In The Fifth Century Bc, Heraclitus Observed That
A Healthcare Model for the 21st Century C i t y C l u b o f C l e v e l a n d | a u g u s t 1 8 , 2 0 1 0 It is an honor to be invited here today. The City Club Forum has always been an outstanding platform for the discussion of important issues. nothing is permanent but change. Healthcare is changing. I’d like briefly to outline these changes, and discuss the effect on patients, diseases, treatments, delivery systems, caregivers and, finally, costs. Healthcare and the economy are in the midst of historic realignments. Cleveland Clinic needs to innovate and evolve if we are to continue to serve our patients and remain an economic engine for the region. Let me begin with a look at the changes in our own community. The city of Cleveland has shrunk dramatically over the past sixty years. The population has fallen – from nine hundred thousand to less than four hun- dred thousand. Cuyahoga County has seen similar but less dramatic change. The population has dropped from 1.7 million to less than 1.3 million. We are treating a different mix of diseases today than in the past. Infant mortality has decreased by ninety-five percent. Devastating infectious diseases like tuberculosis and polio have been virtually eliminated. Life expectancy has gone up to seventy-eight years. We’re seeing more patients who are sixty-five and older. This number is set to explode to more than fifty million people over the next ten years. As life expectancy goes up, the causes of disease and death are changing. Chronic diseases of aging were only three of the six major causes of death in 1960. Today, they are six of the seven major causes of death. Alzheimer’s disease is now more common than diabetes. There are five million cases today. That number will nearly triple by 205 Continue reading >>
Health Risks Of Inhalation Insulin For Diabetics
Diabetes is a disease in which the body does not produce and/or properly use insulin—in other words, the body is insulin resistant.1 The treatment of type I and some cases of type II diabetes with subcutaneous insulin injections is sometimes associated with lack of compliance due to the pain of multiple daily injections.2 Hence, there is a big demand for insulin that can be administered without painful shots. Development of such an insulin delivery system could open the way to a multibillion-dollar market, while making diabetics more treatment-compliant. The search for a non-injectable form of insulin continues as the diabetic population all over the world continues to explode.3-5 An apparent advance arrived with the development of a preparation that could simply be inhaled.6 While the FDA had deemed this novel insulin preparation safe and effective, many questions regarding its long-term health effects remained unresolved.7-9 After an article was published on the potential cancer-causing effects of inhaled insulin using a medication called Exubera®, the Pfizer company withdrew the drug, taking a $2.5 billion loss.10-12 Pfizer later reported the development of lung cancer in six patients who had used inhaled insulin. Pfizer’s timely withdrawal potentially saved hundreds of diabetics using inhaled insulin from developing cancer.13 Unfortunately, on June 27, 2014, the FDA approved another inhaled insulin drug.7 It is obvious that the FDA did not thoroughly look at the ill effects of inhaled insulin. What Causes Diabetes? Insulin is a hormone secreted by endocrine cells (specifically beta cells located in the islets of Langerhans) of the pancreas and is essential for human life. It works by interacting with the insulin receptors on cell membranes to facilitate the ent Continue reading >>
Diabetes & Obesity
According to the Center for Disease Control, we are eating ourselves into a diabetes epidemic. The International Diabetes Foundation (IDF) says that, “Diabetes and obesity are the biggest public health challenge of the 21st century.” The supporting statistics they cite are staggering: As of 1999, diabetes affected 16 million (six percent) of Americans – an increase of 40 percent in just ten years. During the same period, the obesity rate climbed from 12 percent to almost 20 percent. Last year the diabetes and obesity rates increased 6 percent and 57 percent. Every three seconds, someone is diagnosed with diabetes. Of the children born in 2000, one in three will eventually develop diabetes. Although both diabetes and obesity risk factors are often associated with race, age, and family history, it’s becoming more and more clear that the conveniences of modern life also contribute to the development of both diseases. For