The new international Diabetes Federation IDF definition

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• The new international Diabetes Federation (IDF)
  definition
• According to the new IDF definition , for a
  person to be defined as having the metabolic
  syndrome he/she must have
• Central Obesity ( defined as waist circumference
  with ethnicity specific values )
• plus any two of the following four factors

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Diabetes Mellitus and its state of control
and complications in the MENA Region
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• Fasting Hyperglycemia
• - Controlled (lt 120 mg/dl )
  19.8
• - Uncontrolled
  80.2
• ----------------------------------
• Hyperglycemic 121-150 mg/dl 15.6
• Marked hyperglycemia -200 31.3
• Severe hyperglycemia -220 12.5
• Very severe hyperglycemia gt 220 20.8

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Hyperglycemia Fasting
120 mg/dl
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• Post Prandial Hyperglycemia
• - Controlled lt 160 mg/dl 13.5
• - Accepted 161-180 mg/dl 7.9
  Total
  21.4
• - Uncontrolled ( gt180 mg/dl ) 78.6
• Moderate -220 mg/dl 17.4
• Severe - 260 mg/dl 16.0
• Very Severe gt 260 mg/dl 45.2

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Hyperglycemia
180 mg/dl
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Diastolic Blood Pressure
80 mm Hg
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Systolic Blood Pressure
0.50
130 mm Hg
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Lipid Control Serum Cholesterol
200 mg
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Lipid ControlSerum Triglycerides
150 mg
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Obesity as a Risk Factor for Hyperglycemia ,
Hypertension and Hyperlipidemia
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Cardiac Complications
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Retinopathy (in 1173 patients ) - Free
68.9 - Back ground 22.6
- Proliferative 9.5
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Retinopathy in correlation with Duration of DM
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l
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Frequency of Foot Complications
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• Prevalence of foot complications
• 1- Fungus infection
  22.0
• 2- Foot ulcers
  6.8
• 3- Evident Ischaemic changes 9.7
• 4- Amputations
  3.0
• 5- Deformities
  1.0

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Diabetes Keto Acidosis (DKA)-
Occurrence of DKA episodes in 12.2
.----------------------------------------------
----------------------- The mean age in
patients who developed DKA

42.5 years- The mean age in patients who never
developed DKA

53.1 years
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Hypoglycemia- Occurrence of
Hypoglycemic episodes in 20.5--------------
--------------------------------------------------
-------- - The mean age of patients who
developed hypoglycemic episodes at any time
50.8 years- The mean age of patients who
did not experience hypoglyceamic
episodes 52.1 years
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Fertility and Abortions
Abortions 21.5 Fertility 3.6 ch/m
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• The Socio economic Burden

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Middle East Countries- economic statusper
capitum incomes

• High
• Kuwait
• Emirates
• Qatar
• Bahrain
• Oman
• Saudi Arabia
• Libya

• Low
• Syria
• Jordan
• Tunisia
• Morocco
• Egypt
• Yemen
• Sudan

Middle (Iraq) Iran
gt5,000 US



lt 2,000 US
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MENA Countries according to The Mean Health
Expenditure per person with diabetes in ID
(international Dollar) Diabetes Atlas, 3rd Ed.
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Hospital Treatment 2001 Cost /Day
(Egyptian Study )
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Distribution of Hospital Cost
45 Basic ( Food 5 H.C.Team 11 Others 29)
55 Medicine Supp.
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Year Cost / percapit. Burden for Human Insulin
(40 u /d)
8.85
EGYPT
1.9
3.1
SAUDI ARABIA
QATAR
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Cost Burden of Oral Treatment related to
Percapitum
4.2
29.9
EGYPT
QATAR
8.4
SAUDI ARABIA
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What are The IDF Goals ?

