Working Draft v.1 For Input Diabetes Awareness Education

Working Draft v.1 For Input Diabetes Awareness Education May 2013 Lesley Shane, Pfizer Global Health Fellow Partnering with GBCHealth Beijing, China B.Sc.Pharm., Pharm.D. 1 AGENDA Introductions 5 min Pfizer GHF Program & GBCHealth Diabetes Initiative Background Diabetes Awareness Education 45 min For you and to share with your family/ relatives

Diabetes: What is it? Who gets it? Why important? Diabetes burden in China Know the diabetes signs and symptoms ? How to prevent diabetes Diabetes self management tips and treatments Pre-session quiz - questions and answers Questions 10 min Short Feedback Survey on Todays session 2 2 min GBCHealth China Diabetes Initiative GBCHealth is a coalition of more than 220 companies united to keep the fight against HIV/AIDS, tuberculosis, malaria, and non-communicable diseases (including diabetes) a global priority Since early 2012, GBCHealth has been exploring the growing diabetes epidemic in China and has identified two program paths to help drive improvements in raising diabetes awareness:

i. Workplace Employee Education (e.g. this current job assignment) ii. In the future, using social media as a knowledge source 3 Pfizers GHF Program: Applying Pfizer Expertise to Strengthen Health Care Delivery Mission & Goals Promoting access, quality and efficiency of health care delivery for people in greatest need Informing emerging Pfizer leaders on global health challenges & patient populations in emerging markets Over 300 Pfizer colleagues have

served as Fellows & Teams in over 40 countries since 2003 Focus areas align with Pfizer Expertise: Optimizing supply chains, Health prevention/promotion & Health workforce Partnerships with thought leaders & innovators in health Over 40 NGO, govt & multilateral partners over life of program; 12 partners in 2013 Key Facts Partners Recent Awards & Media

2013 PRNews Award finalist for Employee Volunteer Program 2012 Health Volunteers Overseas Golden Apple Award Featured in Forbes, Fortune, Huffington Post, Wall Street Journal Visit: to learn more! Diabetes Awareness Workplace Education Session Objective of Todays Session: To provide Diabetes Awareness Education to enhance Company Employee diabetes disease awareness for future prevention and to promote the sharing of the knowledge with your Family / Relatives who may be at risk for diabetes 5 Source: Diabetes photos website Diabetes Diabetes is serious

Diabetes is often silent Diabetes can kill More and more people have diabetes 6 Adapted From sources:;; Diabetes photos website Diabetes: What Is It ? Diabetes = Too much sugar in the blood and this hurts the Body People with diabetes need life-long treatment There is no cure for diabetes BUT. You can prevent and control diabetes You can be healthy and restore balance 7 Adapted From sources:;;

Diabetes photos website Balancing Blood Sugar Your system is in balance when the body keeps blood sugar levels between 4 and 6 mmol/L Sugar levels in your blood increase from eating food and drinking beverages (except water) Sugar levels in the blood are decreased by Insulin helping to move sugar from the blood into nourish our body cells 8 Food in sugar in blood Insulin acts on sugar to enter cells

Adapted From sources:;; Diabetes photos website Who Gets Diabetes? Three main types of diabetes: Type 1 (5% of diabetes): Natural cause with no insulin production; Usually strikes children Must use insulin for lifetime Type 2: Most common kind (90-95% of diabetes) Usually strikes people over 30 years old (the breadwinners in the Family of working age) Alarmingly, diabetes is increasing in younger people (adolescents, collage students) Common: Overweight, poor lifestyle and family history May need to use pills or insulin for treatment Gestational and Other (5% of diabetes): 9 Gestational happens during pregnancy; Mother needs extra care to have a healthy baby 4th group includes special types such as genetic,

environmental and drug induced People With One Or More Risk Factors Can Get Type 2 Diabetes 10 Certain Medications Ethnicity Chinese risk higher, 1.6 x Caucasian risk Inactivity Pregnancy Smoking, Hypertension Stress 30+ in China Age

10 Excessive Alcohol High Cholesterol In China, people > age 30, overweight, or in well-off urban areas where Western fast food chains are common and more sedentary lifestyle, face a particularly high risk. Overweight (Obesity) Male waist circumference 90 cm, Female waist circumference 85cm; Family History Adapted From sources:;;

Diabetes photos website Diabetes: Why Important ? Diabetes is important because if not controlled you could lose: More than 20 per cent could Your sight not name the types of complica ons most closely Your feet associated with poorly diabetes - blindness, Your sexualcontrolled ability amputa ons, kidney failure, cardiovascular disease and early death. (Hong Kong Survey 2011 Too much sugar in the blood can hurt: Your

