1. Diabetes and How it Is Affecting Regional and Global Health with a Focus on Myanmar Lions Clubs International IAG Mission Myanmar, 2013 Part I 1

2. What is Diabetes? Diabetes mellitus is a condition that occurs when the body can't use glucose (a type of sugar) normally. Glucose is the main source of energy for the body's cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells. In diabetes, the pancreas does not make enough insulin (type 1 diabetes) or the body can't respond normally to the insulin that is made (type 2 diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss to mention a few.type 1 diabetestype 2 diabetes 2

3. Diabetes Association Diabetes and Outreach Pilot Outreach Pilot Program Diabetes is a Global Problem: IDF estimates 366.2 million people worldwide have diabetes. Projected to increase to 551.8 million by 2030 or 9.9% of adults, which equates to approximately three more people with diabetes every 10 seconds. The number of people with diabetes is increasing in every country and disproportionately affects the socially disadvantaged. In 2004, an estimated 3.4 million people died from consequences of high blood sugar. More than 80% of diabetes deaths occur in low and middle income countries. Health systems in many of these developing countries are not equipped to meet the rising demand. 3

4. Diabetes is a Global Problem Cont.: Diabetes has become one of the major causes of premature illness and death in many countries and a leading cause of blindness, amputation and kidney failure. IDF estimates that half of people with diabetes are undiagnosed. WHO projects that diabetes deaths will increase by two thirds between 2008 and 2030. 4.8 million people died and more than $471 B USA spent on healthcare for diabetes in 2012. Healthy diet, regular physical activity, maintaining a normal body weight, avoiding tobacco use and excess use of alcohol can prevent or delay the onset of type 2 diabetes 4

5. Education is essential: “ Access to essential education for everyone is the key to prevention and control of diabetes. In order to reduce the impact of diabetes, basic knowledge on the prevention and optimal management of diabetes must reach those with diabetes, those at risk from the disease, our healthcare provides and policy makers.” Dr. Samlee Plianbangchang-Regional Director SEARO, November 14, 2012 5

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7. In the WHO South East Asia Region, there are an estimated 81 million living with diabetes. Prevalence of diabetes varies between 6% to 16% among adults across countries in the Region. What is of concern in the Region, is that an estimated 33% to 50% of diabetes goes undiagnosed. Delays in diagnosis result in patients developing complications and poor outcomes, resulting in premature mortality. Dr. Samlee Plianbangchang-WHO Regional Director, SEARO November 14, 2012 Diabetes in the WHO South East Asia Region: 7

8. Estimated proportion of deaths by cause, South-East Asia Region, 2008 Total number of deaths in the Region=14.5 million (Source: WHO global Health observatory 2011 http://apps.who.int/ghodata/ )http://apps.who.int/ghodata/ 8

9. Percentage of Non Communicable Disease (NCD) deaths in population aged <60 years by cause, 2008 -NCDs claim younger lives in South-East Asia Region compared to rest of the world (Source: WHO Global Health Observatory 2011 http://apps.who.int/ghodata/ )http://apps.who.int/ghodata/ 9

10. Estimated attributable number of deaths by risk factor, South-East Asia Region, 2004 High blood pressure, high blood glucose and tobacco use are the top ranking risk factors for mortality in the Region (Source: Global Health Risk 2009, WHO) 10

11. Prevalence of Smoking-South East Asia Region 2008 (Source: WHO Global Status Report on Non-communicable Diseases, 2010) 11 There are 250 million smokers and an equal number of smokeless tobacco users in the Region

12. Adult average per capita consumption of pure alcohol, South-East Asia Region, 2008 (Source: WHO Global Status Report on Non-communicable Diseases, 2010; data reported by countries is adjusted for the year 2008) 12

13. Percentage of adults with insufficient physical activity, South-East Asia Region, 2008 (Source: WHO Global Status Report on Non-communicable Diseases, 2010) 13

14. Prevalence of high blood pressure (BP), South-East Asia Region, 2008 (Systolic BP≥ 140 or diastolic BP≥ 90 or on medication. Source: WHO Global Status Report on Non-communicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data) 14 More than a third of the adult population is affected by high blood pressure

