World Diabetes Day: Understand Diabetes, Take Control

UNDERSTAND DIABETES

TAKE CONTROL

A campaign led by the International Diabetes Federation

The premier awareness campaign of the diabetes world When does World Diabetes Day take place? World Diabetes Day takes place on 14 November every year. The date was chosen because it marks the birthday of Frederick Banting, who, along with Charles Best, is credited with the discovery of insulin. While many events take place on or around the day itself, a themed campaign runs throughout the year, with actions planned to influence political opinion and support the goals of the campaign.

healthcare professionals, healthcare decision-makers and the media. Numerous local and national events are organized by the member associations of the International Diabetes Federation and by other diabetes representative organizations, healthcare professionals, healthcare authorities, and individuals who want to make a difference. World Diabetes Day unites the global diabetes community to produce a powerful voice for diabetes awareness.

How did it all begin? World Diabetes Day was introduced by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in 1991, in response to concern over the escalating incidence of diabetes around the world. Since then, the event has grown in popularity every year.

Where does it take place? World Diabetes Day is celebrated worldwide. It brings together millions of people in over 160 countries to raise awareness of diabetes, including children and adults affected by diabetes, 1

The Table of Silence, Targa Jiu, Romania

How is it marked? Diabetes representative organizations, governmental organizations, companies and individuals develop an extensive range of activities tailored to a variety of groups. Activities that are organized each year include: •• Blue lighting events •• Human blue circles •• Dress-up-in-blue days •• Walks and cycle rides •• Radio and television programmes •• Screenings for diabetes and its complications •• Public information meetings •• Governmental activities •• Poster and leaflet campaigns •• Diabetes workshops and exhibitions •• Press conferences •• Newspaper and magazine articles •• Events for children and adolescents For further information see section entitled ‘Bring diabetes to light’ (page 7).

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Is there a theme? Each year World Diabetes Day highlights a theme related to diabetes. Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. In 2007, the decision was taken to spread campaign themes over a longer time period. The theme of diabetes in children and adolescents was extended to cover 2007 and 2008. For 2009 and beyond, the Executive Board of the International Diabetes Federation turned to its global network of diabetes associations to propose the theme. The most popular choices were diabetes education and diabetes prevention. It was felt that significant efforts to prevent diabetes would not be possible without sufficient diabetes education. Consequently, the theme chosen was Diabetes Education and Prevention. A broad theme that will cover the five-year period from 2009 to 2013.

Recent themes include: 2005: Diabetes and Foot Care 2006: Diabetes in the Disadvantaged and the Vulnerable 2007–2008: Diabetes in Children and Adolescents 2009–2013: Diabetes Education and Prevention

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Know the warning signs! www.worlddiabetesday.org

world diabetes day

Understand diabetes and take control The 2009–2013 campaign calls on all those responsible for diabetes care to understand diabetes and take control. For people with diabetes, this is a message about empowerment through education. For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes to make sure that their citizens with and at risk of diabetes receive the best possible care. For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice. For the general public it is a call to understand the serious impact of diabetes, to know how to identify the condition and, where possible, know how to avoid or delay diabetes and its complications.

The 2009–2013 campaign is driven by four aspirational goals: 1. Every government should implement effective strategies and policies for the prevention and management of diabetes. 2. Every person with diabetes should receive education to help them manage their diabetes better. 3. Everyone should know the diabetes warning signs, how to prevent or delay the complications of diabetes and how to prevent or delay type 2 diabetes. 4. Every country should celebrate World Diabetes Day.

The World Diabetes Day logo The diabetes circle, the icon established by the IDF-led ‘Unite for Diabetes’ campaign, was adopted as the World Diabetes Day logo in 2007. The diabetes circle is a simple icon that can be easily adapted and used. The significance of the symbol is overwhelmingly positive. Across cultures, the circle symbolizes life and health. The colour blue reflects the sky that unites all nations and is the colour of the flag of the United Nations. The blue circle signifies the unity of the global diabetes community in response to the diabetes pandemic. Show your support for World Diabetes Day by using the logo as widely as possible. It can be downloaded from www.worlddiabetesday.org.

world diabetes day 14 November

“The blue diabetes circle signifies unity in the global struggle to defeat diabetes.” 4

World Diabetes Day – A United Nations World Day World Diabetes Day is an official United Nations World Day. On 20 December 2006, the UN General Assembly passed resolution 61/225, which designated the existing World Diabetes Day as an official world day beginning in 2007. This landmark resolution also recognized diabetes as “a chronic, debilitating and costly disease associated with major complications that pose severe risks for families, countries and the entire world.”