Your Your Your Your heart brain the main problem for Type 2 diabe cs in kidneys the city is the misconcep on that diabetes blood isvessels not a serious condi on. 'Diabetes can lead to blindness or leg amputa on if not teeth well controlled, and is also associated with around 30 per cent increase in risk of different cancers Eye Damage Blindness Heart Attack Kidney Damage Reduced Blood Supply

There is no cure for diabetes BUT. 1 You can prevent and control diabetes You can be healthy and restore balance 11 Stroke Sexual Problems/ Difficulty Passing Urine Numbness Foot ulcers Foot amputation Adapted From sources:;; Diabetes photos website Symptoms of Diabetes Are Often Silent in Early Stages If You or Family/ Relative

members have one or more of these symptoms, it is important to talk to your Medical Doctor 12 Source: diabetes photos Chinas Diabetes Rates Are High In China (2012), 1 out of 10 people over 18 years old have diabetes +92 million diabetics in China; Largest number of diabetes cases in the World, surpassing USA More common in menIndia than & women (10.2% vs. 9%, respectively)

Higher in the urban than rural areas (12.3% vs. 8.4% respectively) 15.5% of Chinese people (148 million) have pre-diabetes risk factors; 2030 million pre-diabetic move to full-blown diabetes/year Majority, 60%+, of the Chinese diabetic population remain undiagnosed 13 Sources:;; Chinese Ministry of Health, 2010; (CDS); Alarming Epidemic Growth - Diabetes In China Two decades ago, diabetes was very rare in China Over the last decade, there has been a dramatic 3-fold growth increase in diabetes prevalence due to: Increased economic development & status Urban growth Aging Lifestyle change: bad diets, less exercise (with resulting increased obesity) By years year 2030, 130 million

diabetes in mainland China 20 ago average diabetic patient = Age 50+ Now Average age is 30+ (also growing number of teen and collage age diabetics) 14 Sources:;; Chinese Ministry of Health, 2010; (CDS); China Has High Diabetes Burden And Costs Diabetes complications (e.g. heart, kidney, eye diseases and death) impose heavy physical, mental, and economic burdens on patients and their families 13% of total medical expenditures in China are directly cause by diabetes: RMB 173.4 billion or US$25 billion (2010 data); also, RMB 3.4 trillion economic loss for both heart disease and diabetes

Widespread epidemic of diabetes is a serious threat to Chinas public he and adds high medical costs to the country Prevalence is skyrocketing, but China has a window of opportunity to prevent an epidemic of serious diabetes complications and costs 15 Sources:;; Chinese Ministry of Health, 2010; (CDS); China Has Low Awareness Of Diabetes Education Is Important Diabetes awareness low in China in local/community, healthcare provider, patients and their families, and the general public More than half of people with diabetes are not aware they have the disease Only 1/3 of the people treated have successfully managed to control their blood sugar

The Chinese Ministry of Health and CDS have introduced large-scale diabetes awareness and education programs to address diabetes 16 Sources:;; Chinese Ministry of Health, 2010; (CDS); Causes Of Diabetes ? Diabetes can have many causes, such as: Change of lifestyle: Cholesterol High Diet HighFat Blood bad diet, not enough exercise, Pressure alcoholism, smoking, stress Aging Better economy (higher High Fat &

Cholesterol Levels Overweight/ Obesity incomes contributing to obesity, & TYPE Type 22 DIABETES Diabetes Smoking Sedentary Lifestyle/ Inactivity sedentary lifestyles), growing urbanization Overweight and obesity Overweight

Alcohol Use Sedentary Lifestyle Smoking Other risk factors: genetics, etc. 17 Adapted From sources:;; Diabetes photos website Type 2 Diabetes And Our Bodies Diabetes symptoms are often silent in the early stages Usually discovered by route blood tests Awareness is very important In earlier stages diabetes is amendable by behavior / lifestyle changes 18 Adapted From sources:;; Diabetes photos website Obesity Is A Pre-Diabetes Risk Factor

Obesity is a risk factor and key precursor to diabetes Diet Changes, particularly excessive consumption of western type foods The sedentary lifestyle favored by western people has infiltrated Chinese culture, leading to people eating more and exercising less Pre-Diabetic phase can last 10 to 12 years before evolving into Type 2 diabetes What you do in your 20s and 30s age is a total down payment for the life you want to live when you are in your 40s, 50s and 60s and beyond 19 Adapted From sources:;; Diabetes photos website Prevention:

