The worldwide prevalence of type 2 diabetesN IO is increasing at a very alarming rateT

Adults (millions) worldwide with type 2 diabetes 300 250 200 150 100 50 143

THE CIVILIZED WORLDS PAMANA TRAGIC HERITAGE TO THE FUTURE

E D A P
0

1997

N D A

P E

0 2
154 2000 Year Y

1 1

N O 300 C

N E V

600M by 2050??

2025
Kumanyika et al. Int J Obes 2002

ADA Professional Section Quarterly

WINTER 2007 EVERY 21 SECONDS DIABETES HITS ANOTHER AMERICAN

N 4,320 NEW DIABETICSO 24H IN C 1 1 0 CASES EVERYDAY IN THE USA 17 0002 17,000 NEW P E N D A E D A
LIEW, HOLMAN, KULKARNI 2009 NOV DIAB OB METAB II SUPL P 21

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I T

N O

THE CHALLENGE

10M FILIPINOS Double in 2025

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P E

0 2

1 1

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50M 1* RELATIVES

SUMMARY
only one clear message: it is getting worse!! 1983 MOH-WHO Survery 12,000 subjects 4.0% 1998 FNRI-DOH-HDL Survey 4,541 subjects 3.9%

N 82 4% 2006-07: 2006 07: 6 regions revisited 47% of original population; 82.4% E V of subjects accounted for N Incidence of Diabetes over 9 yrs 8.5% O C 2H PG or Prevalence of Diabetes based on either FBG, 1 1 questionnaire 20.6% 0l 26 2% Prevalence of impaired f i 2 glucose 26.2% P l fi i d fasting P Prevalence of impaired glucose tolerance 23.9% E N IFG conversion to DM in 9 yrs 46% Dadult subjects are diabetic or pre-diabetic Roughly 3 out A 5 of E PDA 2008 D A P

I T

N O

N E THERE PROBABLY ARE 500 NEW DIABETICS V APPEARING EVERY 24 H IN THE RP N O UNATTENDED C 1 DUE TO IGNORANCE AND INDIFFERENCE 1 0BRAIN AND KIDNEY 2 DYING OF HEART AND P MACRO AND MICRO VASCULAR CX E N OVERCROWDING OUR DIABETES FACILITIES D A E D A
COMPUTING FOR THE PHILIPPINES
REF ISDF 2007

I T

N O

N For our diabetic p p population ofO million 10 C there probably are no less than 50 million 1 first degree relatives 1 0 parents, sibblings, children, nephews, nieces, parents sibblings children nephews nieces 2 P grandchildren E N D A E D A
THE DIABETICS OF TOMORROW WILL COME FROM THE CHILDREN OF TODAY!!

And where will these new additions come from? MOSTLY FROM FIRST DEGREE RELATIVES OF OUR CURRENT DIABETIC POPULATION!

N E V

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N O

N P.S. AMIDST THE CONFUSION VE N WHILE IT IS IMPORTANT TO IDENTIFY INDIVIDUALS O IMPACT AT HIGH RISK THIS WILL HAVE CLIMITED RISK, A ON THE RATE OF DIABETES AT A NATIONAL LEVEL. 1 THAT WILL REDUCE 1 WHAT ARE NEEDED ARE MEASURES 0 POPULATION. EVIDENCE THE RISK ACROSS THE WHOLE POPULATION 2CHANGES APPLIED TO A WHOLE SUGGESTS THAT LIFESTYLE P A LARGE IMPACT ON THE RATES POPULATION CAN E HAVE N OF DIABETES. MORE ATTENTION SHOULD BE GIVEN TO THIS DIABETES THIS. D DEHKO PROJECT IN FINLAND IS A GOOD EXAMPLE OF THIS. A PREVENTION COSTS FAR LESS THAN TREATING DIABETES E AND ITS COMPLICATIONS D A P
IDF DIABETES ATLAS 2009

I T

N O

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P E

0 2

1 1

N O C

N E V

I T

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THE CHALLENGE THEREFORE IS FOR US TO BE MORE AGGRESSIVE IN OUR FIGHT AGAINST A VERY FORMIDABLE FOE WHICH HAS VICTIMIZED TEN MILLION FILIPINOS RICH AND POOR, THREATENING THEM WITH INFECTIONS, BLINDNESS, DIALYSIS, NEUROPATHIES, IMPOTENCE, HEART ATTACKS, STROKES, LEG AMPUTATIONSAND PROMISING TO DOUBLE THE NUMBER BY THE YEAR 2030, TARGETTING VERY SPECIFICALLY YOUR KIN - SIBBLINGS, CHILDREN AND GRANDCHILDREN!

