1. 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

2. Diabetes Currently affects 246 million people worldwide and 380 million cases predicted by 2025 1 7 million new cases each year 1 Increase in diabetes is linked to the obesity epidemic 2 Diabetes can cause serious complications, including loss of vision, kidney failure and stroke 1 Every year ~ 4 million deaths are attributable to diabetes 1 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.

3. 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 Global prevalence of diabetes (millions) http://www.idf.org/home/index.cfm?node=264 400 2025 > 380 million 2000 Year 1990199520052010201520202025 2007 246 million 1985 30 million 2000 150 million

4. 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 Silink Silink 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.

5. The 1st UN World Diabetes Day http://www.worlddiabetesday.org/ Over 400 global events….with 246 monuments lit Worldwide media coverage

6. Diabetes is a public health challenge

7. 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) MenWomen

8. Economic consequences of premature death due to diabetes Predicted lost income over next 10 years ($ bn) Brazil Russia India China www.idf.org/home/index.cfm?node=41 Accounting for disability might double or triple these figures

9. The burden of premature mortality RegionDALYs (thousands) Developing countries15,804 East Asia and the Pacific4,930 East Europe and Central Asia1,375 Latin America and the Caribbean2,775 Middle East and North Africa843 South Asia4,433 Sub-Saharan Africa1,448 Developed countries4,192 World19,996 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

10. Estimated US costs Year Cost per year (US$ billion) Indirect costs Direct costs Direct costs breakdown 5 Hospital inpatient care Nursing/ residential care Outpatient care Insulin/ diabetic supplies Non-diabetic prescriptions 50% 20% 11%7% 5% 6% Anti-diabetic drugs 1 Huse DM, et al. JAMA 1989; 262:2708–2713. 2 Ray NF, et al. Direct and indirect costs of diabetes in the United States in 1992. ADA; 1993. 3 ADA. Diabetes Care 1998; 21:296–309. 4 ADA. Diabetes Care 2003; 26:917–932. 5 ADA. Diabetes Care 2008; 31:1–20. Diabetes: the total cost of care 0 20 40 60 80 100 120 1986 1 1992 2 1997 3 $98 $92 $20 2002 4 $132 140 2007 5 $174 160 180 <1% Other supplies

11. 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 More Complications 7.6% Three Complications 6.7% Two Complications 10.3% One Complication 33.3% No Complications 42.1%

12. 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 Diabetic Complication Rates Diabetes with Average Complication Rates No Diabetes with Average Complication Rates Annual Per-Capita Healthcare Costs Total Costs Out-of-Pocket Costs

13. 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/ Annual cost of diabetes care (International dollars, billions) 200320252015 20 60 100 80 40 $94.3 billion $1,609/patient Number of Diabetes Patients in Europe = 3719,, 148420 12345 Year

14. ….Although, costs could be more than halved by 2025 if action is taken NOW Annual cost of diabetes care (International dollars, billions) 200320252015 20 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;24:51–55 Saydah SH, et al. JAMA 2004; 291:335–342. Liebl A, et al. Diabetologia 2002; 45:S23–S28. Year

15. Improved blood glucose control = fewer complications = reduced costs Per-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-patient costs (US$) –69% –68% Menzin J, et al. Diabetes Care 2001; 24: 51–55.

16. The urgent need for unified policies

17. 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 2025 1 Effective action plans must be developed and implemented NOW –Prevent costs spiralling and patients continuing to suffer devastating complications 1 www.eatlas.idf.org/

18. The quest for the UN Resolution: Unite for Diabetes International Diabetes Federation campaign Largest ever diabetes coalition Patient organisations from >150 countries Most of worlds professional diabetes societies plus charities, service organisations, industry A partnership that generated international change

19. 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

20. We can improve diabetes care and improve outcomes

21. 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

22. 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 Councils Conclusions on Healthy Lifestyles and Prevention of Type 2 Diabetes urges states to develop national diabetes frameworks Portuguese EU presidencys 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

23. 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

24. 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

25. Despite reminders of A1C goal below 7%, physicians remain complacent Guidelines are not being implemented in everyday practice

26. 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

27. 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

28. 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