example, sedentary lifestyles (reduced physical activity) and the popularity of high fat, high energy diets (think “Super Size Me”) and convenient foods are known to lead to obesity – but do they also cause diabetes? Is There a Link Between Obesity and Diabetes? Of the people diagnosed with type II diabetes, about 80 to 90 percent are also diagnosed as obese. This fact provides an interesting clue to the link between diabetes and obesity. Understanding what causes the disease will hopefully allow us to prevent diabetes in the future. Being overweight places extra stress on your body in a variety of ways, including your body’s ability to maintain proper blood glucose levels. In fact, being overweight can cause your body to become resistant to insulin. If you already have diabetes, this means you will need to take even more insulin to get sug Continue reading >>
Chronic Disease: The Epidemic Of The Twentieth Century Dora Anne Mills University Of New England, [email protected]
Maine Policy Review Volume 9 | Issue 1 Follow this and additional works at: Part of the Community Health and Preventive Medicine Commons, Epidemiology Commons, Health Policy Commons, and the Public Health Education and Promotion Commons This Article is brought to you for free and open access by DigitalCommons@UMaine. Recommended Citation Mills, Dora Anne. "Chronic Disease: The Epidemic of the Twentieth Century." Maine Policy Review 9.1 (2000) : 50 -65, 50 · MAINE POLICY REVIEW · Winter 2000 CHRONIC DISEASE Chronic Disease: The Epidemic of the Twentieth Century by Dora Anne Mills One hundred years ago, the leading causes of death were infectious diseases such as tuberculosis, influenza and pneu- monia. Of equal concern were water-borne diseases such as cholera and typhoid. Yet today, as a result of public health measures to clean up our drinking water and provide immunizations, and by improvements in medical care, such diseases have been eradicated. - As Dora Anne Mills points out, as we begin a new century, we have much to celebrate but still more to consider. Today, we face an epidemic unlike any found in 1900. One hundred years ago only one-in-six people died of a chronic condition; today, three-quarters of Maine people die from four chronic, and mostly preventable, diseases: cardiovascular disease, cancer, chronic lung disease, and diabetes. Not only does Maine have the fourth highest death rate due to chronic disease, it also leads the nation in the three behavioral risk factors that cause or exacerbate chronic disease: tobacco use, poor nutrition, and physical inactivity. - In this article, Mills first chronicles Maine�s c hronic disease epidemic, and second, lays out a plan for strengthening the state�s disease prevention and health promotion effor Continue reading >>
Correlation Between Hemoglobin A1c And Serum Lipid Profile In Afghani Patients With Type 2 Diabetes: Hemoglobin A1c Prognosticates Dyslipidemia
Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular diseases (CVDs). This study is an attempt to determine the correlation between hemoglobin A1c (HbA1c) and serum lipid profile and to evaluate the importance of HbA1c as an indicator of dyslipidemia in Afghani patients with T2DM. A total of 401 Afghani patients with T2DM (men, 175; women, 226; mean age, 51.29 years) were included in this study. The whole blood and sera were analyzed for fasting blood sugar (FBS), HbA1c, total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Diabetes was defined as per American Diabetes Association criteria. The correlation of FBS, HbA1c with lipid ratios and individual lipid indexes were analyzed. The statistical analysis was done by SPSS statistical package version 16.0. The mean age ± standard deviation of male and female patients were 51.71 ± 11.70 and 50.97 ± 10.23 years respectively. There was a significant positive correlation between HbA1c, TC, TG, LDL-C and LDL-C/HDL-C ratio. The correlation between HbA1c and HDL-C was negative and was statistically nonsignificant. Furthermore, HbA1c was found to be a predictor of hypercholesterolemia, LDL-C and TG via a linear regression analysis. Patients with HbA1c value greater than 7.0% had significantly higher value of cholesterol, LDL-C, and LDL-C/HDL-C ratio compared with patients with an HbA1c value up to 7.0%. Apart from a reliable glycemic index, HbA1c can also be used as a predictor of dyslipidemia and thus early diagnosis of dyslip Continue reading >>
- Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?
- Diabetes Dyslipidemia
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
Is Diabetes Becoming The Biggest Epidemic Of The Twenty-first Century?
