TACKLING T2DM IN ASIA: A MULTISECTORIAL APPROACH Prevention and Control of Diabetes: A Public Health Leadership Forum May 17, 2010 The Department of Nutrition, Harvard School of Public Health Dr Chia Kee Seng Dr Chia Kee Seng Professor and Head, Department of Epidemiology and Public Health Professor and Head, Department of Epidemiology and Public Health Director, NUS-GIS Centre for Molecular Epidemiology Director, NUS-GIS Centre for Molecular Epidemiology Professor of Epidemiology, Kaolinska Institutet, Sweden Professor of Epidemiology, Karolinska Institutet, Sweden 1
PREVALENCE OF DIABETES MELLITUS IN ASIA 2010 330 million diabetics globally, 92.4 million from China alone Singapore 247 miles 2 , 4.9m/3.7m 2030 Projected 500 million globally With 50% in Asia Diabetes Atlas, 4 th ed, IDF, 2009 2
TOP 10: PREVALENCE OF DM, 2010 (I DF, 2009) Country/Population Prevalence (%) Nauru 30.9 UAE 18.7 Saudi Arabia 16.8 Mauritus 16.2 Bahrain 15.4 Reunion 15.3 Kuwait 14.6 Oman 13.4 Tonga 13.4 Malaysia 11.6 Singapore: ALL 10.2 Singapore: Chinese 7.1* Singapore: Malay 11.0* Singapore: Indian 15.3* * NHS 2006 3
Prevalence of T2DM in Singapore 9 Age-std. Prevalence (%) of T2DM 8 7 6 5 4 3 2 1 0 1975 1984 1992 1998 2004 National Health Survey 2004, Ministry of Health, Singapore 4
Type II Diabetes Mellitus Impaired Glucose Tolerance National Health Survey 2004, Ministry of Health, Singapore 5
AGE-SPECI FI C PREVALENCE OF T2DM M F Total National Health Survey 2004, Ministry of Health, Singapore 6
Singapore Burden of Disease Study, 2004 7
Singapore Burden of Disease Study, 2004 8
Singapore Burden of Disease Study, 2004 9
Type II Diabetes Mellitus 10
FTO : Gene-Exercise interaction Singapore Chinese 2 Change in BMI (kg/m 2 ) 1.5 1 0.5 0 1 risk allele 2 risk allele -0.5 No exercise Light exercise Hard exercise -1 11
MAJOR RI SK FACTORS “Metabolically obese” Sedentary lifestyle Over-nutrition 12
TREND I N PREVALENCE OF OBESI TY* BY GENDER AND ETHNI C GROUPS Malay Indian F Total Chinese M *BMI >=30 kg/m 2 National Health Survey 2004, Ministry of Health, Singapore 13
Asians are different from Caucasians and from each other in their BMI/body fat percent relationship. Obes Rev 2002;3(3):141-146 14
TREND I N PREVALENCE OF OBESI TY* BY GENDER AND ETHNI C GROUPS F Total M F Total M *BMI >=30 kg/m 2 *BMI >=27.5 kg/m 2 National Health Survey 2004, Ministry of Health, Singapore 15
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TREND I N PREVALENCE OF REGULAR EXERCI SE* BY GENDER AND ETHNI C GROUPS Indian Malay Chinese M Total F * >=3/week; >20 minutes each National Health Survey 2004, Ministry of Health, Singapore 19
Physical inactivity* in Singapore No time Too tired Too lazy Others Age * Not participating in any sports of exercise National Health Survey 2004, Ministry of Health, Singapore 20
National Nutrition Survey, 2004 21
PROPORTI ON OF SI NGAPOREANS WI TH EXCESSI VE I NTAKE OF SELECTED NUTRI ENTS: 1998, 2004 National Nutrition Survey, 2004 22
Mean intake (servings) and proportion of subjects meeting recommended servings of basic food groups, NNS 1998 and 2004 Servings Proportion National Nutrition Survey, 2004 23
Sweetened drinks consumption: Singapore National Nutrition Survey, 2004 Age 24
