Diabetes: Global Perspective
David L. Horwitz, M.D., Ph.D.
Chief Medical Officer
Johnson & Johnson Diabetes Institute
World Burden of Diabetes
Putting the problem in perspective…
World population:
Population with diabetes
6,600,000,000
246,000,000
Population with HIV/AIDS
33,000,000
Eight times the number of people with HIV/AIDS
Projected to increase to 380,000,000 by 2025!
Estimated World Prevalence of Diabetes: 2007
Estimated World Prevalence of Diabetes: 2025
Estimated World Prevalence of IGT: 2007
Estimated World Prevalence of IGT: 2025
United Nations Resolution
61/225:
World Diabetes Day
On 20 December 2006, the United Nations General
Assembly passed Resolution 61/225. This landmark
Resolution recognizes diabetes as a chronic, debilitating
and costly disease associated with major complications that
pose severe risks for families, countries and the entire
world. It designates 14 November, the current World
Diabetes Day, as a United Nations Day to be observed
every year beginning in 2007.
Governments have acknowledged that diabetes is
increasing at epidemic rates and is affecting all countries.
For the first time, a non-infectious disease has been seen
as posing as serious a global health threat as infectious
epidemics such as HIV/AIDS.
Sydney
Taipei
San Francisco
New York
London
Inverness, Scotland
Growth in Diabetes by Region
2007-2025
Top 10 Countries in Diabetes Prevalence
Did you know?
• Diabetes currently affects 246 million people worldwide and
is expected to affect 380 million by 2025.
• In 2007, the five countries with the largest numbers of
people with diabetes are India (40.9 million), China (39.8
million), the United States (19.2 million), Russia (9.6 million)
and Germany (7.4 million).
• In 2007, the five countries with the highest diabetes
prevalence in the adult population are Nauru
(30.7%), United Arab Emirates (19.5%), Saudi
Arabia (16.7%), Bahrain(15.2%), and Kuwait (14.4%).
• By 2025, the largest increases in diabetes prevalence will
take place in developing countries.
Source: IDF
Did you know?
• Diabetes is expected to cause 3.8 million deaths worldwide
in 2007, about 6% of total global mortality, about the same
as HIV/AIDS. Using World Health Organization (WHO)
figures on years of life lost per person dying of diabetes,
this translates into more than 25 million years of life lost
each year.
• The International Diabetes Federation (IDF) estimates that
the equivalent of an additional 23 million years of life are
lost to the disability and to reduced quality of life caused by
the preventable complications of diabetes.
• People living with diabetes and their families feel the impact
of diabetes most directly. They feel the often crushing
expenses of diabetes treatments as costs are not
subsidized, and family income is frequently reduced when
diabetes interferes with work.
Sources:
Diabetes Atlas, third edition, International Diabetes Federation, 2007.
Diabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001.
World Health Organization Diabetes Unit
Did you know?
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People with diabetes face the near certainty, in many countries the stark
reality, of premature death.
Type 1 diabetes is particularly costly in terms of mortality in poor
countries, where many children die because access to life-saving insulin is
not subsidized by governments (who instead tax it heavily), and is often
not available at any price.
Studies recently carried out in Zambia, Mali and Mozambique highlight a
stark reality: a person requiring insulin for survival in Zambia will live an
average of 11 years; a person in Mali can expect to live for 30 months; in
Mozambique a person requiring insulin will be dead within 12 months.
In the poorest countries, people with diabetes and their families bear
almost the entire cost of whatever medical care they can afford.
In Latin America, families pay 40-60% of diabetes care costs out of their
own pockets.
In India, for example, the poorest people with diabetes spend an average
of 25% of their income on private care. Most of this money is used to stay
alive by avoiding fatally high blood sugar levels.
Sources:
Diabetes Atlas, third edition, International Diabetes Federation, 2007.
Diabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001.
World Health Organization Diabetes Unit
Did you know?
