rotarians and diabetes prevention developing healthy communities: part 1 rag on diabetes
DESCRIPTION
he Rotarian Action Group for Diabetes is working to stop the global epidemic of the disease. Come learn how Rotarians can lead communities to better health and prevent children dying from lack of insulin. Learn about model programs of prevention and service that your club can institute to improve health in your own community. Co-moderators: C. Wayne Edwards, Past District Governor Rotary Club of Tallahassee, Florida, USA Larry C. Deeb, Member, The Rotary Foundation Cadre of Technical Advisers Rotary Club of Tallahassee, Florida, USATRANSCRIPT
2014 ROTARY INTERNATIONAL CONVENTION
Rotarian Action Group on Diabetes
2014 ROTARY INTERNATIONAL CONVENTION
Diabetes Overview
Prof Martin SilinkRotary Club of Lane Cove
University of Sydney
Diabetes Atlas 2013
Type 1 children 500,000Type 2 adults 382,000,000>7 million more each year 4,000,000 Deaths per year
1,000,000 Amputations per yearLeading cause of adult blindness
Leading cause of adult kidney failure80% in developing world
Prevalence estimates for 2013
The Size of the Problem
Diabetes in Australia – the epidemic grows
A touch of sugar can’t be too serious ?
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Does Mild Diabetes exist?
Burden of disease in Australia
DALY’s(Disability Adjusted Life Years)
Number of years lost due to ill-health, or early death
Not all cells are equally damaged by high glucose levels
Most cells are able to maintain a relatively normal internal glucose level despite elevated blood glucose
Four organs are not effective in doing this:
Retina NervesKidney Large arteries
Retinopathy Neuropathy Nephropathy
Key Concepts in Chronic Complications
Atherosclerosis
FinnDiane Study of Mortality and Nephropathy
Groop PH et al Diabetes 2009;58:1651-1658
4201 people with T1DFinland major clinicsMean Ages 36-42Diabetes 20-32 years
SMR 2.8
SMR 0.8
SMR 9.2
GLUCOSE + SUPEROXIDE Reactive oxygen species
Damage is caused by:
Prevention of Chronic Complications
Major Trials proving Glucose control matters
Type 1 diabetes• DCCT 1983-1993• Post DCCT/EDIC 1993+
Type 2 diabetes• UKPDS 1978-1998
• Kumamoto 1992-2000
Key Concepts in Chronic Complications
Key Results of DCCT:
1441 patients with T1D, aged 13-39 years Half treated intensively to maintain HbA1c 7.2%Half treated conventionally maintained HbA1c 9.2%
Intensive treatment reduced: • eye disease by 76% • kidney disease by 50% • nerve disease by 60%
Diabetes Control and Complications Trial Results
Trials provedGlucose Control Matters
Key Concepts in Chronic Complications
Modern-Day Clinical Course of Type 1 Diabetes Mellitus After 30 Years’ DurationThe Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications and Pittsburgh Epidemiology of Diabetes Complications Experience (1983-2005) D Nathan et al, and Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group* Arch Intern Med. 2009 July 27; 169(14): 1307–1316. doi: 10.1001/archinternmed .2009.193
Retinopathy
Nephropathy
Cardiovascular Disease
Cumulative incidences after 30 years of diabetes:
CT ITRetinopathy 50% 21%Nephropathy 25% 9%Cardiovascular disease 14% 9%
<1% became blind, required kidney replacement, or had an amputation
DCCT/EDIC Study after 30 Years
Trials proved
Metabolic Memory
Period of good control has longterm benefits
Key Concepts in Chronic Complications
Preventing the Diabetes Burden
PrimaryPrevention
SecondaryPrevention
TertiaryPrevention
Life Expectancy
in T1D and T2D
Glucose monitoring
LifestyleNo smoking
Physical activity
BP control
Lipid Control
Improvingsocial determinants
of healthAccess to care
Self empowerment
Intensive therapy
Diabetes education
Strategies to Improve Life Expectancy in Diabetes
Complications screening
Aspirin
Early diagnosis
What can Rotary do?
SUPPORT:InsulinGlucose monitoringDiabetes educationTraining of health professionalsComplication screeningFoot careEye careBP control
ADVOCATE:Healthy citiesHealthy schoolsHealthy workHealthy foods
PROMOTE:Healthy weightHealthy eatingHealthy activity
What can Rotary do?
LFAC
Be the voice of the community for healthy living
Please join the Rotarian Action Group on Diabetes
RAGD
Thank you
RAGD