World Diabetes Congress 2011



Alarming figures and new
science highlighted at
World Diabetes Congress


 

Figures released at the International Diabetes Federation’s (IDF) World Diabetes Congress (WDC) 2011, which was held at the Dubai International Convention and Exhibition Center from 4-8 December last year, are alarming.

Globally there are 366 million people living with diabetes and this is expected to reach 552 million by 2030, an increase of 50.7%, according to the IDF’s Diabetes Atlas. More alarmingly, with the average annual growth of diabetes increasing by 2.7% a year, diabetes growth rates are actually 1.7 times larger than the annual growth of the world’s adult population. Additionally, IDF estimates suggest that one in five people in the Middle East are now living with diabetes, a number expected to increase to 1 in every 3 by 2030. The region already spends US$5.5 billion annually on diabetes, accounting for 14% of its total health care expenditure and this can be expected to increase. Families with diabetic members spend as much as 15 to 25% of their income on diabetes treatment.

The UAE is ranked second highest worldwide for diabetes prevalence. About 19.5% the of population is currently living with diabetes according to statistics released by the Imperial College London Diabetes Centre at the Arab Health Congress last year. Figures show that 40% of residents over 60 have diabetes and the number is expected to increase over the coming years.

The WDC is one of the world’s largest health-related congresses, attracting 15,000 delegates, more than 1000 high level speakers, and representatives from over 200 diabetes member associations from more than 160 countries.

Type 2 diabetes usually occurs in adults over the age of 40, but is increasingly common in younger people. In virtually every high-income country, diabetes is ranked among the leading causes of blindness, renal failure and lower limb amputation as well as one of the leading causes of death, largely because of a markedly increased risk of coronary heart disease and stroke.

Highlights from the Congress

Following are a few of the highlights from a comprehensive scientific agenda at the event, which ran alongside a busy exhibition floor with leading medical companies showcasing their diabetes related products and services.

The Global Diabetes Forum

The first Global Diabetes Forum brought together 140 leaders from government, the private sector, the health sector and academia to discuss a range of actions from creating healthy workplaces to building effective partnerships to drive the international response to diabetes.

The International Diabetes Federation – established the event at the World Diabetes Congress – to build a Triple P Partnership representing public, private and people.

Proposals and actions identified at the meeting will be published in the New Year and presented at the World Economic Forum at Davos in January.

IDF President Jean Claude Mbanya emphasised the scale of the challenge: “The number of people with diabetes has now reached 366 million and 20 years from now that will rise to 552 million. While we talk more than 3,000 people will die of diabetes – a shocking statistic.

“Finding common interests, not seeking out conflicts of interest, must be our goal. Diabetes is one of the greatest challenges of the 21st century, for whole communities and for national economies.”

“The world needs to make progress on actions that will turn back the diabetes tide, prevent untimely deaths and reduce the suffering. Governments cannot achieve this alone.”

The Forum was designed to build on the momentum generated by the UN Summit on Non-Communicable Diseases held in September last year in New York, which ended in a Political Declaration committing the international community to action on diabetes, cancer, cardiovascular and lung disease.

Cost of diabetes

The Health Authority of Abu Dhabi (HAAD) shared the results from its initial research collaboration with Lilly which looked at the burden and costs of diabetes and cardiovascular disease in the Emirate of Abu Dhabi, with specific analyses on complications, treatment patterns, patient outcomes and projected risk.

Dr Oliver Harrison, Director of Public Health and Policy at HAAD, explained the importance of the research and its outcomes. “Diabetes is a growing global epidemic and cost burden. The Emirate of Abu Dhabi ranks second highest in the world in terms of diabetes prevalence, and that is among a young population. In our aim to understand the cost burden of diabetes and its complications in Abu Dhabi, the research has revealed a number of findings which will help us to shape public health policy. For example, we found a threefold increase in annual treatment costs for patients with complications relating to diabetes as compared to diabetes patients without complications. This data suggests that programmes, procedures or medical solutions that can help prevent or delay complications in diabetic patients might not only be cost-effective, but more importantly could help to increase patients’ quality of life, and potentially reduce the number of diabetes related deaths in the Emirate.”

