1. IDC 1.1 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

2. IDC 1.2 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

3. IDC 1.3 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

4. IDC 1.4 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

5. IDC 1.5 Overview 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) or Casual Plasma Glucose (CPG) Fasting Plasma Glucose (FPG) or Casual Plasma Glucose (CPG) Patient w. Risk Factors and/or Symptoms of 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 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

6. IDC 1.6 Risk Factors for Diabetes Obesity Asian:  120% DBW or BMI  24 kg/m 2 Western:  120% DBW or BMI  27 kg/m 2 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 250 mg/dL Previous IGT or IFG = Impaired Glucose Homeostasis *Rich, Diabetes 1990

7. IDC 1.7 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 countries 170% 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

8. IDC 1.8 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 and Examination Survey 1991

9. IDC 1.9 Add Thai Epidemiology

10. IDC 1.10 Cost of Diabetes Care : Worldwide and the US (in billions dollars)