Diabetes is a major public health problem that is approaching epidemic proportions globally. Worldwide, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate. About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major predisposing factors. Today, more than 1.7 billion adults worldwide are overweight, and 312... [Show full abstract] India with a pluralistic society has a mixed economy. The total expenditure on health is shared by the government and the non-governmental resources. The per capita public sector expenditure is rupees 53.6 , net National Product 663.5, and the per capita income rupees 3284 only. The proportion of Health & Family Welfare investment to the total plan investment allocation has remained barely 3.7... [Show full abstract] Throughout history human populations have undergone shifts in their relations with disease - shifts that are always linked to major changes in the way people interact with the environment. in the past two decades the emergence of illnesses such as Hepatitis C, cat scratch disease, Ebola Virus, Hanta Virus and others has created a third epidemiological transition, a disheartening act of changes... [Show full abstract] India with a pluralistic society has a mixed economy. The total expenditure on health is shared by the government and the non-governmental resources. The per capita public sector expenditure is rupees 53.6 , net National Product 663.5, and the per capita income rupees 3284 only. The proportion of Health & Family Welfare investment to the total plan investment allocation has remained barely 3.7... [Show full abstract] Continue reading >>
Is Diabetes Becoming The Biggest Epidemic Of The Twenty-first Century?
Diabetes is a major public health problem that is approaching epidemic proportions globally. Worldwide, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate. About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major predisposing factors. Today, more than 1.7 billion adults worldwide are overweight, and 312 million of them are obese. In addition, at least 155 million children worldwide are overweight or obese. A diabetes epidemic is underway. According to an estimate of International Diabetes Federation comparative prevalence of Diabetes during 2007 is 8.0 % and likely to increase to 7.3% by 2025. Number of people with diabetes is 246 million (with 46% of all those affected in the 40–59 age group) and likely to increase to 380 m by 2025. The comparative prevalence of IGT is 7.5% in 2007 and likely to go up to 6.0 by 2025. The number of people with IGT is 308 million in 2007 and likely to be 418 m by 2025. (1) Almost 80% of the total adult diabetics are in developing countries. The regions with the highest rates are the Eastern Mediterranean and Middle East, where 9.2 % of the adult population is affected, and North America (8.4%). The highest numbers, however, are found in the Western Pacific, where some 67 million people have Diabetes, followed by Europe with 53 million. India leads the global top ten in terms of the highest number of people with diabetes with a current figure of 40.9 million, followed by China with 39.8 million. Behind them come USA; Russia; Germany; Japan; Pakistan; Brazil; Mexico and Egypt. Two major concerns are that much of this increase in Diabetes will occur in developing countries and that there is a growing incidence of Type 2 Diabetes at a younger age in Continue reading >>
Healthy Policy Poster_new
Diabetes is the loss of the body's ability to respond to or produce the hormone insulin resulting in elevated glucose levels Continue reading >>
Diabetes: The Cost And Effects
Throughout history, human kind has been afflicted by epidemics like cholera, malaria, tuberculosis, influenza etc that have wiped off millions of lives across the globe. In modern times, we have seen HIV/Aids, Ebola and most recently Zika virus adding to the list of epidemics. The common factor in all these cases is that they are communicable diseases. But the biggest epidemic of the 21st century that is affecting the global population is a non-communicable disease – diabetes. According the International Diabetes Federation (IDF) Diabetes Atlas 2015, some 415mn people or 8.8 per cent of adults aged 20-79, worldwide are estimated to have diabetes. About 75 per cent of them live in low- and middle- income countries. If these trends continue, by 2040 some 642mn people, or one adult in ten, will have diabetes. Oman has one of the highest prevalence of diabetes in the world and in 2015 there were over 300,000 cases in the country according to IDF. Diabetes has far-reaching consequences that not only affects an individual's health, but his/her's family's well being, finances employment and a country's economy as whole. According to various reports, majority of the countries spend 5-20 per cent of their health expenditure for the disease and the losses in GDP worldwide from 2011 to 2030, including both the direct and indirect costs of diabetes, will total US$1.7tn. It comprises US$900bn for high-income countries and US$800bn for low- and middle-income countries. Dr Ali Saif al Mamari, senior consultant & head of Endocrinology at Sultan Qaboos University, says, “Around 13-17 per cent of Omanis have diabetes, which is a cause of great concern. The government provides free medical care to Omanis and a significant amount of its healthcare budget goes to the treatment of diabet Continue reading >>
Diabetes Mellitus In Pakistan: A Major Public Health Concern
