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Diabetes: Global Perspective. David L. Horwitz, M.D., Ph.D. Chief Medical Officer Johnson & Johnson Diabetes Institute. World Burden of Diabetes. Putting the problem in perspective…. World population: 6,600,000,000 Population with diabetes 246,000,000
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Diabetes: Global Perspective David L. Horwitz, M.D., Ph.D. Chief Medical Officer Johnson & Johnson Diabetes Institute
Putting the problem in perspective… World population: 6,600,000,000 Population with diabetes 246,000,000 Population with HIV/AIDS 33,000,000 Eight times the number of people with HIV/AIDS Projected to increase to 380,000,000 by 2025!
United Nations Resolution 61/225:World Diabetes Day On 20 December 2006, the United Nations General Assembly passed Resolution 61/225.This landmark Resolution recognizes diabetes as a chronic, debilitating and costly diseaseassociated with major complications that pose severe risks for families, countries and theentire world. It designates 14 November, the current World Diabetes Day, as a United NationsDay to be observed every year beginning in 2007. Governments have acknowledged that diabetes is increasing at epidemic rates and isaffecting all countries. For the first time, a non-infectious disease has been seen as posing asserious a global health threat as infectious epidemics such as HIV/AIDS.
Did you know? • Diabetes currently affects 246 million people worldwide and is expected to affect 380 million by 2025. • In 2007, the five countries with the largest numbers of people with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million). • In 2007, the five countries with the highest diabetes prevalence in the adult population are Nauru (30.7%), United Arab Emirates (19.5%), Saudi Arabia (16.7%), Bahrain(15.2%), and Kuwait (14.4%). • By 2025, the largest increases in diabetes prevalence will take place in developing countries. Source: IDF
Did you know? • Diabetes is expected to cause 3.8 million deaths worldwide in 2007, about 6% of total global mortality, about the same as HIV/AIDS. Using World Health Organization (WHO) figures on years of life lost per person dying of diabetes, this translates into more than 25 million years of life lost each year. • The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23 million years of life are lost to the disability and to reduced quality of life caused by the preventable complications of diabetes. • People living with diabetes and their families feel the impact of diabetes most directly. They feel the often crushing expenses of diabetes treatments as costs are not subsidized, and family income is frequently reduced when diabetes interferes with work. Sources: Diabetes Atlas, third edition, International Diabetes Federation, 2007.Diabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001. World Health Organization Diabetes Unit
Did you know? • People with diabetes face the near certainty, in many countries the stark reality, of premature death. • Type 1 diabetes is particularly costly in terms of mortality in poor countries, where many children die because access to life-saving insulin is not subsidized by governments (who instead tax it heavily), and is often not available at any price. • Studies recently carried out in Zambia, Mali and Mozambique highlight a stark reality: a person requiring insulin for survival in Zambia will live an average of 11 years; a person in Mali can expect to live for 30 months; in Mozambique a person requiring insulin will be dead within 12 months. • In the poorest countries, people with diabetes and their families bear almost the entire cost of whatever medical care they can afford. • In Latin America, families pay 40-60% of diabetes care costs out of their own pockets. • In India, for example, the poorest people with diabetes spend an average of 25% of their income on private care. Most of this money is used to stay alive by avoiding fatally high blood sugar levels. Sources: Diabetes Atlas, third edition, International Diabetes Federation, 2007.Diabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001. World Health Organization Diabetes Unit
Did you know? • Type 1 diabetes, which predominately affects youth, is rising alarmingly worldwide, at a rate of 3% per year. • Some 70,000 children aged 14 and under develop type 1 diabetes annually. • An increasing number of children are developing type 2 diabetes, in both developed and developing nations. • Type 2 diabetes has been reported in children as young as eight. • Reports reveal the existence of type 2 diabetes in child populations previously thought not to be at risk. • In Japan, the prevalence of type 2 diabetes among junior high school children has doubled from 7.3 per 100,000 in 1976-80 to 13.9 per 100,000 in 1991-95, with type 2 diabetes now outnumbering type 1 diabetes in that country. References: All epidemiologic data are drawn from the Diabetes Atlas, third edition
News of the Week • At least 25 states have enacted or proposed cuts in health insurance for the poor. • 12 states have also targeted the State Children’s Health Insurance Program. • $87 billion in stimulus funds will boost Medicaid programs, but may not be enough to stave off cuts as job losses swell Medicaid rolls. • Fewer clinics and doctors offices are accepting Medicaid patients. Wall Street Journal 1/28/09
What are the solutions? • Improved awareness of diabetes (health literacy) • Expanded access to care • Affordability of care • Knowledge of how to provide the best,most cost-effective care These require government or private resources and an adequate number of health care providers
Providers of Diabetes Education Source: Diabetes Atlas 2nd Ed.
Means to Overcome Barriers to Patient Education Source: Diabetes Atlas 2nd Ed.
DIABETES CARE BAROMETER • Assessment of issues and needs of Healthcare Professionals treating diabetes patients at a community level • Telephone survey of over 250 Healthcare Professionals • During January-February 2008 • Commissioned by the Johnson & Johnson Diabetes Institute, LLC • Conducted by Penn, Schoen and Berland, Inc. • Designed to identify the obstacles contributing to poor diabetes outcomes
KEY FINDINGHealthcare Professionals Worry About Impact of Low Health Literacy Healthcare Professionals are increasingly worried about low health literacy as it relates to daily self-care • 82% say low health literacy is challenge, especially when treating medically underserved • 54% cite lack of culturally sensitive materials as barrier to counseling underserved patients • 52% identify limited English language proficiency among many patients as growing problem • 43% cite difficulties with lack of trust
KEY FINDINGImmediate Need for More Professional Education and Skills Training in Diabetes Management A key priority for Healthcare Professionals is having up-to-date information and skills training to improve patient outcomes • 80% agree most practitioners don’t get enough specialized training in diabetes management • 95% want better tools to help them communicate with diabetes patients • 90% say curriculum in diabetes management is needed for Healthcare Professionals
Diabetes Institute Principles • Chronic care model vs. acute care model • Patient centric • Focus on health literacy • Accelerate translation of science and technology into the community • Platform for wide variety of offerings • Dedicated educational facility • Robust web-based presence • Active alumni interaction • Extended training offerings • Local, local, local: leadership, needs assessment, curriculum design, faculty, attendees: relevant to the community environment • Dynamic curriculum design and update
The Institute • Training Centers • Silicon Valley, US • Tokyo, Japan • Paris, France • Beijing, China • Training Satellites • Curriculum Exports • Virtual Presence and Outreach • E-community for alumni and instructors • Web based training programs
Many types of organizations need to come together to improve the situation Pharma / biotech companies Device / diagnostics companies Payors (Employers, government, individuals, health plans) Global dialogue to benefit patients Policy makers / government Advocacy groups Health care professionals Patients/ Community Groups