The research, which combined the expertise of HAAD in population-based data collection and screening programs with Lilly’s data analysis and interpretations capabilities, also provided insights into the treatment of cardiovascular disease, particularly among diabetes patients. In one study comparing the experience of patients in Abu Dhabi with those suffering from similar medical problems in the United States, data indicated a need for more aggressive treatment with anti-hypertensive medication to help regulate blood pressure in diabetes patients, a finding which supports international guidelines.

i-ACT diabetes management programme launched in UAE

i-ACT, a diabetes management programme for the UAE, designed by MetLife Alico in collaboration with LifeScan (a Johnson & Johnson company), was launch during WDC with the aim of helping thousands of MetLife Alico insured members living with Diabetes take control of their condition and live a normal and healthier life.

A recent study done by AC Nielsen on behalf of LifeScan showed that less than 20% of people with diabetes in the UAE are psychologically committed to managing their condition, which is essential for good control of diabetes.

i-ACT provides education and involves free access to medical specialists, diabetes educators as well as the provision of a blood glucose testing kit for each person enrolled in the programme.

Roche’s Accu-Chek

At the DWC Roche Diabetes Care supported an international scientific event titled “Making sense of blood glucose monitoring. How?” Speaking at the event Dr Ali Khalil, Sheikh Khalifa Medical City Abu Dhabi, explained that as diabetes is a chronic disease and has to be treated accordingly – meaning constant, life-long treatment. The prerequisites are an appropriate adaptation of lifestyle and a therapy aimed at keeping blood glucose levels as close to normal as possible. To achieve this, a detailed overview of blood glucose levels over time and the analysis of individual profiles are essential. Nonetheless, many physicians still base their therapy decisions exclusively on HbA1c levels, the average blood glucose value over the past two to three months.

“However, anyone who bases therapy decisions solely on HbA1c will only see parts of the picture of a patient’s metabolic situation. Two patients with identical HbA1c levels may present with totally different glucose profiles,” he said.

HbA1c values fail to capture high blood glucose levels after a meal, for instance, as well as elevated or dangerously low fasting levels. And it is particularly the post-meal blood glucose peaks that are closely linked to secondary complications such as stroke, kidney failure, blindness or heart attacks.

“To be able to overcome the diabetesrelated challenges we currently face, we need to manage the condition in a more comprehensive manner to include the patient’s requirements within the context of his environment and society.”

The basis for individualised and successful diabetes management is structured self-monitoring of blood glucose (SMBG), including data documentation and visualisation. The final results of an international, multi-centre study involving 758 participants demonstrated that the combination of structured testing and the therapy decisions derived from it is successful. Every three months, the patients measured their glucose levels before and after breakfast, lunch, and dinner and again before bedtime on three consecutive days, using Roche’s Accu-Chek 360° View 3-day profile tool. They discussed the results with their physicians, including any necessary therapy adjustments like changes in their medication, diet or exercise habits. At the end of the study after 6 months, patients performing structured testing achieved significantly greater reductions in their blood glucose levels than those who did not follow this approach.

Professor Nebosja Lalic, Institute for Endocrinology, Diabetes and Metabolism Belgrade, Serbia, added: “To implement this knowledge into daily practice, doctors need valid data and reliable methods for data analysis.”

He explained that innovative blood glucose monitoring systems and data management solutions such as the Accu- Chek Smart Pix device reader are readily available to doctors’ practices in many parts of the world. They save time and optimise the patient-doctor dialogue. Experts in many countries already rely on structured testing and existing diabetes management resources and have reached a consensus on integrating them into their national standards of care.

The concept of structured SMBG is an important cornerstone in diabetes therapy for an optimal management of the disease. It clearly visualises how lifestyle affects the metabolism. This makes people with diabetes feel more empowered and confident to derive the important daily therapy decisions on their own.