1 Department of Medicine & Allied, Northwest General Hospital and Research Centre, Peshawar, Pakistan 2 Department of Pharmacy Services, Northwest General Hospital and Research Centre, Peshawar, Pakistan Correspondence Address: Iftikhar Ali Department of Pharmacy Services, Northwest General Hospital and Research Centre, Sector A3, Phase V, Hayatabad, Peshawar Pakistan Source of Support: None, Conflict of Interest: None DOI: 10.4103/2045-080X.174943 How to cite this article: Hussain A, Ali I. Diabetes mellitus in Pakistan: A major public health concern. Arch Pharma Pract 2016;7:30-2 Dear Editor, Diabetes Mellitus (DM) is one of the most prevalent diseases worldwide with an increasing incidence. As a leading cause of morbidity and mortality, it poses an enormous challenge to public health. Reaching epidemic proportions globally, it has emerged as a great socioeconomic burden for the developing world. There is a significant rise in the prevalence of this illness over the past two decades is cause for alarm. According to the current statistics of the International Diabetes Federation (IDF), it has been projected that approximately1 in 11 adults (415 million) has diabetes and is expected to reach 1 in 10 adults (642 million) by 2040. Statistically, the prevalence of DM in Pakistan is high; ranging from 7.6% (5.2 million populace) to 11% in 2011, it is estimated to reach 15% (14 million) by 2030. This places Pakistan at number 7 in the list of countries with a prevalence of DM, and, if the present situation continues, is expected to move to 4 Place. This concerning position presents a challenge for health care professionals and health care policy makers in Pakistan. According to various population-based studies and national surveys, the overall ratio of DM is about 22.04% in Continue reading >>
See The Light: Good Eye Health Is Extra Important For Diabetics
Diabetes, and its prevalence among adults and children, is quickly becoming one of the biggest epidemics of the 21st century. Its growing prevalence has become a topic of concern and health professionals are redoubling their efforts to educate the public to its harmful health complications, including heart attack, stroke — and eye conditions that can cause blindness. “Diabetes is an endocrine disorder that causes blood sugar levels to rise higher than normal. The most common form is type 2 diabetes, where the body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level,” says Dr. Phillip J. Calenda, an ophthalmologist at NewYork-Presbyterian Hudson Valley Hospital in Cortlandt Manor. “High blood sugar can lead to problems such as cataracts, diabetic retinopathy, and glaucoma. In fact, diabetes is the primary cause of blindness in adults ages 20 to 74. Cataracts: A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. “In most instances, cataracts are associated with age-related changes in the eye, though other factors, such as medication, surgery, sun exposure, and disease can also play a role in its development,” says Dr. Calenda. Diabetes can lead to cataracts in younger people as well, and the condition worsens at a faster rate than for non-diabetics. If left untreated, cataracts can cause blindness. In fact, the condition is the leading cause of blindness in the world, according to the Centers for Disease Control & Prevention. A minimally invasive surgical procedure eliminates cataracts from the eyes, but whether surgery is needed depends on the degree of vision loss and whether it affects quality Continue reading >>
The Growing Pandemic Of Type 2 Diabetes: A Crucial Need For Prevention And Improved Detection
Paul Z. ZIMMET,AO, MD, PhD, FRACP, FRCP, FTSE Baker IDI Heart and Diabetes Institute, Caulfield, Melbourne Victoria, AUSTRALIA Changes in human behavior and lifestyle associated with globalization have resulted in a dramatic increase in the prevalence and incidence of type 2 diabetes globally. Until recently, there was a strong emphasis on genetic susceptibility, and on environmental and behavioral factors such as a sedentary lifestyle, overly rich nutrition, and obesity (particularly central adiposity). More recently, focus has shifted to the potential contribution of the maternal environment and the impact of in-utero influences, ie, the role of epigenetics. This may be an important factor in the very high prevalences of type 2 diabetes now being seen in nations such as India and China, two countries that numerically bear the main brunt of the epidemic. Type 2 diabetes is appearing increasingly in children and adolescents, and the frequency of diagnosis of pediatric type 2 diabetes is outstripping that of type 1 diabetes in some countries already. The prevention of diabetes and control of its micro- and macrovascular complications will require a major integrated approach directed at societal and individual behavioral change if we are to see significant reduction in the huge premature morbidity and mortality it causes. Diabetes is looming as one of the greatest threats to public health in the 21st century. This is an impelling rationale for strengthening efforts for its prevention and control. Medicographia. 2011;33:15-21 (see French abstract on page 21) If anyone had predicted 30 years ago that diabetes mellitus would be one of the biggest public health problems facing the human race in 2010, they would not have been taken seriously. Yet, in 1977, when we published th Continue reading >>
Is Diabetes Becoming The Biggest Epidemic Of The Twenty-first Century?
