Diabetes in Punjab

By: Misbah Mehdi Merchant, Nashit Irfan Aziz

Samreena Sardar, Shaharyar Usman (Group 13)
Problem Statement
What is Diabetes?
-chronic disease
-impaired production or utilisation of Insulin
-Insulin is a hormone that regulates blood
glucose.
-over time leads to damage systems:
especially the nerves and blood vessels
(heart, brain, eye, kidneys)

-Heart attack, stroke, vision loss, kidney

failure, foot ulcers, amputations

-types
Tomic D, Shaw JE, Magliano DJ. The burden and risks of emerging complications of
diabetes mellitus. Nature Reviews Endocrinology. 2022 Sep;18(9):525-39.
Why is it a public health issue?

- high prevalence

-complications

-economic impact

-risk factors influenced by

determinants (social, economic, and
environmental)

-health inequities

-lifestyle factors
-Through complications → kills 5 million people annually worldwide
(premature)

-healthcare expenditures for diabetics x2 higher than normal

-needs medications to treat the conditions of complications for primary care

physicians

-needs constant reviews by (different) specialists

Burden
402203DAge-standardised total diabetes prevalence rates in 2021OI
Prevalence of total diabetes by age and GBD super-region in 2021
Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Annals of
medicine and surgery. 2022 Jul 1;79.
Weighted
prevalence of
Diabetes by
provinces (2nd
NDSP, 2016-
2017)
Basit A, Fawwad A, Qureshi H, Shera AS.
Prevalence of diabetes, pre-diabetes and
associated risk factors: second National
Diabetes Survey of Pakistan (NDSP),
2016–2017. BMJ open. 2018 Aug
1;8(8):e020961.
Prevalence of
Diabetes till
2018, by meta-
analysis

Aamir AH, Ul-Haq Z, Mahar SA, Qureshi FM,

Ahmad I, Jawa A, Sheikh A, Raza A, Fazid S,
Jadoon Z, Ishtiaq O. Diabetes Prevalence
Survey of Pakistan (DPS-PAK): prevalence of
type 2 diabetes mellitus and prediabetes using
HbA1c: a population-based survey from
Pakistan. BMJ open. 2019 Feb 1;9(2):e025300.
-According to the International Diabetes
Federation estimation, 26.7% of adults in
Pakistan have DM-2 (approximately 33
million)
-This placed Pakistan having the 3rd
Largest burden, globally (2021)
-Annual per capita expenditure = USD
332.9 (OOPE)
-Pakistan per capita health spending is
less than WHO low-income countries, ie,
USD 38 compared to USD 86
-System is underresourced and
overburdened
-Currently, NCDs are managed individually
through specialized care , with underutility
of PHC and lack of preventative strategies
-Community based LHW, and staff at BHU
don’t provide education or early
diagnostic/management service
Burden from complications ….
Risk factors
-Age

-Gender
-Family history

- Socioeconomic status

- Poor diet
-Sedentary lifestyle

-Genetic predisposition

-Behavioural factors
In context of (Punjab) Pakistan
-urbanization

-noncompliance to medication

-anthropometrics

-hypertension

-obesity

-dyslipidemia

-behavioural and social

-environmental factors

-healthcare access

-limited infrastructure

-healthcare delivery challenges

-low levels of education

Summary of risk factors
Intervention
 Existing strategies in Pakistan

CREATING PROMOTING PRIMARY DEFINING STRATEGIES IMPLEMENTING A

MULTIDISPLINARY TEAMS PREVENTION AND FOR THE MANAGEMENT NATIONWIDE DIABETES
AWARENESS AND PREVENTION OF CARE PROGRAM
DIABETES AND ITS
COMPLICATION
Insulin – My life The Diabetic Foot
Program
Some more progress…

First, government has formally Second, formation of the Center Third, initiation of a Universal
adopted the Disease Control for Disease Control (CDC Health Insurance Scheme (Sehat
Priorities recommended Pakistan), has the mandate of Sahulat Card) under federal and
interventions. seeing surveillance programmes provincial oversight.
Proposed service model
Suggested interventions:
LHWs and BHU Staff can provide education to improve primary
care via triage services and community mobility

Establishment of population based registries (DROP)

Rapid growth of IT and DHIS should lead to relevant

information on DM

Link provincial health and information technology with federal

information and registries

Health insurance programs can expand to ambulatory care

services to reach more marginalized communities
References

1. https://www.who.int/health-topics/diabetes
2. Tomic D, Shaw JE, Magliano DJ. The burden and risks of emerging complications of diabetes mellitus. Nature Reviews
Endocrinology. 2022 Sep;18(9):525-39.
3. Basit A, Fawwad A, Siddiqui SA, Baqa K. Current management strategies to target the increasing incidence of diabetes
within Pakistan. Diabetes, metabolic syndrome and obesity: targets and therapy. 2018 Dec 27:85-96.
4. Bhutta ZA, Haq ZU, Basit A. Diabetes in Pakistan: addressing the crisis. The Lancet Diabetes & Endocrinology. 2022 May
1;10(5):309-10.
5. Basit A, Fawwad A, Qureshi H, Shera AS. Prevalence of diabetes, pre-diabetes and associated risk factors: second National
Diabetes Survey of Pakistan (NDSP), 2016–2017. BMJ open. 2018 Aug 1;8(8):e020961.
6. Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Annals of medicine and surgery.
2022 Jul 1;79.
7. Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R,
Abolhassani H. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study
2019. The Lancet diabetes & endocrinology. 2022 Mar 1;10(3):177-92.
8. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JC, Mbanya JC, Pavkov ME. IDF
Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045.
Diabetes research and clinical practice. 2022 Jan 1;183:109119.
9. Naseer S, Malkera A, Khan N, Siddiqui AH, Khan SA, Ali S, Israr M. Prevalence of diabetic complications in urban and rural
population of Punjab. Pakistan Journal of Medical & Health Sciences. 2022 Mar 27;16(03):69-.
10. Ali QM, AkramM IA, Shafique S, Ullah HM, Khan R, Masroor M, Chaudhary GM. Factors Associated with Poor Glycemic
Control: A Real World Data from a Private Outpatient Clinic of South Punjab, Pakistan. Hypertension. 2022;472(3):52-7 .
Thankyou