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The new international Diabetes Federation (IDF) definition

The new international Diabetes Federation (IDF) definition According to the new IDF definition , for a person to be defined as having the metabolic syndrome he/she must have : Central Obesity ( defined as waist circumference * with ethnicity specific values )

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The new international Diabetes Federation (IDF) definition

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  1. The new international Diabetes Federation (IDF) definition According to the new IDF definition , for a person to be defined as having the metabolic syndrome he/she must have : Central Obesity ( defined as waist circumference * with ethnicity specific values ) plus any two of the following four factors :

  2. Diabetes Mellitus and its state of control and complications in the MENA Region

  3. Fasting Hyperglycemia - Controlled (< 120 mg/dl ) = 19.8 % - Uncontrolled = 80.2 % ---------------------------------- Hyperglycemic 121-150 mg/dl = 15.6 % Marked hyperglycemia -200 = 31.3 % Severe hyperglycemia -220 = 12.5 % Very severe hyperglycemia > 220 = 20.8 %

  4. Hyperglycemia Fasting 120 mg/dl

  5. Post Prandial Hyperglycemia - Controlled < 160 mg/dl = 13.5 % - Accepted161-180 mg/dl = 7.9 %Total=21.4 % - Uncontrolled( >180 mg/dl ) = 78.6 % * Moderate -220 mg/dl = 17.4 % * Severe - 260 mg/dl = 16.0 % * Very Severe > 260 mg/dl = 45.2 %

  6. Hyperglycemia 180 mg/dl

  7. Diastolic Blood Pressure 80 mm Hg

  8. Systolic Blood Pressure 0.50% 130 mm Hg

  9. Lipid Control Serum Cholesterol 200 mg

  10. Lipid ControlSerum Triglycerides 150 mg

  11. Obesity as a Risk Factor for Hyperglycemia , Hypertension and Hyperlipidemia

  12. Cardiac Complications

  13. Retinopathy (in 1173 patients )- Free68.9 %- Back ground22.6 %- Proliferative9.5 %

  14. Retinopathy in correlation with Duration of DM

  15. l

  16. Frequency of Foot Complications

  17. Prevalence of foot complications 1- Fungus infection= 22.0 % 2- Foot ulcers= 6.8 % 3- Evident Ischaemic changes= 9.7 % 4- Amputations= 3.0 % 5- Deformities= 1.0 %

  18. Diabetes Keto Acidosis (DKA)- Occurrence of DKA episodes in= 12.2 %.--------------------------------------------------------------------- The mean age in patients who developed DKA= 42.5 years- The mean age in patients who never developed DKA= 53.1 years

  19. Hypoglycemia-Occurrence of Hypoglycemic episodes in= 20.5%------------------------------------------------------------------------ - The mean age of patients who developedhypoglycemic episodes at any time= 50.8 years- The mean age of patients who did not experiencehypoglyceamic episodes= 52.1 years

  20. Fertility and Abortions Abortions : 21.5% Fertility : 3.6 ch/m

  21. The Socio economic Burden

  22. High Kuwait Emirates Qatar Bahrain Oman Saudi Arabia Libya Low Syria Jordan Tunisia Morocco Egypt Yemen Sudan Middle East Countries-economic statusper capitum incomes : Middle (Iraq) Iran >5,000 US $ < 2,000 US $

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

  24. Hospital Treatment 2001 Cost /Day (Egyptian Study )

  25. Distribution of Hospital Cost 45% Basic ( Food : 5% H.C.Team 11% Others: 29%) 55% Medicine & Supp.

  26. Year Cost / percapit. Burden for Human Insulin (40 u /d) 8.85% EGYPT 1.9% 3.1% SAUDI ARABIA QATAR

  27. Cost Burden of Oral Treatment related to Percapitum 4.2% 29.9% EGYPT QATAR 8.4% SAUDI ARABIA

  28. What are The IDF Goals ? 1. Global Advocacy 2. To raise Global Awareness 3. Promote appropriate Diabetes Care & Prevention 4. Encourage finding a Cure

  29. For improving Diabetes Care and Prevention , Education of Health Care Providers should consider expertise in both: I- Clinical Diabetes , and II- Educations skills

  30. The Way to a National Diabetes Program

  31. Minimal requirements :1- Insulin and medicationsavailability ( affordable) 2- Primary centersfor diagnosis and care3- widedistributionof services allover the country4- Basic requirements tomanage complications5- Education :knowledge & skills to patients – Public orientation6-National basic studiesin epidemiology andsocioeconomics .7- Care forDiabetes in School children8- Care fordiabetes in pregnancy

  32. Potential Adverse Factors1- Economic :Poor FinancialRes. /per capit. /Government expenditure/ House-holdexpend. withHigh Prev. of diab.2- Demographic Extensiveareas with poorcommunications .Highpopulation density3- Social : Illiteracy- Misconceptions – adverse habits and traditions .

  33. WHO IDF Government National Institute Parliament Syndicate NGO Ministry of Health Physician Nurse Dietitian Foot Care Pharmacist Laboratory Medical Group Family Patient Work- school Friends Pharmaceutical industries Society MEDIA

  34. In Developing a National Diabetes Programme :1- Consider thespecific needsin the countryand availableresourcesto decidepriorities2 - Define therole to be playedby each one of the constituents of the community , andIdentifyChampionsfor projects .3- Seekpartnershipswith :WHO , Twining ,WDF , Rotary , etc..

  35. Obligations of Different PartiesThe Government ( Ministry of Health)1-Increase Investmentsin Health/Diabetes2- provideMinimal Diabetes Carein Clinics & Hospitals3- InsureInsulin & Medications Availability4- provideEducation:Patient, Health Care Team and Public5- Coordinate withHealth Care Syndicates6- Coordinate withNGOs7- attractInternational Aidprogrammes8- promoteNational Research( epidemiol.-socioeconomic)

  36. Parliament(Legislation)1-Budget planningto improve diabetes Care2-Taxation Exemption for insulin& medical requirements3- Put rules and regulations forNGOactivities4- Maintain and guardPatients’ Human Rights( anti discrimination, working , children, women , elderly …etc)5-Health InsuranceLaws

  37. The Non-Governmental Organizations (NGOs )1-Advocacy2- EducationPrograms for : -Patients and Families -Health Care Team -Community at large3 -Rules & Regulations- legally recognized - non profitable - accountable and transparent - coordinated & complementary to government - no unhealthy competition, extravagance , business controlled ( by industries )

  38. The Health Care TeamThe Physician 1- is Leader of the HC team 2- is the Final reference for his patient’s education 3- keep harmony with others in the HC team 4- requires continuous training courses and updates 5- acquire education skillsNurses1- Training courses , by whom ? 2- Knowledge + skills & attitude 3- skills in education 4- keep Team work 5- Continuous education , scientific meetings and workshops

  39. Diabetes Care for Special Groups School Children- Registration at national level - Individual records in schools - basic equipments to manage emergencies - Education courses to school attendants. - protecting special rights : play- recreation - treatment .non discrimination …etc

  40. Mothers with Diabetes of Pregnancy- Screening for diabetes of pregnancy - Protocols for management of GD - Care for the N.B. - After-labour follow-up of mothers

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