Program Intervensi Sidartawan

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


3


“Everyone has to die of something”


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


You are what you eatThursday, February 24, 2011

Penduduk Indonesia IMT > 25 kg/m2 :23.1%.

Kelompok usia 38-‐47 tahun : 33.4%


The Thrifty Gene Hypothesis


Diabetes

+ Obesity = Diabesity


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 %


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


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


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


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


Normal

Glucose tolerance

Impaired


Actual Diabetes


Insulin

Blood glucose

Proinsulin

Fatty acids

Visceral obesity



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


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


Normal

Glucose Tolerance

Impaired

Glucose ToleranceIFG Diabetes


Insulin

Blood glucose

Proinsulin

FA

DM detected

Visceral obesity


Actual Diabetes


Insulin Resistance


Islet β-cell

Impaired Insulin Secretion


Normal

Glucose toleranceImpaired

Glucose toleranceIFG

Waist

Insulin

Proinsulin

Glucose


Insulin

Blood glucose

Proinsulin

FA

Dysglicemia Continuum

Visceral obesity


Pro insulin : InsulinBETA CELL DYSFUNCTION


Normal

Glucose tolerance

Impaired


Actual Diabetes


Insulin

Blood glucose

Proinsulin

FA

Visceral obesity



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)


Normal

Glucose toleranc

Impaired


Diabetes

Waist

Insulin

Proinsulin

Glucose


Insulin

Blood glucose

Proinsulin

FA


Diagnosis

Visceral obesity


Normal

Glucose tolerance

Impaired


Waist

Insulin

Proinsulin

Glucose


Insulin

Blood glucose

Proinsulin

FA


Visceral obesity

New Diabetes


New Diabetes

Islet β-cell

Only 50 %

Function 30 %


EBAID ET SProgresive


Normal

Glucose Tolerance

Impaired

Glucose ToleranceIFG Diabetes


Insulin

Blood glucose

Proinsulin

FA

DM detected

Visceral obesity


Actual Diabetes


Diabetes

Diabetes


Insulin

Proinsulin

Fatty Acid

Early Diagnosis

Non Insulin Requiring Insulin Requiring Insulin Dependent

Late Diagnosis


Blood glucose

Visceral obesity


Weight Management


Exercise is Beneficial Even Without Weight Loss


•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


Healthy Eating


Reading Food Labels


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


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


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


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


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


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


Program Intervensi Sidartawan

Documents

Transcript of Program Intervensi Sidartawan