“Diabetes poses severe risks for families, countries and the entire world.”

The United Nations has shown its commitment to the fight against diabetes by throwing its support behind World Diabetes Day and by highlighting the global impact of the disease. The resolution marked the first time that a noncommunicable disease was recognized as posing as serious a global health threat as infectious epidemics like malaria, tuberculosis and HIV/AIDS. The world is experiencing an epidemic of noncommunicable diseases that threatens to overwhelm healthcare systems worldwide. Diabetes, cardiovascular disease, cancer and chronic respiratory diseases cause 35 million deaths a year, with four in every five of these deaths occurring in low- and middle-income countries. 5

Non-communicable diseases are estimated to reduce GDP by up to 5% in many low- and middle-income countries. They are an under-appreciated cause of poverty and now present a serious barrier to economic development. UN Secretary-General Ban Ki-moon recently described the epidemic of non-communicable diseases as posing a greater threat than infectious diseases: “Cancer, diabetes, heart diseases are no longer the diseases of the wealthy. Today, they hamper the people and the economies of the poorest populations even more than infectious diseases. This represents a public health emergency in slow motion.”

Concerted action is need The passage of UN Resolution 61/225 was a major achievement for all people living with or at risk of diabetes. However, it was just the first step in the struggle to reverse the diabetes epidemic and save lives. Resolution 61/225 established the global agenda for the fight against the diabetes pandemic by encouraging all nations to develop national policies for the prevention, care and treatment of diabetes. The global diabetes community must remain united to make sure that all nations follow through on this commitment.

“Resolution 61/225 “Invites all Member States, relevant organizations of the United Nations system and other international organizations, as well as civil society including non-governmental organizations and the private sector, to observe World Diabetes Day.”

Over 250 million people are living with diabetes. Without concerted action to fight the disease, this figure will reach 380 million within a generation.

“To do nothing is not an option.” Read the Resolution online at www.idf.org. World Diabetes Day provides the opportunity for orchestrated global action to improve care for the many millions living with diabetes worldwide and to encourage governments to do more to prevent diabetes in the many more at risk.

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Bring diabet

tes to light!

How will you bring diabetes to light? The monument challenge

Engaging political support for World Diabetes Day

In 2007, the global diabetes community rallied behind the call to light iconic landmarks and buildings in blue to mark World Diabetes Day. A total of 279 iconic monuments were lit as beacons of hope for the millions of people worldwide living with diabetes. In 2008, action to light up in blue continued, with more than 1000 landmark sites and buildings participating from a total of 99 countries. A full list can be found on the World Diabetes Day website. Visit www.worlddiabetesday.org for more information about the challenge, along with support material to help you light a monument in your home town.

In recent years, many individuals and organizations have shown their support by seeking local, national and regional proclamations that encourage action to mark World Diabetes Day and promote key issues. Political representatives around the world responded by issuing official statements on World Diabetes Day. Why not approach your local governmental representative for an official message of support? An official signing provides an ideal opportunity to support the official lighting of a local monument and other awareness-raising activities in your area. You’ll find template documents on the World Diabetes Day website.

Community action Each year, diabetes representative organizations, industry partners and committed individuals organize activities on or around World Diabetes Day. Typical activities include walks, cycle rides, educational rallies and exhibitions. These activities can be linked to an official lighting and/ or the official signing of a proclamation. Recent years have seen a number of human blue circles organized. It is a simple idea that has great visual impact. Share ideas and pictures of events through the World Diabetes Day website at www.worlddiabetesday.org/activities. 9

prevention? Are you helping to implement change that will improve care for people with and at risk of diabetes? You could be eligible to become a World Diabetes Day champion.

Individual action Can’t find an event near you but want to join in? There are many ways that you can get involved. Why not illuminate your home in blue or light a blue candle for World Diabetes Day? Dress up in blue for the day and organize a dress-upin-blue day for diabetes at your workplace. Whatever your idea, be sure to register your activity on the website so that we can share it with the world and add your event to the global total of people who take part.