You Can Take Charge To Stop Diabetes: Prevention at the pre-diabetes stage can reduce the risk of getting diabetes by 50% 20 Better Nutrition, Lifestyle and Active Exercise Fitness Can Prevent Diabetes Avoid Tobacco Avoid Alcohol Diabetes Free Life Eating For Good Health Healthy food is important Healthy weight is important The body needs the right amount of food Eat 3 meals a day (do not skip meals) Eat a variety of good goods Fresh food with fiber, low sugar and good healthy fats is very good 21

Source: diabetes photos Avoid the Bad Foods For Good Health Avoid fried or Fast foods with bad fats Eat less of them Remove and switch out foods with sugar, salt and bad fats Replace with good foods with low sugar, low salt, good fiber and good healthy fats Less salt, less oil Avoid alcohol 22 Source: diabetes photos TIPS for Eating Healthy Foods Diabetes Prevention Chinese Version 23 23 Exercise: Being Active Reduces Diabetes Risk Healthy weight is important;

The body must be able to move Exercise boosts the metabolic rate CDS recommends exercise for at least 150 minutes per week of moderate intensity, such as over 5 days per week, every day for 30 minutes 24 Adapted From sources:;; Diabetes photos website If You Have Symptoms, How Do You Know If You have Diabetes ? Only your doctor can tell if you have diabetes Your doctor may do one of the following laboratory blood tests to confirm diabetes: Fasting Plasma Glucose (FPG) (No food for at least 8 hours before in the morning) 2 hour Oral Glucose Tolerance Test (OGTT) (Glucose level tested 2 hours after drinking 75 g of sugar)

7.0 mmol/L 11.1 mmol/L < 7.0 mmol/L < 11.1 mmol/L 6.1 mmol/L 7.8 mmol/L < 6.1 mmol/L < 7.8 mmol/L >2.6 mmol/L FPG Adapted From sources:;; Diabetes photos website

>2.6 mmol/L OGTT If You Have Diabetes It is Important to Test Your Blood Sugar At Home For Safe Levels Good safe blood sugar levels that you test at home keeps you healthy Normal Too Low Safe Good Level Too High Below 6.1 mmol/L Below 2.6 mmol/L 2.6 to 6.5 mmol/L before you eat Above 11.9 mmol/L Under 9 mmol/L after you eat Feel balanced

Feel shaky and sweaty Feel balanced Feel tired and sleepy Are you sick today? Then you should: 26 Test your sugar Stay safe Drink plenty of water Source: 2010 Chinese Diabetes Society (CDS) Guidelines * IDF 2012 Diabetes Monitoring Management:

Blood testing, blood pressure and cholesterol testing 27 Source: diabetes photos Diabetes Treatment 1st Step = Lifestyle Modification (better diet, more daily exercise, weight management) 2nd Step = Medications Some people take pills There are many kinds Some people take insulin Take your medicine on time; Take it every day 28 Source: diabetes photos Save Your Feet Feet Can Last: Look at your feet every day Wash your feet daily and dry them Socks must be clean and smooth

Shoes must fit If you have a sore, go to the doctor; Do not wait ! Do not go barefoot Save your feet 29 Source: diabetes photos Tips for Diabetes Self Management You Can Take Charge Prevent Diabetes Take an active role ! Engage in healthy lifestyle ! Restore balance ! Having an action plan is my first step to successful diabetes management

30 Keep my average blood sugar, cholesterol and blood pressure at a healthy level Follow a healthy eating plan, do not smoke and avoid alcohol Take the right amount of diabetes medications at the right time Be physically active with exercise I like: Try to do It every day Test my blood sugar regularly and record these test results Visit my diabetes educator and doctor regularly Check my feet every day Have an eye exam every year Aim to lose 1 - 1.5 kgs per month if I am overweight Seek my family support Feel happy Diabetes Myth Busters Quiz Assessment for Correct Answers 0-3 points Still looking for magical cures? Maybe you should take the quiz again and see if you're ready to demystify these myths. 4-7 points Not much gets by you, but there's still some information left

to learn. Ask questions, get the right answers, and help make short work of diabetes mis-informers! 8-11 points Nice job, Mythbuster! You know your stuff, and you won't be duped by any diabetes misinformation. Now help others know more by spreading your knowledge! 32 Source adapted from: Diabetes Myth Busters 33 Source adapted from: Diabetes Myth Busters dfsafdadddddd

34 Source adapted from: Diabetes Myth Busters dfsafdadddddd 35 Source adapted from: Thank-You !! Questions? Please fill out the survey - "! q

,! ! q q q q q q q q q q 1 1.5 !

l, 11.5 ! Please share the Handout Tools with your family / relatives ! ! !! ! !!

! l ! ! ! ! ! ! ! ! !" Ques*ons?!!Email:[email protected]!! Adapted from Sources:;; www.cdschina.orrg 36 37 [email protected]

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