Post on 08-Feb-2016
Director, Indonesia Diabetes Institute (INDINA)
Executive Committee Member,
Western Pacific Region
International Diabetes Federation (IDF)
Temporary Technical Advisor, World Health Organisation (WHO)
Sidartawan SoegondoMD PhD F.A.C.E.
Professor of MedicineUniversity of Indonesia
Thursday, February 24, 2011
Diabesity
Tackling the Global Epidemic
Thursday, February 24, 2011
3
Thursday, February 24, 2011
“Everyone has to die of something”
Thursday, February 24, 2011
UNDERLYING SOCIOECONOMIC,
CULTURAL, POLITICAL AND ENVIRONMENTAL Unhealthy diet
5
Globalization
Urbanization
Population ageing
Physical Inactivity
Tobacco use
NON-MODIFIABLE RISK FACTORS
Age
Heredity
Raised blood pressure
Raised blood glucose
INTERMEDIATE RISK FACTORS
Abnormal blood lipids
Overweight/obesity
Causes of Chronic Diseases
COMMON MODIFIABLE RISK FACTORS
Heart disease
Stroke
MAIN CHRONIC DISEASES
Cancer
Chronic Respiratory diseases
Diabetes
Thursday, February 24, 2011
Thursday, February 24, 2011
You are what you eatThursday, February 24, 2011
Penduduk Indonesia IMT > 25 kg/m2 :23.1%.
Kelompok usia 38-‐47 tahun : 33.4%
Thursday, February 24, 2011
The Thrifty Gene Hypothesis
Thursday, February 24, 2011
Diabetes
+ Obesity = Diabesity
Thursday, February 24, 2011
Prevalence
People who know they have diabetes
People who don’t know they have diabetes
Indonesian Basic Health Research (RISKESDAS 2007)
Diagnosed DM = 1,5%
Undiagnosed DM = 4,2%Total DM = 5,7 %IGT = 10,2 %
Thursday, February 24, 2011
The “Diabesity” Epidemic
Almost two-thirds of adults in the United States are either overweight (BMI of 25-30) or obese (BMI >30), and nearly one-third of children ages 6-18 fit these same descriptions. Moreover, the incidence of type 2 diabetes in children has increased ten-fold in the last 15 years. The “Diabesity” Epidemic
Thursday, February 24, 2011
Normal
Glucose tolerance
Impaired
Glucose toleranceIFG Diabetes
Actual Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
Fatty acids
Visceral obesity
Dysglycemia Continuum
Thursday, February 24, 2011
Type 2 DM is Progressive
Relative function (units)
0
100
200
300
-10 -5 0 5 10 15 20 25 30
Years of Diabetes
Insulin resistance
Normal insulin level Beta cell failure
At risk for diabetes
Adopted from D. Kendall, R. Bergenstal © International Diabetes Center!
Glucose (mg/DL)
50
150
250
350
Fasting glucose
Post-meal glucose
-10 -5 0 5 10 15 20 25 30
Thursday, February 24, 2011
Thursday, February 24, 2011
16
People with normal glycemic levels
People with prediabetes
People with uncomplicated
diabetes
People with complicated
diabetes
Obesity prevalence
Prediabetes detection &
management
Diabetes detection &
management
Death
Complications onsetDiabetes onsetPrediabetes onset
Recovery
Dysglicaemia Continuum
Thursday, February 24, 2011
Normal
Glucose tolerance
Impaired
Glucose toleranceIFG Diabetes
Actual Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
Fatty acids
Visceral obesity
Dysglycemia Continuum
Thursday, February 24, 2011
18
People with normal glycemic levels
People with prediabetes
People with uncomplicated
diabetes
People with complicated
diabetes
Obesity prevalence
Prediabetes detection &
management
Diabetes detection &
management
Elderly fraction
Death
Complications onsetDiabetes onsetPrediabetes onset
Recovery
Diabetes prevalence
Unhealthy days & costs per person with diabetes
Unhealthy days & costs from diabetes
Thursday, February 24, 2011
Thursday, February 24, 2011
Thursday, February 24, 2011
Thursday, February 24, 2011
Thursday, February 24, 2011
Changes in the physical and social
environment
Weight loss/Maintenance services
for individuals
Caloric Balance
Trends and planned
Interventions
Flow-rate between BMI
categories
DeathOverweight and obesity prevalence
Birth Immigration
Population by Age (0-99) and sex
yearly aging
Dynamic Population weight framework
Not Overweight
Moderately overweight
Moderately Obese
Severely Obese
Thursday, February 24, 2011
Thursday, February 24, 2011
Normal
Glucose Tolerance
Impaired
Glucose ToleranceIFG Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
FA
DM detected
Visceral obesity
Dysglycemia Continuum
Actual Diabetes
Thursday, February 24, 2011
Thursday, February 24, 2011
Insulin Resistance
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Thursday, February 24, 2011
Islet β-cell
Impaired Insulin Secretion
Thursday, February 24, 2011
Normal
Glucose toleranceImpaired
Glucose toleranceIFG
Waist
Insulin
Proinsulin
Glucose
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
FA
Dysglicemia Continuum
Visceral obesity
Thursday, February 24, 2011
Pro insulin : InsulinBETA CELL DYSFUNCTION
Thursday, February 24, 2011
Normal
Glucose tolerance
Impaired
Glucose toleranceIFG Diabetes
Actual Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
FA
Visceral obesity
Dysglycemia Continuum
Thursday, February 24, 2011
Intermediate Hyperglicaemia (WHO)
Different names for the same condition
