04/03/2020

Diabetes In The City

SH7003

What is Diabetes Mellitus? (T1 &T2)

• http://www.who.int/mediacentre/factsheets/fs138/en/

1
 04/03/2020

no data 45–52.5
≤ 7.5 52.5–60
7.5–15 60–67.5
15–22.5 67.5–75
22.5–30 75–82.5
30–37.5 ≥ 82.5
37.5–45

World Atlas of Diabetes

Overview of Prevalence
• Globally, an estimated 422 million adults are living with diabetes
mellitus (WHO 2016).
• Diabetes prevalence is increasing rapidly; previous 2013 estimates
from the International Diabetes Federation put the number at 381
million people having diabetes.[ The number is projected to almost
double by 2030.
• Type 2 diabetes makes up about 85-90% of all cases. Increases in the
overall diabetes prevalence rates largely reflect an increase in risk
factors for type 2, notably greater longevity and being overweight or
obese.

2
 04/03/2020

A World View 1
• Diabetes mellitus occurs throughout the world, but is more common
(especially type 2) in developed countries.
• The greatest increase in prevalence is, occurring in low- and middle-
income countries including in Asia and Africa, where the majority of
people with diabetes will be by 2030.
• The increase in incidence in developing countries follows a trend of
urbanisation and lifestyle changes, including increasingly sedentary
lifestyles, less physically demanding work and the global nutrition
transition, marked by increased intake of foods that are high energy-
dense but nutrient-poor (often high in sugar and saturated fats, ie:
the Western pattern diet).
• The risk of developing type 2 diabetes is associated with low socio-
economic status.

A World View 2
• The WHO estimates that diabetes resulted in 1.5
million deaths in 2012, making it the 8th leading
cause of death.
• However another 2.2 million deaths worldwide were
attributable to high blood sugar and the increased
risks of associated complications (e.g. heart disease,
stroke, kidney failure), which often result in
premature death and are frequently noted as the
underlying cause of death (mortality) on death
certificates rather than diabetes per se.

3
 04/03/2020

China
One Chinese adult in ten has diabetes.
A 2010 study estimated that more than 92 million Chinese adults have
the disease, with another 150 million showing early symptoms.
The incidence of the disease is increasing rapidly: a reported 30%
increase in 7 years.
Indigenous nomadic peoples like Tibetans and Mongols are at much
higher susceptibility than Han Chinese.

China & Other Countries:

https://www.youtube.com/watch?time_continue=46&v=_fA02Ui4xik

India
• Until recently, India had more diabetics than any other country in the
world, according to the International Diabetes Foundation (IDA),
although it has now been surpassed by China.
• Diabetes currently affects more than 62 million Indians, which is more
than 7.1% of the adult population.
• The average age on onset is 42.5 years & approx. 1 million Indians
die due to diabetes annually.
• According to the Indian Heart Association, India is projected to have
109 million individuals with diabetes by 2035.
• The high incidence is attributed to a combination of genetic
susceptibility plus adoption of a high-calorie, low-activity lifestyle by
India's growing middle class.

4
 04/03/2020

Africa
International Diabetes Federation (IDF) estimates that 14.2 million are
living with diabetes in Africa.
The region of Africa has the highest percentage of undiagnosed
diabetes cases reaching 66.7%, the highest proportion of diabetes
mellitus related mortality and the lowest health expenditure spent on
diabetes, world-wide

Australia
An estimated 700,000 Australians have diabetes.
Indigenous populations in developed countries generally have higher
prevalence and incidence of diabetes than their corresponding
nonindigenous populations.
In Australia, the age-standardised prevalence of self-reported diabetes in
indigenous Australians is almost four times that of nonindigenous
Australians. Reasons include higher rates of obesity, lack of physical
inactivity, and living in poor housing and environments among
Indigenous peoples.
Preventative community health programmes are showing some success
in tackling this problem.