“Such individualised and target-oriented diabetes management, combined with increased empowerment and motivation of the patients to follow their caregiver’s recommendations and make informed therapy adjustments by themselves, represents the most promising form of diabetes therapy today,” said Dr Lalic.

A1chieve study

New data from the A1chieve study, published in the journal Diabetes Research and Clinical Practice and highlighted at the WDC, show that type 2 diabetes patients can significantly improve their blood glucose control with a low occurrence of low blood sugar. The study showed that before treatment with a Novo Nordisk insulin analogue was initiated, the average blood glucose control (HbA1c) among the 66,726 study participants was 9.5%, which is well above the internationally recognised target of 7%.

Poor blood glucose control puts people at high risk of developing diabetes-related complications; in this study up to 80% of people had diabetes complications and 75% already had cardiovascular diseases. After 24 weeks of treatment with a Novo Nordisk insulin analogue there was a significant reduction

 in HbA1C levels of 2.1%, from 9.5% to 7.4%. Reported rates of overall hypoglycaemia slightly increased in those new to insulin and fell in those who switched from other insulin therapies. Furthermore, patients reported quality of life improved significantly.

The A1chieve looked into the safety and effectiveness of insulin treatment and involved 66,726 people with type 2 diabetes from 28 countries across Asia, Africa, Europe and Latin America. Before entering into the study, people were started on one of three Novo Nordisk insulin analogue regimens – NovoMix 30 (biphasic insulin aspart 30), Levemir (insulin detemir) and NovoRapid (insulin aspart) – based on their physician’s clinical judgement. The primary aim of the study was to evaluate the clinical safety of the study insulins in routine clinical practice, assessed by the incidence of serious adverse drug reactions including rates of major hypoglycaemia. In addition, effectiveness (HbA1c, fasting plasma glucose, and postprandial plasma glucose) and patient quality of life outcomes were measured. After 24 weeks, clinically meaningful improvements in overall blood glucose control were found with all three insulin analogue regimens

MSD’s JANUVIA study

MSD presented its groundbreaking diabetes research and development insights, including a study on how JANUVIA has helped millions of Muslim patients around the world maintain their glucose levels whilst fasting during Ramadan.

Discussing their latest findings, Dr. Harvey Katzeff, Global Director for Scientific Affairs – Diabetes, MSD Research Labs, said: “Despite healthcare providers’ advice to the contrary, 79% of Muslims with Type 2 diabetes continue to fast. Understanding the reality of these numbers, MSD recognized it was crucial to undertake a study to find the best ways to help these patients maintain their sugar levels while fasting. What our studies discovered was that those patients who were taking JANUVIA were less likely to suffer from hypoglycemic attacks, than those taking a sulphonylurea.”

Dr Nancy Thornberry, Senior Vice President Franchise Head Diabetes and Obesity at MSD said: “In the medical community, it has long been believed that only patients who had uncontrolled cholesterol levels and diabetes were at risk. However, our latest research shows that there is a direct link between Type 2 diabetes and heart disease. Persistent levels of high blood sugar, lead to increased plaque build-up in the arteries meaning that over time, patients with diabetes are at higher risk of cardiovascular diseases, including heart attacks and strokes. Of course, the less controlled a patient’s blood sugar is the higher the risk.”

Additionally, the research shows that around two-thirds of patients advised to take cholesterol lowering agents do not take them due to concerns about the possible side effects of diabetes such as blindness, kidney failure or amputation. This clear disconnect between the real dangers of diabetes and patient awareness is a crucial point that MSD addressed during their symposium, in the hope of generating greater awareness amongst physicians, who can then pass this knowledge along to their patients.
 

Posters

A cross-cultural comparison of hypertension prevalence and management in diabetic patients
– Cother Hajat, David Nelson, Sid Bouziane, Oliver Harrison, Bradley Curtis

The aim of this research was to compare the prevalence of hypertension, and anti-hypertensive drug utilization in patients with diabetes between Abu Dhabi and the United States (US). Guidelines suggest that anti-hypertensive drug therapy should be instituted in any person with diabetes and hypertension. A clear understanding of regional patient heterogeneity is important when developing and implementing such guidelines.

