Epidemia Mondiale di Diabete - Azienda Ospedaliera G.Brotzu L'EPIDEMIA DI DIABETE - Azienda Ospedaliera Brotzu
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Azienda Ospedaliera G.Brotzu
Ospedale S.Michele
Cagliari
L’EPIDEMIA DI
DIABETE
195 milioni DM di cui
5 milioni di Tipo 1
(400.000 bambini)
Epidemia Mondiale di Diabete
Cagliari 18 Dicembre 2007
Marco Songini
Direttore SC di Diabetologia
Diabete mellito: classificazione
(2007)
Diabete di tipo 1 (insulino-dipendente)
– Autoimmune classico e LADA/NIRAD, neonatale IPEX (X-linked recessivo)
– Idiopatico
– fulminante
Diabete di tipo 2 (non insulino-dipendente)
Diabete gestazionale (tipo 1 e 2)
Diabete da:
da
– difetti genetici funzione β-cellula: MODY 1, 2, 3, DNA mitocondriale, neonatale...
– difetti genetici azione insulinica: insulino resistenza tipo A, leprecaunismo, . .
– patologie pancreas esocrino: pancreatite, pancreatectomia, tumori, fibrosi cistica . .
– endocrinopatie: acromegalia, Cushing, feocromocitoma, glucagonoma, . .
– da farmaci e sostanze chimiche: glucocorticoidi, tiazidici, diazossido, vacor, . .
– infezioni: rosolia congenita, . .
– sindromi genetiche associate: Down, Klinefelter, Turner, Wolfram, Friedereich, . .
Diabete mellito e
sindrome metabolica
Demenza
+
Alzheimer
Tipo3
Tipo1
classico
+
LADA
Tipo2+SM
Tipo2
Type 2 Diabetes
Resistance to insulin action AND
Relative, rather than absolute, insulin deficiency – inadequate
compensatory insulin secretory response
Hyperglycemia with pathological (macrovascular & microvascular)
and functional changes in target tissues over many years before
clinical symptoms
Other nomenclature used in the literature
– Non-insulin dependent diabetes mellitus (NIDDM)
– Adult onset diabetes mellitus
– Type II diabetes mellitus
What is type 2 diabetes?
A progressive metabolic disorder
characterised by:
Type 2 β -cell
Insulin
resistance diabetes dysfunction
1. Beck-Nielsen H, Groop LC. J Clin Invest 1994;94:1714–1721
2. Saltiel AR, Olefsky JM. Diabetes 1996;45:1661–1669
DM
Undiagnosed
‘hidden’ AGT (IGT e IFG)
‘hidden epidemic’ (IGT e IFG)
IGT+IFG / Pre-Diabetes
‘hidden’ AGT (IGT e IFG)
At-Risk + Met Syn
Harris et al., Diabetes Care, 1998
Natural History of Type 2 Diabetes
Genetic Onset of
susceptibility diabetes Complications
Environmental
factors
Nutrition
Disability
Obesity
Physical inactivity
Insulin resistance IGT Ongoing hyperglycemia Death
Hyperinsulinemia Atherosclerosis Retinopathy Blindness
↓ HDL-C Hyperglycemia Nephropathy Renal failure
↑ Triglycerides Neuropathy CHD
Hypertension
Atherosclerosis Amputation
Hypertension
Impaired Glucose Tolerance (IGT) and
Impaired Fasting Glucose (IFG)
Pre-diabetes -- Glucose is too high for normal but not diagnostic for diabetes;
risk factor for developing diabetes
Categories for fasting plasma glucose (FPG) values:
– FPG < 100 mg/dl = normal fasting glucose
– FPG 100-125 mg/dl = IFG (impaired fasting glucose)
– FPG ≥ 126 mg/dl = provisional diagnosis of diabetes (unconfirmed)
Categories for 2-h postload glucose values from oral glucose tolerance test
(OGTT):
– 2-h glucose < 140 mg/dl = normal glucose tolerance
– 2-h glucose 140-199 mg/dl = IGT (impaired glucose tolerance)
– 2-h glucose ≥ 200 mg/dl = provisional diagnosis of diabetes
Diabetes Care 2005; 28:S37-S42
Natural History of IGT (IFG?)