B Home Hawker Centre Workplace/School Restaurant Fast Food N.A. L Home Hawker Centre Workplace/School Restaurant Fast Food N.A. D Home Hawker Centre Workplace/School Restaurant Fast Food N.A. National Nutrition Survey, 2004 25
� Aging Population CHALLENGES 26
Number of vehicle registrations CHALLENGES 1,000,000 Motorized vehicles 900,000 � Aging Population 800,000 700,000 � Increasing car Cars & station-wagons 600,000 population 500,000 400,000 300,000 200,000 100,000 0 Land Transport Authority, Annual Vehicle Statistics , 2009 27
CHALLENGES � Aging Population 1998 2008 � Increasing car Number of food hawkers 2,261 7,892 population Food establishments 8,782 12,578 � Increase in food Bookings of sports facilities 536,336 669,919 establishments; slow increase in sporting activities Dept of Statistics, Singapore Yearbook of Statistics, 2009 28
GAI proposal: Tackling Type 2 Diabetes Mellitus in Asia – A Multidisciplinary and Multisectoral I nitiative 29
GAI proposal: Tackling Type 2 Diabetes Mellitus in Asia – A Multidisciplinary and Multisectoral I nitiative � OBJECTIVES � Summarize existing knowledge of T2DM epidemic, preventive measures and strategies. Compile various programmes and strategies in use in Singapore and Asia. � Convene a multidisciplinary and multi-sectoral stakeholder group to take ownership in tackling T2DM epidemic. � Identify gaps in current knowledge and conduct feasibility studies in these areas. � Develop a comprehensive preventive strategy and pilot programme for implementation. � Develop a policy paper that will be relevant to Asia. 30
GAI proposal: Tackling Type 2 Diabetes Mellitus in Asia – A Multidisciplinary and Multisectoral I nitiative � STAGES � Stage 1 • Compilation and analyses • Convene a multidisciplinary and multisectoral Stakeholder Group � Stage 2 • Presentations to Stakeholder Group • Identify and prioritize gaps in current knowledge � Stage 3 • Conduct pilot and feasibility studies � Stage 4 • Develop a comprehensive preventive strategy and pilot programme • Develop policy paper 31
HEALTHCARE SECTOR Specialists, POLICY AND SOCIO- primary care LEGISLATION BEHAVIORAL doctors, SECTOR SECTOR epidemiologists, Policy analysts, Sociologists, public health policy makers psychologists, practitioners economists, educationists CITY MANAGEMENT FOOD AND SECTOR BEVERAGE Urban and INDUSTRY transport Importers, planners production, sales, R&D 32
TASKFORCE HEALTHCARE SECTOR POLICY AND SOCIO- LEGISLATION BEHAVIORAL SECTOR SECTOR CITY FOOD AND MANAGEMENT BEVERAGE SECTOR INDUSTRY 33
PI LOT PROGRAMME � INCREASE PHYSICAL ACTIVITY � Paradigm shift: ‘Physical activity as part of everyday living and not merely a leisure’. � DECREASE INTAKE OF CALORIES AND CARBOHYDRATES � Paradigm shift: ‘Low calories and high fibre is good for business’. 34
PUNGGOL 21 35
http://www.nus-cme.org.sg/ Infrastructure for health screening and health monitoring of large number of subjects 36
USE OF MODERN TECHNOLOGI ES I N POPULATI ON STUDI ES Biosensors Bluetooth BODY AREA NETWORK GPRS WiFi NEEDED Respiratory rate plaster Heart rate plaster BP plaster Motion sensors plaster O 2 saturation plaster 37
TREND I N LUNG CANCER I NCI DENCE AND SMOKI NG, MALES, SI NGAPORE 38
PROJECTED TREND I N T2DM PREVALENCE, SI NGAPORE 39
Thank you for your attention Department of Epidemiology and Public Health NUS-GIS Centre for Molecular Epidemiology 40
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