1.1 IDC

Global and National Burden of Diabetes

• Diabetes Mellitus: classification• New (WHO) Screening and Diagnostic Criteria

– Diabetes, Impaired Glucose Homeostasis, Impaired Fasting Glucose, Impaired Glucose Tolerance

• Epidemiological Perspectives – Measurement

– Worldwide incidence and prevalence

– National incidence and prevalence

• Perspectives on Cost

1.2 IDC

• Type 1 Diabetes (5-10%)– Juvenile Onset, IDDM, type I

– Auto-immune disease

– Pancreas is unable to produce insulin (beta-cell destruction)

– Generally diagnosed from birth to age 30, highest incidence between 12-18 years of age. Estimated to be present in 0.3% of the U.S. adult population (>30 years)*

• Type 2 Diabetes (90-95%)– Adult Onset, NIDDM, type II

– Deficiency in insulin secretion coupled with insulin resistance

– Disorder associated with obesity and the aging process

– Generally diagnosed after age 40, may be diagnosed as early as 5 years of age

Diabetes Mellitus - Classification

*Diabetes in America, 1995

1.3 IDC

• Gestational Diabetes Mellitus (5% of all births)– Also known as GDM -- hyperglycemia first diagnosed in pregnancy (not to be confused

with pre-gestational diabetes in which diabetes exists prior to pregnancy)

– Pancreas is unable to produce adequate insulin to overcome insulin resistance which is primarily due to three factors: human placental lactogen, genetic predisposition to insulin resistance, weight gain in pregnancy

– Generally diagnosed after age 25, may be diagnosed at any age of pregnancy

• Other Specific Types– Maturity-Onset Diabetes of the Young* (<1%)

– Pancreatic disease

– Drug

– etc.

Diabetes Mellitus - Classification (continued)

*Hattersley, Diabetic Med, 1998

1.4 IDC

• Slow Onset of Insulin Dependent Diabetes (SIDDM) or Latent Autoimmune Diabetes in Adults (LADA)*– antibodies to glutamic acid decarboxylase (anti-GAD) proposed as an

early differentiating marker of type 1 diabetes in those individuals for whom there is a question of whether they have type 1 or type 2 diabetes

– a correlation has been found between individuals originally classified as type 2 requiring insulin and anti-GAD

– possible early test to identify those with type 2 diabetes who will eventually require insulin

Diabetes Mellitus - Classification (continued)

*Zimmet, Diabetes Care, 1999

1.5 IDC

Overview of Type 2: Screening and DiagnosisOverview of Type 2: Screening and Diagnosis

FPG < 110 mg/dL (6.1 mmol/L)CPG< 140 mg/dL (7.8 mmol/L)

FPG < 110 mg/dL (6.1 mmol/L)CPG< 140 mg/dL (7.8 mmol/L)

Fasting Plasma Glucose (FPG) orCasual Plasma Glucose (CPG)

Fasting Plasma Glucose (FPG) orCasual Plasma Glucose (CPG)

Patient w. Risk Factors and/or Symptoms of Diabetes

Patient w. Risk Factors and/or Symptoms of Diabetes

No Diabetes No Diabetes

FPG > 126 mg/dL (7.0 mmol/L)CPG> 200 mg/dL (11.1 mmol/L)

FPG > 126 mg/dL (7.0 mmol/L)CPG> 200 mg/dL (11.1 mmol/L)

FPG 110-125 mg/dL (6.1 - 6.9 mmol/L)CPG 140-199 mg/dL (7.8 - 11.0 mmol/L)

FPG 110-125 mg/dL (6.1 - 6.9 mmol/L)CPG 140-199 mg/dL (7.8 - 11.0 mmol/L)

If only FPG criteria then: Impaired Fasting Glucose

If CPG criteria then:Impaired Glucose

Homeostasis

If only FPG criteria then: Impaired Fasting Glucose

If CPG criteria then:Impaired Glucose

Homeostasis

Repeat FPG within 7 daysRepeat FPG within 7 days

Diagnosis of Diabetes if FPG > 126 mg/dL (7.0 mmol/L) Type 1 or Type 2 Diabetes dependent upon age and ketones

Diagnosis of Diabetes if FPG > 126 mg/dL (7.0 mmol/L) Type 1 or Type 2 Diabetes dependent upon age and ketones

May screen using capillary blood: FCG>110 mg/dL (6.1 mmol/L) or CCG>160 mg/dL (8.9 mmol/L) then proceed to diagnostic test

May screen using capillary blood: FCG>110 mg/dL (6.1 mmol/L) or CCG>160 mg/dL (8.9 mmol/L) then proceed to diagnostic test

1.6 IDC

Risk Factors for Diabetes

• Obesity• Asian: 120% DBW or BMI 24 kg/m2

• Western: 120% DBW or BMI 27 kg/m2

• Family history (1st degree relative with diabetes)*• High risk ethnicity (any indigenous peoples)• Previous GDM or baby > 9 pounds (4000 g)• Hypertension (BP > 140/90 mm Hg)• HDL < 35 mg/dL, TG > 250 mg/dL• Previous IGT or IFG = Impaired Glucose Homeostasis

*Rich, Diabetes 1990

1.7 IDC

• More than 135 million people worldwide had diabetes in 1995 (4.0%)

• 300 million people are expected to have the disease by 2025 (5.4%)42% increase in developed countries170% increase in developing countries

• Urban dwellers more likely to have the disease than rural inhabitants

Global Epidemic Of Diabetes

*King, et. al., Diabetes Care, 1998

1.8 IDC

The Burden of Diabetes in Thailand

• Population of Thailand is approximately 62 million

• 1.4 million people have diabetes– 46,000 have Type 1 diabetes

– 1.4 million have Type 2 diabetes

• Prevalence: 1.4 million / 62 million in 1999 (2.3%)

• Fair access to diabetes medications

Source: A National Health Interview a ndExaminationSurvey1 9 9 1

1.9 IDC

Add Thai Epidemiology

1.10 IDC

Cost of Diabetes Care : Worldwide and the US (in billions dollars)

30230430630830

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