15. Percentage of adult population with raised cholesterol, South-East Asia Region, 2008 Fasting cholesterol ≥ 190 mg/dl (Source: WHO Global Status Report on Non-communicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data) 15

16. Percentage of adult population overweight, South-East Asia Region, 2008 Note: Overweight=Body mass index≥ 25 kg/m 2 ( Source: WHO Global Status Report on Non- communicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data) 16 Women are more likely to be overweight

17. Percentage of adult population with raised glucose level, South-East Asia Region, 2008 Fasting glucose ≥126 mg/dl or on medication (Source: WHO Global Status Report on Non-communicable Diseases 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data) 17

18. NUMBER OF PEOPLE WITH DIABETES IN SEAR 2011 (MILLIONS) WHO-Number of People with Diabetes in SEAR 2011 (millions) 18 CountryMenWomenCombined Bangladesh4.104.318.41 Bhutan0.01 0.02 DPR Korea0.6660.8421.51 India32.5028.7661.26 Indonesia3.044.257.29 Maldives0.01 0.02 Myanmar0.861.252.10 Nepal0.260.220.48 Sri Lanka0.560.521.08 Thailand1.782.244.02 Timor Leste0.010.020.03 Total SEAR43.8042.4286.21

19. Diabetes in Myanmar: Prevalence of Diabetes in Lower Myanmar is 9% according to a Joint survey completed by Myanmar DOH & WHO, 2011. Findings show 11.1% in urban areas, and 7.3% in rural areas had diabetes. Missima news, June 2011 19 Diabetes Prevalence (Millions) WHO-2011 AgeMenFemales 20-290.0070.009 30-390.0310.044 40-490.0750.113 50-590.1200.168 60-690.1300.153 70-790.0980.092

20. Diabetes in Myanmar Cont. Minister of Health, November 14, 2010, notes: Growing problem of diabetes and emphasized the need to raise public awareness of the disease. Estimates that 6% of people in Myanmar between the ages of 25 and 70 have diabetes. 14% of urban dwellers (due to food and life style) and 7% of the rural population have the disease. Important to raise awareness about the symptoms so that people who develop the disease know they should go to the hospital. 20

21. Year # Men 20-79 1,000’s # Women 20-79 1,000’s # People in Rural Setting 1,000’s # People in Urban Setting 1,000’s # People with diabetes 20-39 1,000’s # People with diabetes 40-59 1,000’s # People with diabetes 60-79 1,000’s # Undiagnosed 1,000’s 2012 820.57956.57769.001,007.64473.58862.10441.451,120.30 2030 1,503.71,979.101,233.922,248.35420.801,992.681,068.78--- 21 IDF Diabetes Atlas 5th Edition UPDATE 2012- Country-Myanmar Details

22. Questions? 22

23. Contacts: PCC Dennis Brining Suzanne Tolson 703-503-8019 804-493-8433 dlbent@aol.com stolson@copper.net dlbent@aol.comstolson@copper.net Nina Litton 202-499-8854 Nina.litton@lc4dp.org Nina.litton@lc4dp.org 23

24. Diabetes 101: A Brief Overview Lions Clubs International IAG Mission Myanmar, 2013 Part II 24

25. What is Diabetes? Diabetes mellitus is a condition that occurs when the body can't use glucose (a type of sugar) normally. Glucose is the main source of energy for the body's cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells. In diabetes, the pancreas does not make enough insulin (type 1 diabetes) or the body can't respond normally to the insulin that is made (type 2 diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss to mention a few.type 1 diabetestype 2 diabetes 25

26. What Happens When We Eat? 26 After eating, most food is turned into blood glucose, the body’s main source of energy.

27. In people without diabetes, glucose stays in a healthy range because Normal Blood Glucose Control Insulin is released at the right times and in the right amounts Insulin helps glucose enter cells

28. In diabetes, blood glucose builds up for several possible reasons… High Blood Glucose (Hyperglycemia) Too little insulin is made Liver releases too much glucose Cells can’t use insulin well

29. Symptoms of Hyperglycemia Increased thirst Increased urination Blurry vision Feeling tired Slow healing of cuts or wounds More frequent infections Weight loss Nausea, vomiting and abdominal pain