5
 04/03/2020

Canada
• Approx 2.4 million Canadians (6.8%) have been diagnosed with type 1 or
type 2 diabetes, based on 2009 chronic disease surveillance data.
Prevalence is higher among males (7.2%) than females (6.4%). This is
probably an underestimate, as data obtained from blood samples indicate
about 20% of diabetes cases remain undiagnosed.
• Accounting for the younger age structure in Aboriginal populations, the
prevalence of diabetes is 2-3 times higher compared to the non-Aboriginal
population.
• The prevalence of diagnosed diabetes among Canadians increased by 70%
from 1999 to 2009. The greatest relative increase in prevalence was seen
younger adults (35 to 44 years), attributable in part to increasing rates of
overweight and obesity.
• If current trends in diabetes continue, the number of Canadians living with
diabetes will reach 3.7 million by 2019.

The Picture In The USA

• According to the 2014 Statistics Report by
the CDC it was found that, “Diabetes
Mellitus affects an estimated 29.1 million
people & is the 7th leading cause of
death.
• It increases the chances of mortality, as
well as the risk for heart attack, kidney
failure, and blindness.
• In 2014, more than 29 million people had
diabetes in the United States, of whom
7 million people remain undiagnosed.
• Post 2012 another 57 million people were
estimated to have prediabetes.
• There were approximately 12.1 million
diabetes-related emergency department
(ED) visits in 2010 for adults aged 18 years
or older (515 per 10,000 U.S. population),
accounting for 9.4 percent of all ED visits.
Diabetes rates at county levels 2004 - 2009.

6
 04/03/2020

USA Trends: Prevalence of Diabetes

The United Kingdom

Diabetes is the fastest modern health crisis after the number of cases doubles in
the last 20 years with 3.7million people being diagnosed
• About 3.8 million people in the United Kingdom have diabetes mellitus, but the
charity Diabetes UK predict that could rise to 6.2 million by 2035/2036.
• The NHS spend a daily average of £2.2m + (€2.6m; $3.7m) yearly on prescriptions
for managing diabetes in primary care, and about 10% of the primary care
prescribing budget is spent on treating diabetes.
• Diabetes UK have also predicted that the NHS could be spending as much as
16.9 billion pounds on diabetes mellitus by 2035 - the NHS could be spending
17% of its budget on diabetes treatment by 2035.
• Diabetes costs the NHS almost £9billion a year and one in six hospital beds at any
one time are occupied by someone with the condition.

7
 04/03/2020

Bradford: 1in 10 people are Diabetic

• Bradford is the diabetes capital of the UK
• One in ten people who live in the West Yorkshire city has diabetes compared
to the national average of 6.6 per cent.
• In comparison, Richmond (SW London) , just 3.6 per cent of residents have
the diabetes
• The occurrence of diabetes is both class linked & ethnically linked eg:
particularly Pakistanis having a high risk, more so than Indians and slightly
more than Bangladeshis. As Bradford has a large percentage of Pakistanis
living in relatively poor conditions, this impacts on the overall picture in
Bradford
• South Asians are believed to be genetically prone to diabetes & approx. 70%
of adults in Bradford are overweight or obese

Cities Changing Diabetes Project, Cities

http://www.citieschangingdiabetes.com/content/dam/cities-changing-diabetes/magazines/CCD-BriefingBook-2017-BendTheCurveOnUrbanDiabetes.pdf

• Beijing
• Copenhagen
• Hangzhou
• Houston
• Johannesburg
• Leicester
• Mexico City
• Rome
• Shanghai
• Tianjin
• Xiamen
• Vancouver

8
 04/03/2020

Prevalence of Diabetes in GB
Country 2006 % 2012 % 2013 %

England 3.6 5.5 4.8%

N Ireland 3.06 3.8 4.1%

Scotland 3.4 4.3 4.6%

WALES 4.1 5.0 5.4%

Diabetes prevalence April 2013 – QOF Database

Modern Malnutrition: more common in people from lower socioeconomic groups

• Diets high in fat, sugar and salt can result

in overweight and obesity – particularly For example, in England: the population
when a person’s intake from food and is failing to meet current recommended
drink exceeds the energy they use. dietary requirements.
• A poor diet which results in ■ children and adults eat 50% more
overweight/obesity is known as ‘modern saturated fat than the recommended
malnutrition’. A significant proportion of level
the population is failing to meet current
recommended dietary requirements.
■ children eat only one quarter, and
adults only half the recommended levels
of fruit & vegetables
■ children eat 50% more sugar than the
recommended level.