Normal Diabetes
25%
IGT After 10 years 50%
25%
IGT
The World ‘Epidemic’ Trend of Diabetes & Obesity
Estimated prevalence increasing….has incidence
paralleled as much? 0.9 western countries but 2.9%
yearly far east countries
350
300
millions of patients
250
200
150
100
50
0
1990 1995 2000 2005 2010 2015 2020 2025 2030
calendar yearGLOBAL PROJECTIONS FOR THE DIABESITY
EPIDEMIC: 2003-2025 (millions) 20-79 age group
48.4
58.6
France 1 .7
20%
23.0 Germany 2.6
Italy 4.3
36.2 UK 1.7
57% 19.2
39.4 39.3
105% 81.6
7.1
15.0 108%
111%
14.2
43.0
26.2
75.8
85%
2003 = 194 million 76%
World 2025 = 333 million
2003 = 194 million
Global increase 72%, 70-80% NOT EXPLAINED by
= 5.1% of adult population
2025 = 333 million demography(improved life exp,lower mortality) and
= 6.3% of adult population decreasing age of onset
Mortality excess DM 2000 = 6%(3.2mil)Epidemiologia del
diabete nel mondo sino ad ieri…
8
7
6
Prevalenza %
5 1995
4 2000
3 2002
2
1
0
paesi sviluppati paesi in via di mondo
sviluppo
Diabetes Care (1998) 21: 1414-1431L’epidemia di diabete - Australia
8
7
6
5
4
3
110% increase in 18 years
2
1
0
1981 1999
Dunstan D Care 2002L’epidemia di diabete
Nord America
16
14
12
10
8
6
25% increase in 12 years
4
2
0
1976 1988
NHANES dataPrevalence of Obesity* Among U.S. Adults
BRFSS, 1985
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1986
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1987
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1988
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1989
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1990
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1991
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1992
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1993
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1994
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1995
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1996
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1997
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.Prevalence of Obesity* Among U.S. Adults
BRFSS, 1998
(*Approximately 30 pounds overweight)
15%
Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.L’epidemia di diabete
India urbana
14
12
10
8
6 40% increase in 6 years
4
2
0
1989 1995
Ramachandran Diabetologia 1997L’epidemia di diabete
Cina
3,5
3
2,5
2
1,5 190% increase in 12 years
1
0,5
0
1986 1994
Pan, D Care 1997L’epidemia di diabete
Danimarca
10
9
8
7
6
5
4 38% increase in 22 years
3
2
1
0
1974 1996
Drivsholm Diabet Med 2001TOP 10: NUMBER OF PEOPLE WITH DM
2003 2025
• India 37M • India 74 M
• China 24 • China 46
• USA 16 • USA 23
• Russia 10 • Russia 11
• Japan 7 • Japan 7
• Germany 6 • Germany 7
• Pakistan 6 • Pakistan 12
• Brazil 6 • Brazil 11
• Mexico 4 • Mexico 9
• Egypt 4 • Egypt 8DIABESITY
Top Three Countries in the world
60
Diabetic patients in Millions
50
40
57 million
30
20
19 million
10
0
U.S. CHINA INDIA U.S. CHINA INDIA
1995 2025
King et al, Diabetes Care, 1998Prevalenza in Europa del diabete manifesto (%) per
fasce d’età (anni), DECODE
25
Prevalenza del diabete manifesto (%)
21.5
20
14.5
15 12.8
11.8
M
9.3
10 9 F
5.7 5.1
5 2.7
1.9
1.1 1.5
0
30-39 40-49 50-59 60-69 70-79 80-89
Negli anni 1991-2001 le diagnosi di DM dei GP UK sono aumentate del 50%Diabetes in Italy
2000 = ~ 3.7% population (M 3.5%,F 4%)
2007 = ~4.5% population (M 4.3%, F 4.6%)*
5.000
4365!?
