gms | German Medical Science

49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI)
Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Schweizerische Gesellschaft für Medizinische Informatik (SGMI)

26. bis 30.09.2004, Innsbruck/Tirol

NIDDM Explosion in WHO SEARO Countries: Development and Implementation of Integrated Care Model is Eminent to Combat Diabetes in Nepal

Meeting Abstract (gmds2004)

Suche in Medline nach

  • corresponding author presenting/speaker Ram Krishna Dulal - Human and Health Sciences, University of Bremen, Bremen, Deutschland
  • Manfred B. Wischnewsky - Center for Applied Information Technologies [ZAIT], University Bremen, Bremen, Deutschland

Kooperative Versorgung - Vernetzte Forschung - Ubiquitäre Information. 49. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 19. Jahrestagung der Schweizerischen Gesellschaft für Medizinische Informatik (SGMI) und Jahrestagung 2004 des Arbeitskreises Medizinische Informatik (ÖAKMI) der Österreichischen Computer Gesellschaft (OCG) und der Österreichischen Gesellschaft für Biomedizinische Technik (ÖGBMT). Innsbruck, 26.-30.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04gmds366

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2004/04gmds366.shtml

Veröffentlicht: 14. September 2004

© 2004 Dulal et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction

Non-Insulin-Dependent Diabetes Mellitus (NIDDM), also known as type 2 diabetes, is a chronic disease characterized by a hyperglycaemia, which is increasing worldwide and estimated to be double by 2025, with a largest proportion in developing countries particularly in the South East Asia (India and China) [1]. Diabetes is steadily increasing in Nepal: comprising 2.6% in 1990/'91, 5.6% in 1993/'94 [2], 9.55% in 1995 [3], 12.3% in 2000 [4], and 14.6% in 2003 [5] [Fig. 1]. The NIDDM prevalence in South East Asia is reported to have all higher than the WHO value for developing countries [3.5%] [6], and among 4 countries, Nepal has the highest prevalence of diabetes and impaired glucose tolerance [Tab. 1] [7].

The cause of metabolic defect is largely unknown; however, risk factors of NIDDM are demographic ageing, dietary habits and sedentary lifestyle. Generally, active economic transaction spreads from the urban where almost all people have a higher standard of living; the higher social status, the better health situation and probably the longer life. In Nepal, life expectancy of people in Kathmandu has 30 years more compared to remote district Mugu (74 vs. 37) and an average life expectancy of Nepalese has also increased (M-60/F-61) compared to 56.1 years in 1998/'99 [8], [9], [10], [11].

Population is shifting towards urban [6.3% in 1981 and 14.2% in 2001] [Fig. 2] at an average annual rate of 3.45%. In the past, having much less rich food people used to work manually and walk on foot, but, gradually urban population becoming physically less active then a generation ago as they tend to use car, motorbike, bus or alike. Economic prosperity is lumped mainly in the cities and the urban society is moving towards from old caste-cultural to new class-culture and competition of consumerism has already been surfaced. With an increasing income, sedentary life-style, consumption of rich-nutrient, fatty food is also increasing proportionately. Subsequently, putting on over-weight, which leads to obesity; and obesity is one of the leading causes to develop metabolic defects.

Problem

The scenario is further fuelled by continuous rural-to-urban shifts, changes in dietary habit, decreasing physical activities and demographic ageing. The advancement in hoodia (cactus) substance that is highlighted as to have miracle molecules to reduce hunger and the beta-cell transplant still remains to be seen. There is no cure for NIDDM to date. Treatment has become all the time more sophisticated for normalization of blood sugar, but, it is one of the most costly, burdensome for all countries, certainly a more serious in Nepal where resources are limited. An increasing burden of patients with renal failure, blindness, heart infracts and amputations associated with diabetes complications will occur in the future, if the current trend of diabetes prevalence continues.

Methods

Only the actions of early diagnosis, primary and secondary prevention, can reduce the incidence and complications. As with many other diseases, host (genetic factor, physiological adjustment and personal behaviour), vector (food content, food package and food delivery) and environment (physical, economic, political and socio-cultural environmental conditions that impact individuals) ought to be considered [12].

Recommendation

A health care model must incorporate the local needs and diseases occurrences where this study furnishes complete knowledge in sequence and implementation of integrated care model will affect positively in diabetes management in Nepal. The 6 components of model contain- [i] The health care system, [ii] Clinical information system, [iii] Decision support, [iv] Delivery system design, [v] Self-management support and [vi] Community resources [13].


References

1.
WHO-SEARO, Non-communicable Diseases, SCN Dept., New Delhi, 2000; 1[1] [Newsletter].
2.
Singh et al., Demographic Profile of Diabetic Patients Admitted in the Medical Wards of Bir Hospital, Nepal, 1990 to 1994, International Diabetes Digest, 1995; 6[4]: 87-88.
3.
Acharya GP, Diabetes Mellitus at TU Teaching Hospital, Reports of International Symposium on Diabetes Mellitus, March 23-24, 1995, Kathmandu, Nepal, 7 (Abstract).
4.
Bhattarai M D, Diabetes in Nepal, in Diabetes in Middle East, Eastern Mediterranean & South East Asia [DIMEMSEA], Second Conference, March 02-04, 2000, Dhaka Bangladesh, 22-23.
5.
Singh DL and Bhattarai MD, High Prevalence of Diabetes and Impaired Fasting Glycemia in Urban Nepal (Letter), Diabetic Medicine, 2003; 20: 167-68.
6.
White f and Rafique G, Diabetes Prevalence and Projections in South Asia, The Lancet, 2002; 360, Sept. 7.
7.
Ramachandran et al., Explosion of Type 2 Diabetes in the Indian Subcontinent, International Diabetes, 2003; 15(5).
8.
CBS/MOPE- HMG-Nepal, 2001, Available from http://www.mope.gov.np/population/chapter9.php, accessed (24 November 2002).
9.
Health Authorities Must Deal With "Unfinished Agenda", The World, Bank In Nepal, News Release No. 41 RMN99, available from http://www.worldbank.org.np/worldbanknew/news/releases/health.html (assessed 23 March 2001).
10.
Department of Health Services, Annual Report, 1998/1999: 11.
11.
Mueller R, Public Health und Gesundheit, Gesundheitspolitik: in Kolip, P., (ed.), Gesunfheitswissenschaften, Juventa Verlag, Weinheim und Muenchen, 2002:149-170.
12.
Histon T, Determinants of the Epidemic of Overweight and Obesity, The Kaiser Permanent Institute for Health Policy, Prevention and Treatment of Overweight and Obesity: Towards a Roadmap for Advocacy and Action (Roundtable Summary Report. Fall, 2003).
13.
Pronk N, Chronic Care Model as a Framework for Comprehensive Prevention and Treatment Strategies: Application to Over Weight and Obesity, The Kaiser Permanent Institute for Health Policy, Prevention and Treatment of Overweight and Obesity: Towards a Roadmap for Advocacy and Action (Roundtable Summary Report. Fall, 2003).