9
 04/03/2020

Undiagnosed Problems (Diabetes)

Vulnerability Assessment:
https://www.youtube.com/watch?v=DCSrzzzO0HM

Cities Changing Diabetes Project:

https://www.youtube.com/watch?time_continue=2&v=Z3KtndYE6SY
http://www.citieschangingdiabetes.com/

The following slides are for use in the seminar

session

10
 04/03/2020

Diabetes in London
• One in five adults is now obese. Twenty-three per cent of both men and women in London are obese, and a
further 39 per cent of men and 30 per cent of women are overweight.
• Black or Black British groups, representative of the largest BAME group in London, have the highest
prevalence of obesity of any ethnic group.
• Children living in the capital are more likely to be obese than elsewhere in England.
• Twelve per cent of children in London aged 4-5 years and 22 per cent of children aged 10-11 years are at risk
of being obese.
• This is higher than the national average for both age groups. The growth in the number of obese children in
London is driving up demand for extreme courses of treatment to manage their obesity.
Discuss what needs to happen to address the challenges related to “Diabetes in London”?
Consider approaches that are:
• Up-stream & Down-stream
• Age focused
• Workplace based
• Urban/ City Planning focused
• Clinical / Health Service focused

Discuss the implications of this framework in

terms of addressing Diabetes In The City

11
 04/03/2020

Intervention in the UK: Healthier You

Video (Click)

Does this approach leave any gaps that need to be addressed?

Key Considerations
• sedentary lifestyles
? Also Consider:
• obesity
• insufficient physical activity • The Metabolic Syndrome
• consumption of “fast food” / poor diet https://www.nhs.uk/conditions/metabolic-
• alcohol consumption
syndrome/
• Mental illness • Pre-Diabetes https://www.diabetes.co.uk/pre-
• low socio-economic status
diabetes.html
• genetic vulnerability • Eye health
• High stress levels
http://www.elcloc.org/index.asp?id=40&page=1
13
• Environmental Pollution
• Tobacco smoking
• Mental Health Problems & Diabetes
• Poverty https://www.diabetes.co.uk/diabetes-
complications/diabetes-and-mental-health.html
• Class Discussion: how do each of these • Medication side effects & Diabetes
factors relate to city (urban living)? http://www.medsafe.govt.nz/profs/PUarticles/anti
psychdiabetes.htm

12
 04/03/2020

Diabetes in London – a lot to explore!

Cities Changing Diabetes – how UCL is helping combat urban diabetes
• http://www.ucl.ac.uk/consultants/case-studies-pub/urbandiabetes

Understanding diabetes in London

• http://www.londonscn.nhs.uk/publication/understanding-diabetes-in-london/

Blood Sugar Rush Diabetes time bomb in London

• https://www.london.gov.uk/sites/default/files/gla_migrate_files_destination/Diabetes%20report_0.pdf
3 Dimensions of care For Diabetes ( KCL London )
• https://www.kcl.ac.uk/ioppn/depts/pm/people/acaprof/3-Dimensions-of-care-For-Diabetes-(3DFD).aspx

Link between air pollution and diabetes grows stronger

• http://geographical.co.uk/places/cities/item/2321-link-between-air-pollution-and-diabetes-grows-stronger

The London Clinical Networks

• http://www.londonscn.nhs.uk/diabetes/

Diabetes guide for London - NHS

• http://www.londonprogrammes.nhs.uk/wp-content/uploads/2011/03/Diabetes-Guide.pdf

Further Reading & Follow up

Built environment and diabetes paper:
• https://www.youtube.com/watch?v=vpyUDScZS0w

Cities Changing Diabetes Summit, video:

• https://www.youtube.com/watch?v=dr_sJY2Pk_o

Cities Changing Diabetes:

• https://www.facebook.com/CitiesChangingDiabetes/?fref=nf

With better data access, urban planners could help ease our weight problems
• https://theconversation.com/with-better-data-access-urban-planners-could-help-ease-our-weight-problems-80604

Built environment and diabetes

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878692/

The built environment and health: an evidence review

http://www.gcph.co.uk/assets/0000/4174/BP_11_-_Built_environment_and_health_-_updated.pdf

Review- Environmental Risk Factors for Developing Type 2 Diabetes

• http://www.mdpi.com/1660-4601/15/1/78/pdf.

13