educating and inspiring policy makers – driving change

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Educating and inspiring policy makers – driving change. The Global Partnership for Effective Diabetes Management, including the development of this slide set, is supported by GlaxoSmithKline. Diabetes. Currently affects 246 million people worldwide and 380 million cases predicted by 2025 1 - PowerPoint PPT Presentation


  • Educating and inspiring policy makers driving changeThe Global Partnership for Effective Diabetes Management, including the development of this slide set, is supported by GlaxoSmithKline

  • DiabetesCurrently affects 246 million people worldwide and 380 million cases predicted by 202517 million new cases each year1Increase in diabetes is linked to the obesity epidemic2Diabetes can cause serious complications, including loss of vision, kidney failure and stroke1Every year ~ 4 million deaths are attributable to diabetes1

    1. International Diabetes Federation. Did You Know? Mokdad AH et al. JAMA 2003; 289: 7679.

  • Type 2 diabetes: a global epidemicType 2 diabetes accounts for 8595% of diabetes cases

    0501001502002503003501985Global prevalence of diabetes (millions) > 380 million2000Year19901995200520102015202020252007 246 million1985 30 million2000 150 million

  • The UN Resolution on DiabetesUN Resolution 61/225 passed on 20 December 2006Diabetes 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): 58.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): 3846.

  • The 1st UN World Diabetes Day 400 global events.with 246 monuments litWorldwide media coverage

  • Diabetes is a public health challenge

  • Type 2 diabetes affects the most productiveAlmost half of diabetes deaths occur in people under the age of 70 yearsEconomic consequences of premature death may be severeSubstantial productivity is lost from diabetes, primarily from premature death KM et al. J Am Med Assoc 2003; 290:18841890.1 in 32 in 5Increased lifetime risk of developing diabetes for individuals born in 2000 (US)

    Men Women

  • Economic consequences of premature death due to diabetesPredicted lost income over next 10 years ($ bn)

  • The burden of premature mortality Estimated diabetes deaths and DALYs* lost among people aged 2079 years, by region, 2001Disease Control Priorities in Developing Countries, second edition, 2006.* Disability Adjusted Life Years

  • Diabetes: the total cost of careEstimated US costsYearCost per year (US$ billion)Indirect costsDirect costsDirect costs breakdown5Hospital inpatient careNursing/ residential careOutpatient careInsulin/ diabetic suppliesNon-diabetic prescriptions50%20%11%7%5%6%Anti-diabetic drugs1Huse DM, et al. JAMA 1989; 262:27082713. 2Ray NF, et al. Direct and indirect costs of diabetes in the United States in 1992. ADA; 1993. 3ADA. Diabetes Care 1998; 21:296309. 4ADA. Diabetes Care 2003; 26:917932. 5ADA. Diabetes Care 2008; 31:120.
  • Serious health risks from complicationsEvery 10 seconds a person dies from diabetes-related causes3 out of 5 have a serious complicationLargest cause of kidney failure in developed countriesLeading cause of vision loss in 2065 year olds in industrialised countriesPeople with type 2 diabetes:die 510 years before people without diabetes2x more likely to have heart attack or stroke than people without diabetes American Association of Clinical Endocrinologists. State of Diabetes Complications. 2007. Number of serious complications affecting people with type 2 diabetesFour or MoreComplications7.6%ThreeComplications6.7%TwoComplications10.3%One Complication33.3%No Complications42.1%

  • The major cost of diabetes lies in the management of avoidable complicationsAnnual healthcare costs with diabetes and complications 3x cost without diabetesTotal yearly expenditure with complications ~$10,000 per personAmerican Association of Clinical Endocrinologists. State of Diabetes Complications. 2007. $10,000$8,000$6,000$4,000$2,000$0$2,848$541$8,039$1,429$9,797$1,566Diabetes with DiabeticComplication RatesDiabetes with AverageComplication RatesNo Diabetes with Average Complication RatesAnnual Per-Capita Healthcare CostsTotal CostsOut-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; cost of diabetes care (International dollars, billions)20032025201520601008040$94.3 billion $1,609/patientNumber of Diabetes Patients in Europe = 12345Year