• Type 1 diabetes, which predominately affects youth, is rising
alarmingly worldwide, at a rate of 3% per year.
• Some 70,000 children aged 14 and under develop type 1 diabetes
annually.
• An increasing number of children are developing type 2 diabetes,
in both developed and developing nations.
• Type 2 diabetes has been reported in children as young as eight.
• Reports reveal the existence of type 2 diabetes in child populations
previously thought not to be at risk.
• In Japan, the prevalence of type 2 diabetes among junior high
school children has doubled from 7.3 per 100,000 in 1976-80 to 13.9
per 100,000 in 1991-95, with type 2 diabetes now outnumbering
type 1 diabetes in that country.
References:
All epidemiologic data are drawn from the Diabetes Atlas, third edition
News of the Week
• At least 25 states have enacted or proposed cuts
in health insurance for the poor.
• 12 states have also targeted the State Children’s
Health Insurance Program.
• $87 billion in stimulus funds will boost Medicaid
programs, but may not be enough to stave off
cuts as job losses swell Medicaid rolls.
• Fewer clinics and doctors offices are accepting
Medicaid patients.
Wall Street Journal 1/28/09
What are the solutions?
• Improved awareness of diabetes (health
literacy)
• Expanded access to care
• Affordability of care
• Knowledge of how to provide the
best,most cost-effective care
These require government or private
resources and an adequate number of health
care providers
Providers of Diabetes Education
Source: Diabetes Atlas 2nd Ed.
Means to Overcome Barriers to
Patient Education
Source: Diabetes Atlas 2nd Ed.
DIABETES CARE BAROMETER
• Assessment of issues and needs of Healthcare
Professionals treating diabetes patients at a community
level
– Telephone survey of over 250 Healthcare Professionals
• During January-February 2008
• Commissioned by the Johnson & Johnson Diabetes
Institute, LLC
• Conducted by Penn, Schoen and Berland, Inc.
• Designed to identify the obstacles contributing to
poor diabetes outcomes
KEY FINDING
Healthcare Professionals Worry About Impact of Low Health Literacy
Healthcare Professionals are
increasingly worried about
low health literacy as it
relates to daily self-care
• 82% say low health literacy is
challenge, especially when treating
medically underserved
• 54% cite lack of culturally sensitive
materials as barrier to counseling
underserved patients
• 52% identify limited English language
proficiency among many patients as
growing problem
• 43% cite difficulties with lack of trust
KEY FINDING
Immediate Need for More Professional Education and Skills Training in Diabetes
Management
A key priority for
Healthcare Professionals is
having up-to-date
information and skills
training to improve patient
outcomes
• 80% agree most practitioners don’t get
enough specialized training in diabetes
management
• 95% want better tools to help them
communicate with diabetes patients
• 90% say curriculum in diabetes
management is needed for Healthcare
Professionals
The Johnson & Johnson Diabetes Institute
Diabetes Institute Principles
•
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Chronic care model vs. acute care model
Patient centric
Focus on health literacy
Accelerate translation of science and technology into the
community
• Platform for wide variety of offerings
– Dedicated educational facility
– Robust web-based presence
– Active alumni interaction
– Extended training offerings
• Local, local, local: leadership, needs assessment,
curriculum design, faculty, attendees: relevant to the
community environment
• Dynamic curriculum design and update
The
• Training Centers
– Silicon Valley, US
– Tokyo, Japan
– Paris, France
– Beijing, China
Institute
• Training Satellites
• Curriculum Exports
• Virtual Presence and Outreach
– E-community for alumni and instructors
– Web based training programs
www.jjdi.us
Many types of organizations need to come
together to improve the situation
Pharma / biotech
companies
Device /
diagnostics
companies
Policy makers /
government
Payors
(Employers,
government,
individuals, health
plans)
Global dialogue
to benefit
patients
Advocacy groups
Health care
professionals
Patients/
Community
Groups