Each year, 7 million people develop Diabetes and the most dramatic increases in type 2 Diabetes have occurred in populations where there have been rapid and major changes in lifestyle, demonstrating the important role played by lifestyle factors and the potential for reversing the global epidemic. Pre-diabetes is present in about 23% of adults under the age of 34 years In adults over the age of 65, a total of 51% have pre-diabetes and 27% have diabetes Mark Priemer shares with us how to deal with diabetes and some insights into a new Infinitus Product soon to be released. Continue reading >>
A Twenty-first Century Cancer Epidemic Caused By Obesity: The Involvement Of Insulin, Diabetes, And Insulin-like Growth Factors
Copyright © 2013 Rosalyne L. Westley and Felicity E. B. May. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Obesity has reached epidemic proportions in the developed world. The progression from obesity to diabetes mellitus type 2, via metabolic syndrome, is recognised, and the significant associated increase in the risk of major human cancers acknowledged. We review the molecular basis of the involvement of morbidly high concentrations of endogenous or therapeutic insulin and of insulin-like growth factors in the progression from obesity to diabetes and finally to cancer. Epidemiological and biochemical studies establish the role of insulin and hyperinsulinaemia in cancer risk and progression. Insulin-like growth factors, IGF-1 and IGF-2, secreted by visceral or mammary adipose tissue have significant paracrine and endocrine effects. These effects can be exacerbated by increased steroid hormone production. Structural studies elucidate how each of the three ligands, insulin, IGF-1, and IGF-2, interacts differently with isoforms A and B of the insulin receptor and with type I IGF receptor and explain how these protagonists contribute to diabetes-associated cancer. The above should inform appropriate treatment of cancers that arise in obese individuals and in those with diabetes mellitus type 2. Novel drugs that target the insulin and insulin-like growth factor signal transduction pathways are in clinical trial and should be effective if appropriate biomarker-informed patient stratification is implemented. Continue reading >>
Diabetes: The Epidemic
On Barbara Young's office table is a graph. A bar chart, actually: four columns of green, purple, red and bright blue showing the progression, in England, of rates of coronary heart disease, stroke, cancer and diabetes over the past five years. The first two are flatlining or falling. Cancer, in red, is rising, but slowly. Trace a line between the blue bars from 2005 to 2010, and it soars off the chart. "Diabetes," says Young flatly, "is becoming a crisis. The crisis. It's big, it's scary, it's growing and it's very, very expensive. It's clearly an epidemic, and it could bring the health service to its knees. Something really does need to happen." Baroness Young is, admittedly, the chief executive of Diabetes UK, Britain's main diabetes charity and campaigning group. It's her job to say such things. But the figures are behind her all the way: diabetes is fast becoming the 21st century's major public-health concern. The condition is now nearly four times as common as all forms of cancer combined, and causes more deaths than breast and prostate cancer combined. Some 2.8m people in the UK have been diagnosed with it; an estimated 850,000 more probably have type 2 diabetes but don't yet know. Another 7m are classified as high-risk of developing type 2; between 40% and 50% of them will go on to develop it. By the year 2025, more than 5m people in this country will have diabetes. The implications for the NHS, obviously, don't bear thinking about. Diabetes already costs the service around £1m an hour, roughly 10% of its entire budget. That's not just because the condition generally has to be managed with medication or insulin, but because by the time they are diagnosed, around half the people with type 2 – by far the most common and fastest growing form – have developed a Continue reading >>