  • .Although, costs could be more than halved by 2025 if action is taken NOWAnnual cost of diabetes care (International dollars, billions)20032025201520601008040$94.3 billion $1,609/patient$38.9 billion $664/patientBased on data available at the International Diabetes Federation. E-Atlas. 2005. Menzin J, et al. Diabetes Care 2001;24:5155Saydah SH, et al. JAMA 2004; 291:335342.Liebl A, et al. Diabetologia 2002; 45:S23S28.Year

  • Improved blood glucose control = fewer complications = reduced costsPer-patient costs reduced by more than half in 3 years with better blood glucose controlSignificant cost reductionsMenzin J, et al. Diabetes Care 2001; 24: 5155.

  • The urgent need for unified policies

  • Governments must respond nowGovernments and healthcare systems can be better prepared E.g. only 12 out of 25 EU countries currently have a national diabetes frameworkIf the situation continues, governments will need to spend up to 13% of healthcare budgets on diabetes by 20251Effective action plans must be developed and implemented NOWPrevent costs spiralling and patients continuing to suffer devastating complications

  • The quest for the UN Resolution: Unite for DiabetesInternational Diabetes Federation campaignLargest ever diabetes coalitionPatient organisations from >150 countriesMost of worlds professional diabetes societies plus charities, service organisations, industryA partnership that generated international change

  • Together, we can achieve changeGovernment 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 CollaborativesUS public health partnership Pools healthcare resources at state, local and community levelDiabetes care and prevention programmes:improved trainingtechnical assistance with clinical care and patient educationlinks with other diabetes organisationsassisting with data collection and analysis

  • Developing unified policy initiatives: the European exampleFEND and IDF call for EU Council recommendation on diabetes and screeningFeb 2006April 2006June 2006July 2007 Written EU parliamentary declaration adopted by absolute majorityEU Health Councils Conclusions on Healthy Lifestyles and Prevention of Type 2 Diabetes urges states to develop national diabetes frameworksPortuguese EU presidencys Health Strategies in Europe meeting towards European Health StrategyFormal recommendations from Portuguese Presidency due June 2008National action plans in 14 states Need for unified policy initiatives

  • Local and national programmes: The Finnish examplePartnership between government and Finnish Diabetes AssociationScreening of at-risk patients; lifestyle counsellingObesity prevention in general populationQuality assurance of careStudy assessing cost-effectivenessAim to reduce CV complications by one-thirdNow serving as model for other countriesFirst EU state to roll out diabetes prevention strategy

  • Local and national programmes: Council of Australian Governments10-year reform planMultifaceted approach to primary preventionTargeting modifiable risk factorsImproving cost-effective early detection and interventionEnhanced healthcare $137 million from government of Victoria and $548 from Commonwealth Government over next 4 yearsDrawing on Finnish example: national hotline, website and risk assessment toolPlan to address the growing impact of obesity and type 2 diabetes

  • Despite reminders of A1C goal below 7%, physicians remain complacentGuidelines are not being implemented in everyday practice

  • Meeting the challenge by changing policy

    APPGD key recommendations

    Treat to HbA1c target of 6.5% Reward physicians for the number of patients achieving a 1% drop in HbA1cEncourage continued vigilance and better glycemic controlIncentives for GPs to educate patients All Party Group on DiabetesCurrent Qualities and Outcomes Framework Renegotiations and the Impact on Diabetes Care A Parliamentary Stakeholder Investigation. November 2007

  • Developing countries: World Diabetes FoundationLinks people and resourcesEducates and advocates globally for prevention and treatment of diabetes in developing countriesSupporting Sudanese project to improve capacity for diabetes care12-week training programmes for physicians; training diabetes educatorsRegional summit in Kenya to build support for similar projects and showcase successful examples

  • Rising to the challengeAlberti KGMM et al. Int J Clin Pract 2007; 61 (s157): efforts will enable improved, earlier and more intensive diabetes care


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