World Diabetes Day champions show their support by organizing activities that align with the campaign goals and promote World Diabetes Day to the public and media, or promote government action for change. Examples include government action to improve diabetes care and prevention, individual or group action to lobby local or national governments to improve diabetes care, or awareness-raising activities that attract public and media attention such as Desert Dingo - the World Diabetes Day VW Beetle that races to raise awareness of diabetes or the motorcycle enthusiast who crosses the desert on the World Diabetes Day bike. Find out more from www.worlddiabetesday.org/champions. World Diabetes Day champions are promoted through the website and are encouraged to work closely with the campaign team to make the most of opportunities to promote World Diabetes Day. Contact [email protected] and let us know what you are planning.

Become a World Diabetes Day champion Do you have an interesting idea that will grab public and media attention? Do you want to change the way that people think about diabetes? Are you lobbying your local or national government to improve diabetes care and 10

Join the cyber celebrations Across the internet, individuals and online communities mark World Diabetes Day and add their voices to the call for action to improve diabetes care and promote the prevention of diabetes and its complications. There are many places online to join the movement. Find out more from the World Diabetes Day website. Over recent campaigns, World Diabetes Day has extended its reach through various social networking sites in order to seek new audiences and further engage the campaign’s global network of supporters. A variety of information and material about the campaign, including pictures of the Blue Monument Challenge, World Diabetes Day event videos and updated information on the 2009 World Diabetes Day campaign is available through various sites. Find World Diabetes Day on the following: Facebook •• World Diabetes Day Group http://www.facebook.com/group.php?gid=100331240644&ref=mf

•• Become a fan of World Diabetes Day http://www.facebook.com/pages/Brussels-Belgium/World-DiabetesDay/67935817021?ref=mf

Twitter ••  http://twitter.com/wdd

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YouTube •• World Diabetes Day Channel http://www.youtube.com/worlddiabetesday

•• International Diabetes Federation Channel http://www.youtube.com/user/IntDiabetesFed

Flickr •• World Diabetes Day group http://www.flickr.com/groups/wdd

•• International Diabetes Federation http://www.flickr.com/photos/idf/sets/

Myspace ••  http://www.myspace.com/officialworlddiabetesday Visit these sites to join the campaign and help bring diabetes to light!

What is diabetes? Diabetes is a chronic disease that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin is a hormone made by the pancreas that enables cells to take in glucose from the blood and use it for energy. Failure of insulin production, insulin action or both leads to raised glucose levels in the blood (hyperglycaemia). This is associated with long-term damage to the body and the failure of various organs and tissues. Understand diabetes: Know the warning signs* •• Frequent urination •• Excessive thirst •• Increased hunger •• Weight loss •• Tiredness •• Lack of interest and concentration •• Vomiting and stomach pain (often mistaken as the flu) •• A tingling sensation or numbness in the hands or feet •• Other signs include blurred vision, frequent infections and slow-healing wounds *These can be mild or absent in people with type 2 diabetes.

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Type 1 diabetes Type 1 diabetes is an autoimmune disease characterized by the destruction of the insulin-producing cells in the pancreas. Consequently, people with type 1 diabetes produce very little or no insulin and must take insulin to survive. Type 1 diabetes, which used to be called juvenileonset diabetes, is most commonly diagnosed in children and young adults.

Type 2 diabetes The development of type 2 diabetes is marked by insulin resistance. People with type 2 diabetes cannot use the insulin that they produce effectively. They can often manage their condition through exercise and diet. However, in many cases oral drugs are needed and often insulin is required. Type 2 diabetes accounts for over 90% of the more than 250 million people living with diabetes worldwide. Both type 1 and type 2 diabetes are serious and both can affect children. It is important to know the warning signs of diabetes.

“There is no such thing as mild diabetes.”

