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 PresentationTRANSCRIPT
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 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
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 HbA1c• Encourage continued vigilance and better
glycemic control• Incentives for GPs to educate patients
UK All-Party Parliamentary Group on Diabetes calls for tougher targets to reduce the risk of complications
“Current treatment
targets leave diabetes
patients at risk”
All Party Group on Diabetes
Current Qualities and Outcomes Framework Renegotiations and the Impact on Diabetes Care
A Parliamentary Stakeholder Investigation. November 2007
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