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DIABETES MELLITUS

ARI UDIYONO
United Nations World Diabetes Day 2007
United Nations General Assembly
20 December 2006

 Resolution recognizing the global threat of the


diabetic epidemic
 Acknowledge a non infectious disease as a serious
threat to world health as infectious diseases like
HIV/AIDS,TB and Malaria
 Inspire, energize and empower the diabetes world
 Focus on helping and encouraging governments
worldwide to develop national policies to improve
diabetes care and prevention.
UN Resolution

 World Diabetes Day , 14 November as a


United Nations Day to be observed every
year starting 2007.
 Calls on UN member states to observe the
day
 Develop national policies for the prevention,
treatment and care of diabetes
Diabetes is much ignored
Responsible for 4 million deaths every year
Leading cause of heart attack, stroke, blindness,
kidney failure and amputation
Over 380 million people will live with diabetes in
2025
300 million will live in developing countries
The diabetes population
is increasing rapidly throughout the world
 In 2000, 171 million people worldwide had diabetes; in 2030,
the figure will be 366 million
 In 2030, >82 million people aged over 64 will have diabetes in
the developing countries; the figure for the developed countries
is >48 million
79.4

India 42.3

30.3
20.8
17.7 31.7

USA China
18.6 †104%
2000 †71%

7.1 21.3
2030 †151%

†161% 8.4
11.3
4.6 Indonesia
Brazil †154%
†146%
Sub- Saharan
Africa

*Figures are in millions


Wild S, et al. Diabetes Care 2004; 27: 1047-53. † Percentage change in number of people with diabetes
International Estimation WHO Perspective

Indonesia

 2000  8.4 milions people with DM (1.9%)


 2030  21.3 milions people with DM (2.8%)

World 4th largest prevalence!!!


Wild, et al. 2004
Indonesian Diabetes Prevalence
(Guestimate for 2003 / 2030)- BPS

Year
2003 2030
BPS
l Rural 5,548,869 8,076,613
l Urban 8,248.601 12,006,186

l  of DM patients 13,797,470 20,082,799

-Total population BPS = 214 Mil


-Total population  20 years = 133 Mil ;
Urban = 56 Mil, Rural = 77 Mil
DM Prevalence in Indonesia

1982
1982
6.1 %

5.1%
1.6 %
1991
2005 1.5 % 1981
1.1% 1.4%
1998
1995 1992 2004 3.5 %
Padang Surabaya
5.7 % 7.2% Jakarta Bali
Singaparn Makassar
2001 9.2% 12.5 % a
Pekajanga Manado
14.7 % 2003 n
2005
Late Breaking News

Prevalence of Diabetes in Jakarta


Special Province with a population of
more than 4 million (11.7 - 12.3 %)
Urban Vs. Rural
Areas
Diabetes
Prevalence

URBAN RURAL
Jakarta 1.6% (1982) Tasikmalay 1.1%
5.7% (1992) a (1981)
Depok 14.7
(Jakarta’s sub-urban)
(2001)
Makassar 1.5% (1981) Tana Toraja 0.8%
3.5% (1998)
12.5% (2005) (1981)
Surabaya / rural areas of East Java (1991)
1.4%
Indonesian Population

Population : 241,973,879 ( July 2005 est.)


Rate of growth: 1.4% / year
Age structure :
Gender
Male Female
0 – 14 35,826,456 34,590,631
15 – 64 79,447,560 79,449,399
65 and over 5,526,389 7,126,444
• Total population > 15 years = 171,549,792
NCD in Indonesia
National Monica***
Risk Sex survey **** (%) (3 countryside of South Jakarta)
Factors 2001 1988 1993 2000

Hypertension* Male 27 13.6 16.5 22.0


Female 29 13.6 17.0 22.7
Obesity* Male 1.3 2.6 3.6 6.3
Female 4.6 8.9 10.3 12.0

Hypercholesterol Male - 12.3 14.8 12.2


Female - 16.0 17.8 17.1

Smoke Male 54.5** 59.9 56.9 38.5


Female 1.2** 5.9 6.2 1.8

exercise 3x or > 14.3 22.5 22.7 59.2


per times/week*

* population > 25 yrs


** population > 10 yrs
*** population 25-65 yrs
**** SKRT
Number of Adults With Diabetes Is Expected to
Double by 2025
350

300

250
1995
200
2000
150 2025

100

50

0
Developed Developing Total
countries countries
.
*Prevalence of diabetes in the adult population (> 20 years of age).

King H, Aubert RE, Herman WH. Diabetes Care. 1998;21:1414 - 1431.


People with Diabetes Have
Increased Cardiovascular Risk
Factors

Risk factor Type 1 Type 2


Dyslipidemia
Small, dense LDL + ++
Increased apoB + ++
Low HDL +/– ++
Hypertriglyceridemia ++ ++
Hypertension + ++
Hyperinsulinemia/insulin resistance + ++
Central obesity – ++
Family history of atherosclerosis – +
Cigarette smoking – –

+ = moderately increased compared with nondiabetic population; ++ = markedly increased compared with nondiabetic population;
– = no increase compared with nondiabetic populations; LDL = low-density lipoprotein; apoB = apolipoprotein B; HDL = high-density lipoprotein
Adapted from Chait A, Bierman EL. In: Joslin's Diabetes Mellitus. 13th ed. Philadelphia: Lea & Febiger, 1994:648-664.
Patients with Diabetes are at 2-4 Times Greater Risk
for CVD

In this study, patients with diabetes without previous myocardial infarction


(MI) have as high a risk of MI as patients without diabetes with previous MI

60
Diabetes, prior MI; n=169
No diabetes, prior MI; n=69
7-year incidence of fatal

50
Diabetes, without prior MI; n=890
or nonfatal MI

40 No diabetes, without prior MI; n=1304

30

20

10

Haffner SM, Lehto S, Rönnemaa T, et al. N Engl J Med. 1998;339:229-234.


Indonesia Household
Survey
SKRT 1995 SKRT 2001

Hipertension 8.3 % 21 %

Diabetes Mellitus 1.2 % 7.5 %

Cardiovascular Dis. 0.3 % 4.2 %