30. Hyperglycemia Can Cause Serious Long-Term Problems Blindness Diabetic Retinopathy Kidney disease Nerve damage Heart attack Stroke Poor circulation in legs  Amputation Chronic complications of diabetes

31. Two Main Types of Diabetes Pancreas makes too little or no insulin Type 1 diabetes Type 2 diabetes Cells do not use insulin well (insulin resistance) Ability for pancreas to make insulin decreases over time

32. Type 1 Diabetes 1 in 10 people with diabetes have type 1 Most people are under age 20 when diagnosed Body can no longer make insulin Insulin is always needed for treatment

33. Symptoms of Type 1 Diabetes Weight loss Loss of energy Increased thirst Frequent urination Diabetic ketoacidosis (emergency condition of nausea, vomiting, dehydration, could lead to coma) Symptoms usually start suddenly

34. Managing Type 1 Diabetes Blood glucose monitoring Education Healthy food choices Physical activity Insulin

35. Type 2 Diabetes 9 in 10 people with diabetes have type 2 Most people are over age 40 when diagnosed, but type 2 is becoming more common younger adults, children and teens Type 2 is more likely in people who: Are overweight Are non-Caucasian Have a family history of type 2

36. Symptoms of Type 2 Diabetes Usually subtle or no symptoms in early stages: Increased thirst Increased urination Feeling tired Blurred vision More frequent infections Symptoms may be mistaken for other situations or problems 1 in 4 with type 2 aren’t aware they have it

37. Treatment for Type 2 Diabetes May Change Over a Lifetime Always Includes: Education Healthy eating Blood glucose monitoring Physical Activity May Include: Oral Medications Insulin

38. Risk Factors for Type 2 Diabetes Overweight and obesity Sedentary lifestyle Family history of diabetes History of gestational diabetes Getting older Ethnic/racial background: African American Hispanic/Latino Native American Asian American

39. Burden of Diabetes The leading cause of: new blindness among adults kidney failure non-traumatic lower-limb amputations Increases the risk of heart attack and stroke by 2-4 fold Mortality rates 2-4 times greater than non-diabetic people of the same age Source: Centers for Disease Control and Prevention

40. What is Prediabetes? Occurs before type 2 diabetes Blood glucose levels are higher than normal but not yet diabetes Most people with pre- diabetes don’t know they have it

41. Is There Any Good News? Yes, we can reduce the chances of developing type 2 diabetes in high-risk people (weight loss, exercise, medications) Yes, we can reduce the chances of developing diabetes complications through: Blood glucose control (diet, monitoring, medication) Blood pressure control Cholesterol control Regular visits to healthcare providers Early detection and treatment of complications

42. Preventive Efforts Are Key o Most of the diabetes costs are due to end-stage complications o Investment of resources into early diagnosis, patient education, prevention and treatments pays off in: Longer lives Increased productivity o Reduced costs over the long term o By eliminating common risk factors, such as unhealthy diet, physical inactivity, tobacco use and excessive use of alcohol, o It is possible to prevent: 80% of heart diseases and stroke 80% of Type 2 diabetes over 30% of cancers

43. Steps to Lower Your Risk of Diabetes Complications A1C < 7, which is an estimated average glucose of 154mg/dl Blood pressure < 130/80 Cholesterol (LDL) < 100, statin therapy for high risk Get help to quit smoking Be active Make healthy food choices Take care of your feet Get recommended screenings and early treatment for complications

44. More Information Email askADA@diabetes.orgaskADA@diabetes.org Social media information: www.Facebook.com/AmericanDiabetesAssociation@AmDiabetesAssn www.diabetesstopshere.org Web: www.diabetes.org www.stopdiabetes.com --- WHO: SEARO Dr. Renu Garg: gargr@searo.who.int www.who.intwww.stopdiabetes.com@searo.who.int ---NIH: www.nei.nih.gov ---International Diabetes Foundation www.idf.orgwww.idf.org

45. Questions? 45

46. Contacts: PCC Dennis Brining Suzanne Tolson 703-503-8019 804-493-8433 dlbent@aol.com stolson@copper.net dlbent@aol.comstolson@copper.net Nina Litton 202-499-8854 Nina.litton@lc4dp.org Nina.litton@lc4dp.org 46