Type 1 diabetes Previously known as insulin-dependent characterized by deficient insulin production and requires daily insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge. It is characterized by excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue.

Type 2 diabetes Formerly called insulin-independent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after it’s onset.

Gestational diabetes Gestational diabetes is hyperglycemia with onset or first recognition during pregnancy. Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms.

Diagnosis and treatment Early detection can be accomplished through relatively inexpensive blood testing. Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Key facts • More than 220 million people worldwide have diabetes. • 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. • Healthy diet, regular physical activity, • maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset • of type 2 diabetes.

Interventions that are both cost saving and feasible in developing countries: Moderate blood glucose control. People with type 1 diabetes require insulin. People with type 2 diabetes can be treated with oral medication, but may also require insulin.

Blood pressure control . • Foot care. • Screening for retinopathy (which causes blindness. • Blood lipid control (to regulate cholesterol level. • Screening for early signs of diabetes-related kidney disease. • These measures should be supported by a healthy diet, regular physical activity, and maintaining a normal body weight.

What is the economic impact of diabetes? Diabetes and its complications have a significant economic impact on individuals, families, health systems and countries. For example, WHO estimates that in the period 2006-2015, China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes alone.

Diabetes mellitusin the world Abdallah Abu-Zant

Diabetes in the world The prevalence of diabetes has reached epidemic proportions. WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle income countries.

Diabetes in the world • Lack of sufficient diagnosis and treatment. • In developing countries, less than half of people with diabetes are diagnosed. • Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially. • Diabetes costs – a burden for families and society.

Diabetes in the Arab world Prevalence Arab world, recent figures show that it is suffering terribly from this scourge. In the Middle East alone, 9.2% of the population is believed to be affected, making it a world record. 6 from 10 countries with highest rate of diabetes are Arab countries ….

Diabetes in the Arab world

MENA Countries according to The Mean Health Expenditure per person with diabetes in ID (international Dollar) : Diabetes Atlas, 3rd Ed.

Diabetes in Palestine The incidence of diabetes in Palestine is relatively high, ranging between 7 and 10% of the population. The Palestinian diabetes care is characterized by an over-emphasis on medication and an inadequate attention to prevention. Recent studies also indicate that obesity is a severe problem with up to 40% of the women and 20% of the men in the age group 30-55 years being obese. These people are at high risk of developing diabetes.

Diabetes in Palestine أصدرت دائرة الأمراض المزمنة بوزارة الصحة، كتيبا يحتوي على نتائج تحليل ألف حالة من مرضى السكري في المحافظات الشمالية، ويعطي صورة أوضح وأشمل عن مرض السكري في الضفة الغربية، حيث لا يزال الوضع الوبائي الحقيقي لمرض السكري في فلسطين غير معروف بصورة دقيقة. التوعية والتثقيف الصحي .

Diabetes in Nablus By IFMSAIN 2009 : أجريت دراسة على 275 شخص و تبين ما يلي : 16شخص مصابين بالسكري, 4 منهم سكري حمل, شخص واحد مصاب بالنوع الأول , 11 مصابين بالنوع الثاني. شخصين تم اكتشافهم. 9 من اصل 16 غير منتظم. 5 من المصابين مدخنين. 8 من المصابين عندهم تاريخ عائلة لمرض السكري. 120 شخص من أصل 275 مدخن .

Stages in the History of Type 2 Diabetes Type 2 Diabetes Normal IGT Disability Death Complications Clinical disease Preclinical state Complications Primary Secondary Tertiary prevention preventionprevention

Primary prevention of diabetes May Abu-ZAnt

Primary prevention identifies and protects individuals at risk from developing diabetes. It therefore has an impact by reducing both: the need for diabetes care and the need to treat diabetes-related complications.

What are the risk factors which increase the likelihood of developing diabetes? Being overweight or obese.(for each kilo gain, you increase the risk by 4.5%) Having a parent, brother, or sister with diabetes. Being African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage.

4. Having a prior history of gestational diabetes or birth of at least one baby weighing more than 9 pounds. 5. Having high blood pressure measuring 140/90 or higher. 6. Having abnormal cholesterol with HDL ("good") cholesterol is 35 or lower, or triglyceride level is 250 or higher. Being physically inactive—exercising fewer than three times a week. Smoking.