Gestational diabetes Gestational diabetes (GDM) is a condition in which women without previously diagnosed diabetes have high blood glucose levels during their pregnancy. GDM affects about 4% of all pregnant women. It has few symptoms and usually disappears when the pregnancy ends. However, GDM poses a risk to both child and mother. Babies of mothers with GDM are at increased risk of being large for gestational age (which can lead to delivery complications), are at higher risk for some other medical complications after delivery and often have an increased life-long risk of glucose intolerance and obesity. Women who have had GDM have a significantly increased risk of developing type 2 diabetes. Other rarer types of diabetes also exist.

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The complications of diabetes Diabetes is a chronic, life-long condition that requires careful monitoring and control. Without proper management it can lead to very high blood sugar levels. These are associated with long-term damage to the body and the failure of various organs and tissues. Complications include: •• Cardiovascular disease, which affects the heart and blood vessels, and may cause fatal complications such as coronary heart disease (leading to a heart attack) and stroke. •• Kidney disease (diabetic nephropathy), which may result in total kidney failure and the need for dialysis or kidney transplant. •• Nerve disease (diabetic neuropathy), which can ultimately lead to ulceration and amputation of the toes, feet and lower limbs. •• Eye disease (diabetic retinopathy), characterized by damage to the retina of the eye which can lead to vision loss.

World Diabetes Day and education Diabetes is difficult. It imposes life-long demands on people with diabetes, requiring them to make multiple decisions related to managing their diabetes. People with diabetes need to monitor their blood glucose, take medication, exercise regularly and adjust their eating habits. Furthermore, they may have to face issues related

© Jesper Westley

to living with the complications of diabetes and may be required to make considerable psychological adjustments. As outcomes are largely based on the decisions they take, it is of paramount importance that people with diabetes receive ongoing, high-quality diabetes education that is tailored to their needs and delivered by skilled health professionals. Without diabetes education, people with diabetes are less prepared to take informed decisions, make behavioural changes, address the psycho-social issues presented by diabetes and, ultimately, may be ill-equipped to manage their diabetes effectively. Poor management will result in reduced health outcomes and an increased likelihood of developing complications. Education is therefore of the utmost importance in the prevention of diabetes complications and central to the World Diabetes Day campaign. The role of the diabetes educator is of critical importance within the diabetes care team. 14

The educator enables people with diabetes to manage their diabetes-related health to the best of their ability so that choices and actions are based upon informed judgement. Most people with diabetes cannot access diabetes education due to factors such as cost, distance, and the lack of appropriate services. Many more may be unaware of the services that do exist or perhaps not convinced of the benefits that diabetes education can bring. They may feel, for example, that interaction with their physician provides all the education they need. The World Diabetes Day campaign promotes the importance of structured diabetes education programmes as key to the prevention and control of diabetes and advocates for increased opportunities for diabetes education within healthcare systems and communities.

“Education is of the utmost importance in the prevention of diabetes complications and central to the World Diabetes Day campaign.”

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Diabetes education is particularly lacking in developing countries. Even in developed countries, many people cannot access education because there are not enough educators or centres to cope with the rising number of people with diabetes. The International Diabetes Federation is working to identify and fill the gaps in the provision of diabetes education worldwide. In 2003, the Federation produced International Standards for Diabetes Education. Revised and updated in 2009, these standards can be found online at www.idf.org/diabetes_education along with IDF’s International Curriculum for Diabetes Health Professional Education. Diabetes education is best provided by a multidisciplinary team. While multidisciplinary education is available in some countries, in many others it is not available and its value is not fully recognized by the medical profession. The World Diabetes Day campaign sets out to challenge this. It is hoped that the awareness raised by the campaign will encourage healthcare systems everywhere to recognize the need to provide structured diabetes education and help establish access to skilled diabetes education as the right of every person with diabetes.

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Understand diabetes: know the risks There are many risk factors for type 2 diabetes. They include: •• Obesity and overweight •• Lack of exercise •• Previously identified glucose intolerance •• Unhealthy diet •• Increased age •• High blood pressure and high cholesterol •• A family history of diabetes •• A history of gestational diabetes •• Ethnicity - higher rates of diabetes have been reported in Asians, Hispanics, Indigenous peoples (USA, Canada, Australia) and African Americans.