• 1. Global Advocacy
• 2. To raise Global Awareness
• 3. Promote appropriate Diabetes Care
  Prevention
• 4. Encourage finding a Cure

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For improving Diabetes Care
and Prevention , Education of
Health Care Providers should
consider expertise in both
I- Clinical Diabetes , and
II- Educations skills
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The Way to a National Diabetes Program
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Minimal requirements 1- Insulin and
medications availability ( affordable) 2-
Primary centers for diagnosis and care 3-
wide distribution of services allover the
country 4- Basic requirements to manage
complications 5- Education knowledge
skills to patients Public
orientation 6- National basic studies in
epidemiology and
socioeconomics . 7- Care for Diabetes in
School children 8- Care for diabetes in
pregnancy
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Potential Adverse Factors 1- Economic
Poor Financial Res. /per capit. /
Government expenditure/ House-hold
expend. with High Prev. of diab. 2-
Demographic Extensive areas with poor
communications . High population density
3- Social Illiteracy- Misconceptions
adverse habits and
traditions .

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WHO
IDF
Government
National Institute
Parliament
Syndicate
NGO
Ministry of Health
Physician Nurse Dietitian Foot
Care Pharmacist Laboratory
Medical Group
Family
Patient
Work- school Friends
Pharmaceutical industries
Society
MEDIA
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In Developing a National Diabetes Programme
1- Consider the specific needs in the country
and available resources to decide priorities
2 - Define the role to be played by each one
of the constituents of the community ,
and Identify Champions for projects .3-
Seek partnerships with WHO , Twining
,WDF , Rotary , etc..
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Obligations of Different Parties The
Government ( Ministry of Health) 1- Increase
Investments in Health/Diabetes 2- provide
Minimal Diabetes Care in Clinics Hospitals
3- Insure Insulin Medications Availability
4- provide Education Patient, Health Care Team
and Public 5- Coordinate with Health Care
Syndicates 6- Coordinate with NGOs 7-
attract International Aid programmes 8-
promote National Research ( epidemiol.-socioecono
mic)
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Parliament (Legislation) 1-
Budget planning to improve diabetes Care 2-
Taxation Exemption for insulin medical
requirements 3- Put rules and regulations for
NGO activities 4- Maintain and guard
Patients Human Rights ( anti
discrimination, working , children, women ,
elderly etc) 5- Health Insurance
Laws
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The Non-Governmental Organizations
(NGOs ) 1- Advocacy 2-
Education Programs for
-Patients and Families
-Health Care Team -Community
at large 3 - Rules Regulations
- legally recognized - non
profitable - accountable and
transparent - coordinated
complementary to government -
no unhealthy competition, extravagance ,
business controlled ( by industries
)
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The Health Care TeamThe Physician
1- is Leader of the HC team 2- is the
Final reference for his patients education
3- keep harmony with others in the HC team
4- requires continuous training courses and
updates 5- acquire education skills
Nurses 1- Training courses , by whom ?
2- Knowledge skills attitude 3- skills
in education 4- keep Team work 5-
Continuous education , scientific meetings and
workshops
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Diabetes Care for Special Groups
School Children - Registration at national
level - Individual records in schools
- basic equipments to manage emergencies
- Education courses to school attendants.
- protecting special rights play-
recreation - treatment .non
discrimination etc
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Mothers with Diabetes of Pregnancy -
Screening for diabetes of pregnancy -
Protocols for management of GD - Care for
the N.B. - After-labour follow-up of
mothers
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The National Diabetes Registry - essential
as source of information for planning public
services - Central
location - paper or computer recordings
- contains individual patient data -
complemented by local peripheral registries
(in schools - work Health insurance,
etc ) - network connections for exchange
information
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Diabetes Screening Programmes - Specifically to
high risk groups - By central
planning and organization
- ensure unified criteria for diagnosis
- Screening for early detection of
complications - Sending
study groups to remote areas .
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International RelationsThe International
Diabetes Federation 1- get moral support from
IDF to National Associations programs
2- use as source of information educational
material 3- Benefit from IDF Task forces
activities and
programs 4- Benefit from WDD events
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The WHO1- Government /
collaborative programmes for promotion of
diabetes Care2- NGO collaboration in
promoting diabetes care through training
education programmes
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The Patient Obligations 1- Take active role
seek to be educated 2- follow proper life
style 3- comply 4- not to accept
misconceptions and deceptive propaganda
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Thank You
Bibliotheca Alexandrina on WDD