North America & Caribbean

  • 12.9% of population
  • 29.9% undiagnosed
  • $320 billion in direct healthcare costs
  • 50% of adults diabetic or pre-diabetic

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

Europe

  • 9.1% of population
  • 39.3% undiagnosed
  • Diabetes accounts for 9% of total healthcare costs
  • 627,000 diabetes-related deaths in 2015

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

Western Pacific

  • 9.3% of population
  • 52.1% undiagnosed
  • Region accounts for 37% of adult diabetics
  • 1.9 million diabetes-related deaths in 2015

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

South-East Asia

  • 8.5% of population
  • 52.1% undiagnosed
  • 1 in 5 of worldwide undiagnosed diabetics
  • 1 in 4 of diabetic deaths worldwide

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

Middle East & North Africa

  • 9.1% of population
  • 40.6% undiagnosed
  • 83.9% of diabetics live in low- or middle-income countries

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

South & Central America

  • 9.4% of population
  • 39% undiagnosed
  • Projected 65% increase by 2040

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

Africa

  • 66.7% undiagnosed
  • 321,100 diabetes-related deaths in 2015
  • 79% of diabetes-related deaths occurred in people under age 60

Source: International Diabetes Federation Diabetes Atlas, seventh edition, 2015

More than 400 million people have diabetes.

Diabetes is a global emergency. More than 400 million people live with the disease and as many as half are undiagnosed. Below is a diabetes world map from the International Diabetes Federation depicting current numbers by region and projections for 2040 if present growth continues. Because of their large populations, China and India have by far the most diabetics with 109.6 million and 69.2 million, respectively. And in the complex interplay of population and diabetic rates, the United States has the third most diabetics with 29.3 million because of its higher prevalence of diabetes in the population.

Worldwide Costs

The costs of treating diabetes and its complications are staggering. The International Diabetes Federation estimates that global health spending in 2015 ranged from $673 billion to $1.1 trillion. By 2040, spending is expected to exceed $802 billion and may reach $1.5 trillion. Below is a table outlining the 2015 costs of diabetes and projected 2040 costs, by country/territory. insulin algorithms diabetes by country

Costs in the United States

The United States leads the world in per capita spending on diabetes. Diabetes-related expenditure totaled more than $320 billion in 2015, and spending could reach $349 billion by 2040. The disease also costs the US economy more than $69 billion per year in lost productivity.

High vs. Low Income Issues

Diabetes prevalence rates and patient outcomes vary significantly by income group. Data from two longitudinal studies in Canada determined that men who earn less than $15,000 per year are twice as likely to develop type 2 diabetes as men who earn more than $80,000 per year; women in the lowest-income category were three times as likely to develop diabetes as women in the highest-income category. Meanwhile, a separate study in Boston found poor diabetes control in 46% of low-income patients, despite the fact that Boston has had an insurance program similar to the Affordable Care Act for nearly a decade (“How economic insecurity impacts diabetes control among patients,” JAMA Internal Medicine, 2014). This suggests that “the Patient Protection and Affordable Care Act (Obamacare), with expanded healthcare provision for people with diabetes, may not improve control of the disease among low income groups.” Instead, expanded health coverage in low-income communities, coupled with the growing needs of an aging population, have stretched health systems to the limit. Overburdened doctors may have only a few minutes with each patient, even those whose insulin regimens require the analysis of up to 200 glucometer readings in a single visit. Our solution is a software tool that analyzes glucometer data and optimizes insulin dosing in seconds, at a cost of only a few dollars per patient, per month.

iabetes mellitus, or simply diabetes, is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas that is needed to convert sugar, starches, and other food into energy needed for daily life. It acts like a key, letting glucose from the food we eat pass from the blood stream into the cells in the body, which produces energy. All carbohydrate foods are broken down into glucose in the blood, and insulin helps glucose get into the cells. Inability to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term, high glucose levels damage the body and cause lead to the failure of various organs and tissues. Diabetes takes more lives each year than HIV/AIDS, malaria and tuberculosis combined.