Pts with DM ( x 1000 )
4.000
3458 3592
3369
3.000
2.000
1995 1997 2000 2025
* Higher than expected increase
WHO, 1999 (http://www.who.int/ncd/dia/dia_est.htm).Fattori predittivi di Diabesità • Sedentarietà, short sleep (10h/w) • Familiarità, sesso/età (F>M), razza, classe sociale • BMI (>21 con aumento esponenziale) • Liver fat • Insulino Resistenza (IR) • < risposta ins alla 2a ora dell’OGTT (starling) • > glicemia alla 2a ora dell’OGTT • Markers infiammazione (PCR,FGB,fase acuta)* *Atherosclerosis Risk in Communities (ARIC),Lancet 1999
Human Evolution and Adipocytes
In Nauru From this . . . . . . to this
Diabesità: prevalenza
USA: adulti MessicoAmericani/Anglo-Americani
25
Prevalenza di T2D (%)
20
15 Messicani
Americani
10 Anglo
Americani
5
0
magri obesi magre obese
maschi femmine
Stern et al. Am J Epidemiol 12:834-851, 1984Diabesità:incidenza
USA: Indiani Pima (adulti) - incidenza/1000 anno
80
Incidenza di T2D71000 anno
70
60
50
40
30
20
10
0
40
BMI
Knowlwr et al. Am J Epidemiol 113: 144-156; 1981Genetica
Incidenza di T2D in relazione al BMI e alla familiarità Indiani Pima
USA (prevalenza diabesità > il 50%*)
100
T2D/1000 anno
80
incidenza
60
40 2 genitori DB
1 genitore DB
20
non familiari DB
0
40
Categorie BMI
* I Pima Messicani il 15%
Knowler et al. Am J Epidemiol 113: 144-156; 1981Diabete, obesità e rischio CV
Effect of Obesity: Ten-Year Risk of Morbidity
BMI >35 vs.in i
mb
b a
ei
n
i tà
es
i ab
DCome erano i nostri bambini anni 60’….
I nostri ragazzi adesso……. From Childhood & Adolescent Obesity and Type 2 Diabetes by Francine Kaufman MD
Junk food baby!
Distribution of Hours of TV Per Day:
NHES Youth Aged 12-17 in 1967-70 and
NLSY Youth Aged 12-17 in 1990
35
30
25
Percent 20
Distribution
15
NHES 1967-70
10 NLSY 1990
5
0
0-
0-11 1-
1-22 2-
2-33 3-
3-44 4-
4-55 5+
5+
TV
TV Hours
Hours ((Youth
Youth Report)
Report)COUCH POTATO-NINTENDONIZATION
COCA-FAST FOOD - WESTERNISATION CIVILITATION &
GENERATION
Jama,289,1785,2003Type 2 Diabetes in the Young
The evolving epidemic
• 33% of all diabetes presenting between the ages of 10 – 20 years are Type 2 diabetes in
Cincinatti Ohio and Arkansas:
• 31% of Mexican American childrenThe Changing Face of
Childhood Diabetes
The Past The Present
Type 2 Diabetes
and Others
Type2
Type1
Other
(Mody)
Type 1 Diabetes
Double
Diabetes
(Type1+Type2)Age at Diagnosis of T2DM
25
25
20
20
Number
Number 1515
of
of
Patients
Patients
10
10
5
5
0
0
1
1 2
2 3
3 4
4 5
5 6
6 7
7 8
8 9
9 10
10 11
11 12
12 13
13 14
14 15
15 16
16 17
17
Age (years)
0901026aObesity children in USA 1960-2000
BMI >95-centile (boys)
16
14
12
1963-65
10 1966-70
8 1971-74
1976-80
6
1988-94
4 1999-2000
2
0
2-5y 6-11y 12-19y
Ogden & al, JAMA 2002, 288, 1728-32Prevalenza dell’obesità in età pediatrica in Europa
30% 36%
20% 22%
19%
15%
G
E F S SP IT
R R V GRAN A AL
M A E BRETAGNA G IA
A N Z N
N C I A
I I A
A ADiabesità nei bambini/giovani:prevalenza
USA (1999-2001) vs Italia (1994-2001)
L’ Italia ha la prevalenza di obesità infantile più alta d’ Europa (36%)
Prevalenza di alterazioni del metabolismo glucidico in
bambini e adolescenti obesi (età 4-18 aa)
25 22,1
20
prevalenza (%)
15
USA n = 167
10 Italia n = 701
4,4
5 2,4
0,1
0
IGT diabete
Sinha R et al. NEJM (2002); 346: 802-810
Invitti C et al. Diabetes Care (2003); 26: 118-124MODY
DEFINIZIONE MODY
CHE TIPO DI DIABETE E’?