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World Diabetes Day and primary prevention At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation. Type 2 diabetes, however, can be prevented in many cases by maintaining a healthy weight and being physically active. In 1985, 30 million people worldwide were thought to have diabetes. A little over a decade later, the estimate rose to over 150 million. Today, according to IDF figures, it exceeds 250 million. Unless action is taken to implement effective prevention and control programmes, the total number of people with diabetes will reach 380 million by 2025. The explosion in diabetes will overwhelm healthcare systems everywhere and subvert the gains of economic development. Investment in diabetes education and diabetes prevention programmes will save money in the long term and deliver significant returns in quality of life for people with diabetes and people at high risk of diabetes. The International Diabetes Federation proposes a simple three step plan for the prevention of type 2 diabetes in those at increased risk. IDF recommends that all people at high risk of developing type 2 diabetes be identified through opportunistic and self-screening. People at high risk can be easily identified through a simple questionnaire to assess risk factors such as age, waist circumference, family history, cardiovascular history and gestational history. 18 19

Once identified, people at high risk of diabetes should have their plasma glucose levels measured by a health professional to detect Impaired Fasting Glucose or Impaired Glucose Tolerance, both of which indicate an increased risk of type 2 diabetes. Prevention efforts should target those at risk in order to delay or avoid the onset of type 2 diabetes. There is substantial evidence that achieving a healthy body weight and moderate physical activity can help prevent the development of type 2 diabetes. In primary prevention there is an important role for the diabetes educator to help people understand the risks and set realistic goals to improve health. IDF recommends a goal of at least 30 minutes of daily exercise, such as brisk walking, swimming, cycling or dancing. Regular walking for at least 30 minutes per day, for example, has been shown to reduce the risk of type 2 diabetes by 35-40%.

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Show you care Wear the diabetes pin to mark World Diabetes Day. The blue circle is the global symbol for diabetes. Buy the pin online from the IDF shop and give life to a child with diabetes. http://shop.idf.org

Income generated by sales of the diabetes pin is used to support children on the IDF Life for a Child Program. The Program provides life-saving diabetes supplies to children in developing countries (www.lifeforachild.org).

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The International Diabetes Federation The International Diabetes Federation (IDF) is an umbrella organization of over 200 national diabetes associations in over 160 countries. It represents the interests of the growing number of people with diabetes and those at risk. The Federation has been leading the global diabetes community since 1950. IDF’s mission is to promote diabetes care, prevention and a cure worldwide. Led by the International Diabetes Federation, the Unite for Diabetes campaign secured a United Nations Resolution on diabetes in December 2006. The Federation continues to lead the global effort to implement Resolution 61/225 under the Unite for Diabetes banner. The Resolution encourages UN Member States to develop national policies for the prevention, treatment and care of diabetes in line with the sustainable development of their health-care systems, taking into account the internationally agreed development goals, including the Millennium Development Goals. The International Diabetes Federation is engaged in action to tackle diabetes from the local to the global level from programmes at community level to worldwide awareness and advocacy initiatives. IDF’s activities aim to influence policy, increase public awareness and encourage health improvement, promote the exchange of high-quality information about diabetes, and provide education for people with diabetes and their healthcare providers. 21

The content of this booklet draws on the following sources: •• Riley P, McClaughlyn K. Understand diabetes and take control: World Diabetes Day 2009. Diabetes Voice, June 2009. •• Metzger B, et al. New findings in gestational diabetes – the HAPO Study. Diabetes Voice, Special Issue: May 2009. •• McGill M, McGuire H. The IDF framework for diabetes education – current status and future prospects. Diabetes Voice. March 2009. •• International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabetic Medicine, 2007: 24, 451463. •• Patient Education and psychological care. Diabetes Voice, Supplement September 2006. •• Diabetes Atlas 3rd Edition, International Diabetes Federation, 2006.

Find your campaigntoolkit online at: www.worlddiabetesday.org/toolkit

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Information about World Diabetes Day and campaign materials can be found on the World Diabetes Day website: www.worlddiabetesday.org. Additional information about the International Diabetes Federation is available from www.idf.org. Direct your enquiries to the IDF Executive Office: International Diabetes Federation (IDF) Chaussée de La Hulpe 166 B-1170 Brussels, Belgium tel: +32 2 5385511 fax: +32 2 5385114 For e-mail enquiries about World Diabetes Day, please contact [email protected] For general enquiries to IDF, please use [email protected]