Data confirm significant differences between the management of hypertension in patients with diabetes between Abu Dhabi and US populations, with lower rates of anti-hypertensive medication use in Abu Dhabi. Despite this difference, there is no difference in systolic blood pressure (SBP) levels between patients with diabetes in the two populations. In both populations, being diabetic was associated with poorer BP control only in those not on antihypertensive medication. This finding supports international guidance on the need for aggressive medical treatment of hypertension in diabetic patients.

The cost of diabetes and associated complications in the UAE, USA, and Europe: A multinational comparison
– Oliver Harrison, Jeff Durthaler, Lina Jichi, Allen Nyhuis, Steve Babineaux, Eman Hassan Curtis

Diabetes is a growing global epidemic and cost burden. At 19 per cent in those over 18 years, the prevalence of diabetes in the Emirate of Abu Dhabi is the second highest worldwide, and that in a very young population. The aim of this study was to compare the incidence and cost of complications for diabetes in Abu Dhabi compared to the USA. These results were then compared to the published results of the CODE-2 study, the first attempt to assess the incidence and impact of complications on the cost of diabetes across Europe.

The analysis suggested that, in Abu Dhabi, having diabetes and at least one of the many complications of the disease, is associated with an approximate threefold increase in annual costs of diabetes treatment, compared with patients with no complications. Compared to the cost of treating patients without complications, the burden and cost of treating the complications of diabetes is high. Effective programs for prevention, early diagnosis through screening, and early treatment to prevent complications may reduce the morbidity and costs associated with managing people with diabetes in Abu Dhabi.

A comparison of anti diabetic medication utilization patterns by HbA1C levels in Abu Dhabi with the United States of America
– Eman Hassan, Jeff Durthaler, Lina Jichi, Allen Nyhuis, Brad Curtis, Cother Hajat, Oliver Harrison.

Diabetes is a growing global epidemic and cost burden. The prevalence of diabetes in Abu Dhabi, UAE is 19% (2nd highest in the world). High glycosylated hemoglobin (HbA1C) levels may increase costs. The aim of this study was to compare the use of anti-diabetic medications (ADM) in patients with Type 2 diabetes, segmented by HbA1C levels, in the Emirate of Abu Dhabi (AD) compared to a similar USA cohort. Results may identify treatment regimens that improve outcomes and reduce costs.

The research found that, compared to USA, patients with diabetes in AD are more likely to be treated with less complex ADM regimens and less likely to achieve a low HbA1C level (< 7 %), and more likely to have a high HbA1C level (> 9%). Patients with diabetes in AD may benefit from routine monitoring of HbA1C and greater use of combination ADM regimens involving oral and insulin therapies.

A comparison of complications, cost, and medical service use among patients with diabetes in Abu Dhabi compared to United States of America.
– Eman Hassan, Jeff Durthaler, Lina Jichi, Allen Nyhuis, Brad Curtis, Cother Hajat, OliverHarrison.

Diabetes is a growing global epidemic and cost burden. The prevalence of diabetes in Abu Dhabi, UAE is 19% (2ndhighest worldwide). High glycosylated hemoglobin (HbA1C) levels may increase costs. The aim of this research was to compare costs, complications, and medical service use, segmented by HbA1C levels, in patients with Type 2 diabetes in the Abu Dhabi (AD) compared to a similar USA cohort. Results from this study couldl inform future public health program planning.

Discussion / Conclusions: The study found that Patients with diabetes in AD experience more outpatient visits, less inpatient visits, more microvascular complications, and less macro-vascular complications, compared to the USA. Although the costs of care per patient in AD are lower than in the USA, the higher prevalence of diabetes and associated complications add financial burden on the AD health system. This burden can be alleviated through effective preventive interventions and diabetes management programs.

 Date of upload: 21st Jan 2012

 

                                  
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