• NON AUTOIMMUNE
• MONOGENICO (tutti gli altri tipi di Diabete sono poligenici)
• EREDITA’ AUTOSOMICA DOMINANTE (Elevata penetranza)
• MUTAZIONE PUNTIFORME O DELEZIONE DI GENI IMPORTANTI
PER LO SVILUPPO DELLE CELLULE BETA DEL PANCREAS
ALTERAZIONE DELLA SECREZIONE
INSULINICA
FAJANS, NEJM 2001CLASSIFICAZIONE MODY
Sono attualmente conosciute 6 forme causate da mutazioni di geni situati su differenti cromosomi:
Le forme più frequenti sono MODY 2 e MODY 3
TIPO GENE CARATTERISTICHE CLINICHE TRATTAMENTO
MODY 1 HNF-4α Diabete; Complicazioni cardio-vascolari; riduzione di Ipoglicemizzanti orali e
trigliceridi nel siero insulina
MODY 2 GK Alterazioni glicemiche a digiuno; alterata tolleranza del Esercizio fisico e dieta
glucosio; diabete; normale rapporto *
insulina/proinsulina nel siero
MODY 3 HNF-1α Diabete; complicanze microvascolari; glicosuria, Ipoglicemizzanti orali e
aumento di sensibilità alle sulfaniluree; aumento del insulina
rapporto insulina/proinsulina nel sangue
MODY 4 IPF-1 Diabete Ipoglicemizzanti orali e
insulina *
MODY 5 HNF-1β Diabete; cisti renali e altre anormalità nello sviluppo Insulina
del rene; insufficienza renale cronica;
Anormalità interne nei genitali (femmine)
MODY 6 NeuroD1 Diabete Insulina
o BETA2
*Nell’omozigote: agenesia pancreatica e diabete neonatale.
Necessita di trattamento insulinico permanente FAJANS, NEJM 2001MODY
CRITERI DI DIAGNOSI
Eredità autosomica dominante
Assenza di autoimmunità
Iperglicemia/e a digiuno (IFG o DMThe Metabolic Syndrome Front Back “Balzac” by Rodin
Features of the Metabolic Syndrome
Central obesity(lean)
hypoadiponectinemia
hyperleptinemia
Microalbuminuria
Low-grade
Inflammationimmune act
IRtype2DM Prothrombotic state
Ins antiinflamm vs Glucose proinflamm
(PAI-1,FBG,vW,fX,plt)
PCOS,NAFLD
Cardiodiabetes
(CVdiseases&diabetes)
IGT, T1& 2DM
InsResistance
(+/- iperins.; Alzheimer?
40-50% exposed to excess ins)
Hypertension
Dyslipidemia
(↑ TG e/o ↓ HDL)
Epi/Genetics +
Lifestyle (fetal programming)
Low-Ins longer lifeTessuto Adiposo
Addominale
Sindrome Aumentato
Metabolica Rischio CVSPerché la SM e il T2DM?
SURVIVAL OF OUR ANCHESTORS
• High intensity physical
activity (flight/fight
situations)
• Prolonged physical
activity (migrations)Genetica
Thrifty gene/pheno hypothesis (Neel,1962)
Mediated by hyperinsulinemia
10.000 a.C. lean/LBW
Thrifty genotype
20° secolo belly-fat (apple)
Thrifty phenotype
Gentile concessione del prof. P. ZimmetDiabete Mellito
Tipo 1 LADA Tipo 2
5-12%T1D incidence in the world Risk range:
(0-14 yrs) • Sardinia: 42
• Venezuela, China: 0.1
• 420 fold difference!