While there is yet no conclusive evidence to suggest that type 1 diabetes can be prevented, primary prevention of type 2 diabetes is potentially possible.

Lifestyle changes aimed at weight control and increased physical activity are important objectives in the prevention of type 2 diabetes. The benefits of reducing body weight and increasing physical activity are not confined to type 2 diabetes; they also play a role in reducing heart disease, high blood pressure, etc…..

The Diabetes Prevention Program (DPP), a major federally funded study of 3,234 people at high risk for diabetes, showed that people can delay and possibly prevent the disease by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week and healthier eating.

Diabetes prevention and nutrition: • The incidence of diabetes in Palestine is relatively high, ranging between 7 and 10% of the population. • The Palestinian diabetes care is characterized by an over-emphasis on medication and an inadequate attention to prevention. • Recent projects seek to address this problem by incorporating nutrition counseling and behavior change into the medical treatment of people with diabetes and high risk groups.

What is prediabetes? People with blood glucose levels that are higher than normal but not yet in the diabetic range . If you have prediabetes, you have a higher risk of developing type 2 diabetes. Studies have shown that most people with prediabetes go on to develop type 2 diabetes within 10 years, unless they lose weight through modest changes in diet and physical activity. People with prediabetes also have a higher risk of heart disease.

1. Know the numbers. 2. Be strong. 3. Learn the history. 4. Fill up on fiber. To help prevent prediabetes, keep in mind the following four lifestyle factors:

World Diabetes Day (WDD) • World Diabetes Day (WDD) is celebrated every year on November 14 • World Diabetes Day was created in 1991 by the International Diabetes Federation and WHO • the day itself is celebrated on November 14, to mark the birthday of Frederick Banting who , first conceived the idea which led to the discovery of insulin in 1922.

Activities organized each year include: Radio and television programmes Sports events Free screenings for diabetes and its complications Human blue circles Newspaper and magazine articles

JUZOOR FUNDATION IN PALESTINE: This foundation began a project to develop and implement a community based approach to diabetes mellitus management in selected Palestinian communities . This project includes capacity building of health professionals and clinks in the targeted areas as well as the development of two models centers that can fully implement the standard protocols in preventing, screening, managing diabetes.

Secondary prevention Rania Younes

Goals: • The purpose of secondary prevention activities such as screening is to identify asymptomatic people with diabetes. • Is there an effective intervention that may minimize the impact of a disease on the patient once it has been established.

Good diabetes control means keeping your blood sugar levels as close to normal as possible. • This can be achieved by a combination of the following: • Early Detection • Diet Modification • Physical exercise • Lifestyle Modification • Medication

Early Detection Getting the word out to those people who are at risk so that they will participate in diabetes screening is an important first step in secondary diabetes prevention.

Assumptions for Screening Model Treatment of diabetes Screened and diagnosed Onset of diabetes Treatment of diabetes Clinical diagnosis t=0 t=5 t=10

Screening: • In medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease.

Screening approaches Population screening or Universal screening: involves screening everyone. Selective screening: identifies people who are known to be at higher risk of developing the disease. Opportunistic screening:

Cost/ QALY of Target and Universal Screening versus No Screening(55-year-old cohort) Strategy HoergerTJ et al., Ann Intern Med 2004; 140: 689-99.

Who should be considered for screening? • Currently, the ADA recommends that all adults aged >45 years be considered for diabetes screening by their Health Care Provider every 3 years. • USPSTF recommends screening in adults without symptoms whose blood pressure is > 135/80 mmHg. • The WHO recommends only testing those groups at high risk. • Obviously, the two criteria that are most easily ..available to the majority of practitioners are age and BMI.

Children and youth: Overweight youths with any two of the risk factors be screened. Testing should be done every 2 years starting at age 10 years or at the onset of puberty if it occurs at a younger age.

Risk factors: • Age >45. • Body mass index (BMI) >27-30. • Membership of a high-risk ethnic group for type 2 diabetes. • Family history of type 2 diabetes. • High waist circumference. • Sedentary lifestyle.

Other criteria might include: • Those with CVD. • A history of gestational diabetes. • Obese women with polycystic ovary syndrome. • Previous evidence of impaired glucose tolerance.

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