Type 1 Diabetes

Diabetes-type-1

Type 1 diabetes used to be called juvenile-onset diabetes because it usually occurs in children or young adults, although people of any age can suffer from this type of diabetes. It is usually caused by an autoimmune reaction in which the body’s defense system attacks insulin-producing cells. Little is known about why the reaction occurs, but type 1 diabetics produce little or no insulin as a result. Only 5% of diabetics have type 1 diabetes. To control the levels of glucose in their blood, type 1 diabetics need insulin injections every day. With the help of insulin therapy and other treatments, even young children with type 1 diabetes can learn to manage their condition and live long, healthy, happy lives.

Type 2 Diabetes

diabetes web 21

At least 90% of all diabetics have type 2 diabetes, which used to be called non-insulin dependent diabetes or adult-onset diabetes. The disease is characterized by insulin resistance and relative insulin deficiency, either or both of which may be present at the time diabetes is diagnosed. Type 2 diabetes can occur at any age, and it may remain undetected for many years, until a health complication appears or a urine glucose test is administered. It is often, though not always, associated with being overweight or obese, which can cause insulin resistance and lead to high blood glucose levels. Although type 2 diabetics can initially manage their condition through exercise and diet, over time most people will require oral drugs and/or insulin. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin, and glucose builds up in the blood instead of reaching cells, which can lead to diabetes complications. Both type 1 and type 2 diabetes are serious; there is no such thing as mild diabetes.

Gestational Diabetes

Gestational-Diabetes-Dos-and-Donts-01-722x406

Gestational diabetes (GDM) is a form of diabetes that involves high blood glucose levels during pregnancy. It develops in one in 25 pregnancies worldwide and is associated with complications to both mother and baby. GDM usually disappears after pregnancy, but women with GDM and their children are at an increased risk of developing type 2 diabetes later in life. Approximately half of women with a history of GDM go on to develop type 2 diabetes within 5 to 10 years after delivery.


 

Treatment Methods

Basic diabetic care can be broken down into three categories: behavioral, medicinal, and insulin therapy. Type 1 diabetics are primarily treated with insulin therapy, while type 2 diabetics can be treated with all three categories depending on the severity of the individuals disease. The primary long term goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. Adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation.

Behavioral Changes

EXERCISE2

Behavioral changes can help type 2 diabetics lose weight and thereby increase insulin sensitivity. Treatment usually begins with increased physical activity, eliminating saturated fat and reducing sugar and carbohydrate intake. Even modest weight loss (for example, 5 kg or 10-15 lbs lost) can restore insulin sensitivity, especially when weight loss occurs in abdominal fat deposits. Diets low in saturated fats may even help reverse insulin resistance.

Medication

Meds

Treatment of diabetes with medication usually involves hypoglycemic treatment using either oral hypoglycemics and/or insulin therapy. There is emerging evidence that type 2 diabetes can be evaded in those with only mildly impaired glucose tolerance. There are several classes of anti-diabetic medications available. Metformin is generally recommended as a first line treatment because there is some evidence that it decreases mortality. If metformin is insufficient, a second oral agent of another class may be used. Other classes of medications include: sulfonylureas, nonsulfonylurea secretagogues, alpha glucosidase inhibitors, thiazolidinediones,glucagon-like peptide-1 analog, and dipeptidyl peptidase-4 inhibitors. Metformin should not be used in those with severe kidney or liver problems. Injections of insulin may either be added to oral medication or used alone. Type 1 diabetics require direct injections of insulin because their bodies produce little or none. As of 2010, there is no other clinically available form of insulin administration other than injection for patients with type 1 diabetes. Managing diabetes requires patients to be educated about their disease and in compliance with their treatment plan. Improper use of insulin and other medications can cause dangerous hypoglycemic or hyperglycemic episodes.