Incidence per 100,000
Diabetes Atlas 200310
42
T1D incidence in
Europe and in other 21
36
26
Mediterranean 17 20 10
countries (0-14 yrs) 7
16 7
6
13 6
16
13
7 6
10 14
High risk 12 7
8 8 9
Moderate risk 9
10 6 7
Low risk 19 11 10
12 8 7
14 5
12 8
15 6
42 6
9
Casu, Songini et al.Diabetes Care 12
2004 7 15
15 8
5DM 1 in Italy and Sardinia
13
High risk countries
11
7 Finland: ¸ body weight
9
¨ T1D incidence
12
10 9 T1D incidence
Sardinia: d
X body weight
10
8 9
6
42
The Accelerator hypothesis
27%of all DM are insulin-
treated compared to Italy
8% `Body weight
` insulin secretion and IR
12
`Activation of Immune system
`expression of betacell-autoantigens
Songini et al. 2004 betacell-autoimmunityEpidemiologia del T1D
Distribuzione geografica del T1D (0-14) RR
RR Alghero: 0.986 (0.979-0.993)
Incid. Catalogna : 11.5 (10.6-12.4)
RR Arborea: 0.2
Incid. Veneto 0-29: 10.9
T1D RR
1.10
Rischio relativo di T1D 0-14 aa (1989-99)Definizione di LADA
Forma di DM fenotipicamente tipo 2 che:
• insorge solitamente in età adulta (>35 anni)
• non richiede il trattamento insulinico per almeno
6 mesi dalla diagnosi di DM
• si associa alla presenza di uno o più auto-anticorpi
anti-isola pancreatica e, spesso, ad uno stato di
attivazione della flogosiPrevalenza del LADA in diverse aree geografiche
Alaska (Eschimesi) 0-1%
NIRAD Italia (eccetto Sardegna) 3-4%
Spagna meridionale 3-4%
Sardegna 8-10%
Cina 9-10%
Inghilterra 10-12%
Italia Centrale 11-12%
Tailandia 25%
India orientale 45%
Latvia 55%Diabetes : The Problems
Macrovascular
Retinopathy
2–4 x increased risk
Common cause of
blindness in people of CVD, 75% have
of working age in West hypertension
Nephropathy
20% of all ESRD Foot Problems
15% develop
foot ulcers; 5–15% need
amputation
Osteoporosis
Erectile Dysfunction
May affect up to 50%
The Audit Commission. Testing Times. A Review of Diabetes Services in England and Wales, 2000.The timetable of horror:
diabetes complications in the World
Every
• 12 minutes a stroke
• 19 minutes a myocardial infarction
• 19 minutes an amputation
• 60 minutes a new case of blindness
Liebl A,et al..Exp Clin Endocrinol Diabetes 2002,110(1):10-6FREQUENZA DELLE COMPLICANZE CRONICHE
NELLA POPOLAZIONE DIABETICA ITALIANA
Cardiopatia ischemica(1° causa mortis) 45%
Disfunzione erettile 35,8%
Retinopatia 23-35%
Polineuropatia periferica 28,5%
DE 35-50%
Nefropatia 22-23%
Vasculopatia periferica 8-16%
Cerebrovasculopatie 9,3%
Ulcere diabetiche 2%
Fonte: Gruppo di studio sul rischio cardiovascolare nel diabete, 2001Cardiodiabetes
Metabolic
Syndrome
IR
ASCVD AGT,T2DMPrevalenza di complicanze cardiovascolari
nella sindrome metabolica
(NHANES III, soggetti di età > 50 a.)