Prediabetes (IDF)
Increased Risk for Diabetes (ADA)
Impaired Glucose Regulation (IGR)Non Diabetic Hyperglycaemia (NDH) (UK)
Thursday, February 24, 2011
Normal
Glucose toleranc
Impaired
Glucose toleranceIFG Diabetes
Diabetes
Waist
Insulin
Proinsulin
Glucose
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
FA
Dysglicemia Continuum
Diagnosis
Visceral obesity
Thursday, February 24, 2011
Thursday, February 24, 2011
Normal
Glucose tolerance
Impaired
Glucose toleranceIFG Diabetes
Waist
Insulin
Proinsulin
Glucose
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
FA
Dysglicemia Continuum
Visceral obesity
New Diabetes
Thursday, February 24, 2011
New Diabetes
Islet β-cell
Only 50 %
Function 30 %
Thursday, February 24, 2011
EBAID ET SProgresive
Thursday, February 24, 2011
Normal
Glucose Tolerance
Impaired
Glucose ToleranceIFG Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Blood glucose
Proinsulin
FA
DM detected
Visceral obesity
Dysglycemia Continuum
Actual Diabetes
Thursday, February 24, 2011
Diabetes
Diabetes
Modified from: DeFronzo RA et al., Diabetes Care 1998
Insulin
Proinsulin
Fatty Acid
Early Diagnosis
Non Insulin Requiring Insulin Requiring Insulin Dependent
Late Diagnosis
Dysglycemia Continuum
Blood glucose
Visceral obesity
Thursday, February 24, 2011
Weight Management
Thursday, February 24, 2011
Exercise is Beneficial Even Without Weight Loss
Thursday, February 24, 2011
Thursday, February 24, 2011
•Turn off the television•Children walk (run, bike, hike,
swim)•Water/low fat milk are the only
beverages at home•Fast food is a 1 time per week
treat•Fruits and vegetables are the only
snacks
Thursday, February 24, 2011
Thursday, February 24, 2011
Thursday, February 24, 2011
Healthy Eating
Thursday, February 24, 2011
Reading Food Labels
Thursday, February 24, 2011
Plate Method Fill ! of the plate with non-starchy vegetables
Add a serving of a protein food
Choose a carb serving
Don’t forget the dairy!
Finish with a fruit
Thursday, February 24, 2011
COMMUNITYLOCALITY
Agriculture/Gardens/
Local markets
Health Care
PublicSafety
PublicTransport
Manufactured/Imported
Food
Sanitation
Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org
POPULATION
% OBESE
AND OVER--WEIGHT
WORK/SCHOOL/HOME
SchoolFood &Activity
Infections
Labour
Worksite Food & Activity
LeisureActivity/Facilities
Family &Home
INDIVIDUAL
EnergyExpenditure
Food intake :Nutrient density
Societal policies and processes influencing the population prevalence of obesity
NATIONAL/ REGIONAL
Education
Food & Nutrition
Urbanization
Health
Social security
Transport
Media &Culture
Nationalperspective
INTERNATIONALFACTORS
Development
Globalizationof
markets
Media programs
& advertising
Thursday, February 24, 2011
Thursday, February 24, 2011
Components of an integrated comprehensive model for school-based obesity prevention.
School food
services
Nutrition environment of
the school
School health
services Health instruction
(curriculum)
School counselling and psychology
programs
Family and community
linkages
Physical education classes
School-site health promotion for faculty
and staff
Goal: enhancing healthy eating practices and physical
activity patterns and achieving healthy weights in
children and adolescents
Thursday, February 24, 2011
1. Advertising2. Food labelling3. Fiscal policies4. Research policies5. Food standards for pre-school nurseries/
schools6. Public sector catering7. Health policy development8. New role for Public Health Sector9. Health education
Governmental responsibilities for food
Thursday, February 24, 2011
Obesity: Time for Action A joint statement from a CPG/IOTF meeting of 25 NGOs.
Recommend that the Government:
u Appoint a cabinet minister for comprehensive cross-departmental action
u Establish an independent government agency responsible to Parliament for monitoring action & progress, proposing new measures and ensuring compliance
u Ban the marketing of high fat/sugar/salt products e.g. on TV
u Simple labelling on all foods and outlets of high/medium/low fat/sugar/salt content
u Use public procurement and fiscal measures to counteract current subsidies
u Require all urban planning, transport etc to ensure safe activity as part of normal living
u Increase obesity directed resources in NFS management for PCTs and guidelines for monitoring children and progress in management and prevention
Thursday, February 24, 2011
Obesity: Time for Action A joint statement from a CPG/IOTF meeting of 25 NGOs.
The Food Industry and Retail Sector should:uDevelop a range of reformulated staple foods with
a benefit to healthuSupport rules to prohibit promotion of high fat/
sugar/salt foodsuDevelop healthier snacks ,confectionery and soft
drinksu Initiate and support a long-term marketing
campaign to promote fruit and vegetables to children
Thursday, February 24, 2011
Thursday, February 24, 2011
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Thursday, February 24, 2011