E D A P

P NA PILIPINAS! E GISING N D A
R E FERNANDO MD PRESIDENT, ISDFI 2009

0 2

1 1

N O C

N E V

I T

N O

N O INTRODUCING C 1 1 0 2 THE P E INFLAMMMATORY TRIANGLE N D A E 2011 D A P

REF MD PCP PSEM PSD

WELCOME TO I T A TASTE OF TOMORROW N

N O

E V

DM2

E D A P

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P E

0 2

1 1

N O C

N E V

I T

N O

E D A P

N D A

P E

0 2

1 1

N O C

N E V

I T

N O

DM

N EC DYSFUNCTION BY OXIDATIVE STRESS E V N O C 1 1 0 2 P E N D A E D A

PERTICONE ET AL DIAB 2001 50;159-165

OBESITY

I T

N O

E D A P

N D A

P E

0 2

1 1

N O C

N E V

I T

N O

DM OB/

HPN

E D A P

N D A

P E

0 2

1 1

N O C

N E V

I T

N O

HPN

E D A P

N D A

P E

0 2

stroke

1 1

N O C

N E V

I T

N O

DM OB

AS

HISTORY

INFLAMM IS THE UNDERLYING CAUSE OF ATHEROSCLEROSIS 1815 HODGSON 1858 VIRCHOW 1999 ROSS NEJ M 340;115-126

DRUGS ADDRESSING INFLAMM ARE MORE EFFECTIVE IN RX AND PREVENTION OF C V D HIGH CHOL IS NOT THE ULTIMATE CAUSE OF ATHEROSCLEROSIS 90% OF CHOL 150-300 USELESS IN PREDICTING CAD 150 300 FRAMINGHAM 35% OF 150-200 HAD CAD 35% OF 230-300 HAD CAD IN THE USA HALF OF MI AND STROKES HAVE NORMAL CHOL CHOLESTEROL DOES NOT CORRELATE WITH DEGREE OF AS AT AUTOPSY OR ON ANGIOGRAPHY H S C R P USEFUL BUT NOT A UNIVERSAL MARKER

E D A P

N D A

P E

0 2

1 1

N O C

N E V

I T

N O

E D A P

N D A

HPN

Pstroke E

0 2

1 1

N O C

N E V

I T

N O

AS DYSLIP

DM/OB

ENTER INTO THE WORLD OF INFLAMMATION

A REALITY THAT HAS ESCAPED OUR ATTENTION OVER THE PAST 10 Y ref 2010 @

AT CENTERSTAGE

HPN
Beyond bp ANG II ENOS

E D A P

N D A

P E

ECD OXI-STRESS INFLAMM CYTOKINES TNFa ET-1 CYCLOOGYGENASE

0 2

1 1

N O C

N E V

I T

N O

AS
DYSLIP
Beyond lipids

DM OBESITY
BLOOD SUGAR INSULIN R FATTY ACIDS

T2DM is Associated with Serious Microvascular and Macrovascular Complications

MICROVASCULAR Retinopathy, glaucoma or cataracts

MACROVASCULAR

Nephropathy p p y

E D A P

Neuropathy

N D A

P E

0 2

1 1

N O C

Cerebrovascular disease

N E V
CHD

I T

N O

Peripheral vascular disease

WHO/IDF. The economics of diabetes and diabetes care: a report of the Diabetes Health Economics Study Group. Geneva/Brussels: WHO/IDF, 1999.

FINALLY

TEACH PEOPLE EAT LESS MOVE MORE

E D A P

N D A

P E

THE PRIEST BMI 23 W/H RATIO /

0 2

1 1

N O C

N E V

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N O