost reductions

= Short-term complications

= Long-term complications

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Poor blood glucose control

Good blood glucose control

Per

-pat

ient

cos

ts (

US

$)

–69%

–68%

Menzin J, et al. Diabetes Care 2001; 24: 51–55.

The urgent need for unified policies

Governments must respond now

• Governments and healthcare systems can be better prepared

– E.g. only 12 out of 25 EU countries currently have a national diabetes framework

• If the situation continues, governments will need to spend up to 13% of healthcare budgets on diabetes by 20251

• Effective action plans must be developed and implemented NOW

– Prevent costs spiralling and patients continuing to suffer devastating complications

1www.eatlas.idf.org/

The quest for the UN Resolution: Unite for Diabetes

• International Diabetes Federation campaign

• Largest ever diabetes coalition• Patient organisations from >150

countries• Most of world’s professional

diabetes societies plus charities, service organisations, industry

• A partnership that generated international change

Together, we can achieve change

Government initiatives

+Sustained, united effort from all interested parties

Integrated approach to global, regional and local projects

Sustained improvement in public health worldwide

We can improve diabetes care and improve outcomes

Health Disparities Collaboratives

• US public health partnership • Pools healthcare resources at state,

local and community level• Diabetes care and prevention

programmes:– improved training

– technical assistance with clinical care and patient education

– links with other diabetes organisations

– assisting with data collection and analysis

Developing unified policy initiatives: the European example

FEND and IDF call for EU Council

recommendation on diabetes and screening

Feb 2006

April 2006

June 2006

July 2007

Written EU parliamentary

declaration adopted by

absolute majority

EU Health Council’s Conclusions on Healthy Lifestyles and Prevention of

Type 2 Diabetes urges states to develop national diabetes frameworks

Portuguese EU presidency’s Health Strategies in Europe meeting towards European

Health Strategy

Formal recommendations from Portuguese Presidency due

June 2008

National action plans in 14 states

Need for unified policy initiatives

Local and national programmes: The Finnish example

• Partnership between government and Finnish Diabetes Association– Screening of at-risk patients; lifestyle

counselling

– Obesity prevention in general population

– Quality assurance of care

• Study assessing cost-effectiveness• Aim to reduce CV complications by

one-third• Now serving as model for other

countries

First EU state to roll out diabetes prevention strategy

http://www.diabetes.fi/sivu.php?artikkeli_id=831

Local and national programmes: Council of Australian Governments

• 10-year reform plan– Multifaceted approach to primary prevention

– Targeting modifiable risk factors

– Improving cost-effective early detection and intervention

– Enhanced healthcare • $137 million from government of Victoria

and $548 from Commonwealth Government over next 4 years

• Drawing on Finnish example: national hotline, website and risk assessment tool

Plan to address the growing impact of obesity and

type 2 diabetes

Despite reminders of A1C goal below 7%, physicians remain

complacent

Guidelines are not being implemented in everyday practice

Developing countries: World Diabetes Foundation

• Links people and resources• Educates and advocates globally for prevention and treatment of

diabetes in developing countries• Supporting Sudanese project to improve capacity for diabetes care

– 12-week training programmes for physicians; training diabetes educators

• Regional summit in Kenya to build support for similar projects and showcase successful examples

Rising to the challenge

Alberti KGMM et al. Int J Clin Pract 2007; 61 (s157): 38–46.

www.blackwell-synergy.com/toc/ijcp/61/s157

Continued efforts will enable improved, earlier and more intensive diabetes care and a healthier public

Prioritise diabetes as a public health challenge

Governments respond to the UN resolution

Practical, sustainable models of diabetes care and prevention require working closely with diabetes organisations, healthcare professionals and patients

Case studies around the world serve as leadership models