20,0% 19,2%
18,0%
16,0%
Prevalenza di CHD
13,9%
14,0%
12,0%
10,0% 8,7%
8,0% 7,5%
6,0%
4,0%
2,0%
0,0%
Normali S. Metab. Diabete SM+ / DM+
Alexander CM, Diabetes 2003; 52: 1210-4Potential mechanisms of atherogenesis
in diabetes
• Abnormalities in apoprotein and lipoprotein particle distribution
• Glycosylation and advanced glycation af proteins (AGE) in
plasma and arterial wall
• “Glycoxidation” and oxidation
• Procoagulant state
• Insulin-resistance and hyperinsulinemia
• Hormone-, growth-factor- and cytokine-enhanced smooth
muscle cell proliferation and foam cell formationPrevenzione del diabete tipo 2
TYPE 2 DIABETES - A preventable disease Where is the evidence?
• ‘Obesity and physical activity are the most preventable risk factors for diabetes, and could potentially lead to more than 50% reduction in prevalence of the diabetes’
Criteria for Undertaking Community-
based Interventions
• Common and serious disease
• Strong causal relationships between risk factor levels
and disease risk
• Predominantly social factors which determine risk
levels e.g. lifestyle behaviours
• Established benefit and safety of interventions
• Potential for community control exists
• Added value to “community” based rather than
individual based approachINTERVENTI EDUCATIVI
Empowerment + Motivazione OS Abilità di coping
controllo e dominio strategie di adattamento +
della propria malattia psicotx cognitivo-comportamentale
MIGLIORAMENTO QUALITA’ DI VITA
verifica
AUTOGESTIONE
Diabetes Care, 18, 943-949, 1995 Diab. Educ., 19, 210-214, 1993Come and get it!
Exercise Every Little Bit Helps
EVIDENZE DEGLI STUDI EPIDEMIOLOGICI E DI INTERVENTO
Prevenzione secondaria del T2D
Studio No. di Trattamento Follow-up Riduzione del RR
partecipanti (anni)
DPS1 522 Stile di vita controllo (svc) 3.2
vs stile di vita intenso 58%
IGT
DPP2 3234 placebo + svc 2.8 58%
IGT vs metformina (1.6g/die)+svc
vs stile di vita intenso
Da Qing5 530 dieta vs esercizio fisico vs dieta 6.0 41%
IGT +esercizio vs controllo
STOP-NIDDM3 1429 placebo vs acarbose 3.3 25%
IGT
XENDOS4 3304 placebo + stile di vita Fino a 4 37%
IGT+norm vs orlistat + stile di vita
1. Tuomilehto J et al. N Engl J Med 2001; 344: 1343-50 2. DPP N Engl J Med. 2002; 346: 393-403
3. Chiasson J-L et al. Lancet 2002; 359: 2072-77 4. SjÖstrÖm et al. 9th ICO, San Paolo 2002.
5. Xiao-ren T et al. Diabetes Care 1997; 20 537-544Prevenzione del Diabete Tipo 2
Metformina vs Modificazioni dello Stile di Vita
Diabetes Prevention Program Research Group
N Eng J Med 346:393, 2002Studies to Treat Or
Prevent Pediatric Type 2
Diabetes
(STOPP-T2D)
Funded by
National Institute of Diabetes and Digestive and Kidney Diseases
National Institutes of HealthCosti del diabete
Costi del Diabete
€ 5.422.797,44 (7 % del totale della SS)
Procapite: € 3.135,93 l’anno
Morte prematura
17.3%
Disabilità 37.8% 28% Ricovero
6.7% 5.6%
Infermiere
Ambulatorio
domiciliare
Type 2 diabetes accounted for between 3% and 6% of total healthcare
expenditure in eight European countries (CODE-2)=29bil€
US ’97 $ 98 billions 2002 132 ; pt/y 13.243 vs healthy/y 2.560 = 1\3 spesa sanità USPR of China: 1.323.000.000 people
40.000.000 with diabetes
Health DM care costs in 2007: 20.5 bn US $ or
14.2% of total health expenditure
Productivity loss due to diabetes in 2007:
20.5 Billion US $
• Mortality: 8 bn
• Morbidity: 0.5 bn
• Disability: 12.0 bnunite for diabetes
www.unitefordiabetes.org
UN Resolution adopted in New York on December 20,2006
International Diabetes Federations (IDF) OMS,WHOProblemi? Il mio personale ringrazia!
You can also read
