1. Are we ready for the Diabetes tsunami?
Dr Nancy Ngugi
Consultant Physician , Endocrinologist

2. Diabetes Mellitus
Diabetes is a chronic metabolic condition characterized by hyperglycemia, that occurs as a result of lack of insulin or insulin sensitivity.

3. Types of Diabetes Mellitus (DM)
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)

4. Predisposing factors to type 2 DM
Physical inactivity
Obesity
Unhealthy diet
Increasing age
Family history of diabetes
Ethnicity
Poor nutrition during pregnancy affecting the developing child

5. excessive hunger and thirst symptoms of peripheral neuropathy
Symptoms of Diabetes
Type 2 diabetes is often without symptoms in its early stages. That’s the reason there are 50% of people with Type 2 diabetes are unaware of their disease.
feeling tired and weak
Polyuria, nocturia
recurrent infections
blurred vision
weight-loss
excessive hunger and thirst
symptoms of peripheral neuropathy
slow healing wounds

6. Diagnosis Diabetes: -RBS >11.1 mmol/ l -FBS > 7.0 mmol/l
-HbA1c >6.5%
If the RBS is > 5.6 mmol/l and < 11.1 then do the FBS or OGTT
OGTT- 75 g CHO in 250mls of water

7. OGTT Interpretation FBS (Mmol/l) 2 hrs post prandial (mmol/l) Normal
<6.1
<7.8
IFG
IGT
Diabetes
>7.0
>11.1

8. Diabetes: Complications
Macrovascular
Microvascular
Stroke
Diabetic eye disease
(retinopathy and cataracts)
Heart disease and hypertension
2-4 X increased risk
Renal disease
Peripheral
vascular disease
Erectile Dysfunction
The risk of CAD and stroke is increased two to four times in patients with diabetes. Cardiovascular disease is a major cause of morbidity and mortality in diabetes. Morbidity and mortality rates are two to four times higher than in age- and sex-matched groups in the population without diabetes.
The eye and the kidney are common sites for microvascular complications of diabetes. Diabetic retinopathy is the leading cause of adult blindness in North America. Cataracts and glaucoma are also significantly more frequent in patients with diabetes, especially those over age 65. Diabetes is the leading cause of end-stage renal failure.
Foot problems, a frequent consequence of neuropathy and peripheral vascular disease, constitute a major complication. Diabetes is the leading cause of non-traumatic lower-extremity amputations in North America.
Peripheral Neuropathy
Foot problems
Meltzer et al. CMAJ 1998;20(Suppl 8):S1-S29.

9. Management
The primary treatment for type 2 diabetes is exercise and diet.
The aim of pharmacological management is to reduce the risks of complications from diabetes through;
Glycemic control:
Insulins
Oral agents
BP control
Cholesterol control
Aspirin
Smoking cessation
Moderate alcohol intake

10. Prevention   
Screening for type 2 diabetes and people with no symptoms is recommended for:
Overweight children who have other risk factors for diabetes, starting at age 10 and repeating every 2 years
Overweight adults (BMI greater than 25) who have other risk factors
Adults over 45, repeated every 3 years
Those with a history of gestational diabetes
Maintain a healthy body weight and keep an active lifestyle to help prevent type 2 diabetes.

11. Add title to this slide.

12. Diabetes is an increasing healthcare epidemic throughout the world
52.6
64.0
+22%
37.7
51.2
+36%
Africa
Eastern Mediterranean and Middle East
131.9
187.9
+42%
Europe
32.8
59.7
+83%
North America
South and Central America
The IDF found that, as a global phenomenon, the prevalence of diabetes is predicted to increase from 246 million in 2007 to 380 million by 2025, an increase of 55%.1 T2DM alone has reached epidemic proportions and affects approximately 5.9% of adults worldwide. The prevalence is increasing steadily and is expected to affect 7.1% of adults by the year In particular, the increase in T2DM is seen among younger people and in developing countries. Indeed, a disproportionate number of diabetic patients live in the Asia-Pacific region; approximately 81 million people with diabetes live in India and China compared with 19 million in the USA.1
In summary, these data provide an updated quantification of the current and growing public health burden of diabetes across the world. The human and economic costs of this epidemic have severe implications for healthcare resource use.
Reference
International Diabetes Federation. Diabetes Atlas 3rd Edition (2006): Page 5
71.4
120.9
+69%
South-East Asia
14.7
28.0
+90%
Western Pacific
25.1
39.9
+59%
Worldwide:
366 million people in 2011
552 million projected for % increase
IDF. Diabetes Atlas 5rd Edition – 2011

13. Global situation
Type 2 DM is increasing in every country
80% of people with DM live in low and middle income countries
Most people with DM are between 40 to 59 years of age
183 million people (50%) with DM are undiagnosed
DM caused 4.6 million deaths in 2011
78,000 children develop type 1 diabetes every year
280 million people with IGT in 2011, will increase to 398 million in 2030

14. Situation in Kenya Prevalence of diabetes Prevalence of IGT/IFG
2.7% in rural areas
10.7% in urban areas
Prevalence of IGT/IFG
8.8 % in rural areas
14.4 % in urban areas
53% of all hospital admissions are due to Non Communicable Diseases of which 28% due to Diabetes
Increasing cases of childhood diabetes
Increasing cases of gestational Diabetes

15. Situation in KNH Adult diabetic clinic attendance in 2011 (Jan- Dec)
new pts revisits
Main clinic (Fri)
Mini clinic ( Mon-Fri)
Pead diabetic/ endo
(Tue clinic)

16. What are we doing as the diabetes fraternity in Kenya?
Kenya national diabetes strategy
National clinical guidelines for management of diabetes
National diabetes educators manual
Diabetes comprehensive care manual
Diabetes prevention and management: A guide for community health workers
Kenya Diabetes Study group (KDSG)- Diabetes Manual

17. Diabetes Projects
MoMS and MoPHS in conjunction with DMI (NGO) with funding from WDF
-diabetes education and awareness project ( )
-diabetes comprehensive care project-DCC ( )
-mobile foot clinic project-MFC ( )
-changing diabetes in children-CDIC ( )
National diabetes registers
National insulin registers
Rockefeller foundation- DMI - diabetes awareness and screening project
Others projects by CDC, APHRC, Diabetes Kenya.

18. Diabetes programs
Diabetes medical camps –by Safaricom-DMI, Diabetes Kenya, Pharmaceuticals companies , hospitals
Diabetes children's camps-Safaricom, Johnson and Johnson
Diabetes training-Diabetes Kenya, Handicap international
Patient support groups
Diabetes educators programs
Nutrition-diabetes programs
Diabetes education through audio, radio and print
SMS web portal diabetes support programs-Tuzungumzie kisukari (DMI-WDF) English - SMS “subscribe” to , Swahili “jisajili” to

19. What are we doing in KNH?
The diabetes fraternity has invested a lot in setting up structures for the national diabetes care centers country wide
Over 70 diabetes comprehensive care centers (provincial, district and sub district hospitals
UoN and KNH diabetologists have improved the curriculum in diabetes medical training
Diabetes education training programs, diabetic foot training, diabetes awareness and screening- world diabetes day (14th November)
Diabetes and Endocrinology center

20. Thank You