Insulin

Injection

Beta cells in the pancreas produce the insulin hormone and release it with each meal to help the body use or store the glucose derived from food. In people with type 1 diabetes, the beta cells have been destroyed and the pancreas no longer makes insulin, which is why they require insulin treatment to survive. People with type 2 diabetes make insulin, but their bodies don’t respond well to it. Some people with type 2 diabetes need diabetes pills or insulin injections to help their bodies use glucose for energy. Insulin cannot be taken as a pill because it would be broken down during digestion, just like the protein in food. It must be injected into subcutaneous fat in order to reach the bloodstream.
Types of Insulin

  • Rapid-acting insulin, begins to work about 5 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours. Types: Insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog)
  • Regular or Short-acting insulin usually reaches the bloodstream within 30 minutes after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 3 to 6 hours. Types: Humulin R, Novolin R
  • Intermediate-acting insulin generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 18 hours. Types: NPH (Humulin N, Novolin N)
  • Long-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over a 24-hour period. Types: Insulin detemir (Levemir) and insulin glargine (Lantus)

Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. It is also useful for those who have poor eyesight or dexterity and is convenient for people whose diabetes has been stabilized on this combination. Characteristics of Insulin Insulin has 3 characteristics:

  • Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
  • Peak Time is the time during which insulin is at maximum strength in terms of lowering blood glucose.
  • Duration is how long insulin continues to lower blood glucose.

Insulin Strength All insulins come dissolved or suspended in liquids. The standard and most commonly used strength in the United States today is U-100, which means it has 100 units of insulin per milliliter of fluid, though U-500 insulin is available for patients who are extremely insulin resistant. U-40, which has 40 units of insulin per milliliter of fluid, has generally been phased out around the world, but it is possible that it could still be found in some places (and U-40 insulin is still used in veterinary care). If you’re traveling outside of the U.S., be certain to match your insulin strength with the correct size syringe. Insulin Additives All insulins have added ingredients. These prevent bacteria from growing and help maintain a neutral balance between acids and bases. In addition, intermediate and long-acting insulins also contain ingredients that prolong their actions. In some rare cases, the additives can bring on an allergic reaction.

To properly manage the disease, an insulin-taking diabetic must have their blood sugar levels regularly analyzed by a healthcare professional. This is done using a blood glucose meter to record a patient’s blood sugar levels multiple each day so that a specialist in diabetes, typically an endocrinologist, can review the readings and make any necessary insulin dose adjustments.

Specialists in Short Supply

blog-diabetic-patient-doctor

There are not nearly enough endocrinologists to care for the millions of patients with diabetes around the world. The shortage is significant: according to Andrew F. Stewart, MD, chief of the Division of Endocrinology at the University of Pittsburgh, School of Medicine, in 2010 the American Board of Internal Medicine statistics showed that there were only 5,811 board-certified endocrinologists for the approximately 6,300 hospitals in the United States. Approximately 2,000 were academic endocrinologists who tend not to see many patients, while thousands more were employed by the pharmaceutical industry. By Stewart’s estimate, that left only about 1,000 board-certified endocrinologists to work with insulin-taking diabetics. To care for all of the 5 million insulin-taking diabetics in the United States, 1,000 endocrinologists would have to take on 5,000 patients each. If they worked 50 weeks out of the year and saw each patient every 2 months, or 6 times per year (the minimum number of visits required to manage an insulin regimen), each endocrinologist would have to see 600 patients per week, or 120 patients every day. Due to the impracticality of such a scenario, most insulin-taking diabetics rely on primary care providers who lack sufficient training to make reasoned insulin adjustments. Considering that there are over 30 million diabetics in the United States and more severe shortages of specialists in the rest of the world, the situation is very serious.

 

Meter Readings

Natural-Type-2-Diabetes-Treatment

A patient who is on insulin therapy to control diabetes may take blood sugar readings every day, up to 4 times per day. When first prescribed insulin, their readings should be reviewed every 1-2 weeks to ensure necessary dosage adjustments; once the patient’s blood sugar levels have stabilized, their blood glucose meter readings should be reviewed every 30-60 days. A doctor who reviews a patient’s blood sugar levels every 60 days must review as many as 240 blood glucose meter readings at one time. Many doctors can only allot 15-20 minutes for each patient visit, which is not enough time to review all the meter readings, analyze them, and determine a well-reasoned dosage adjustment in addition to addressing all the other medical issues diabetic patients commonly face.

 

Dose Adjustments

Dosing Confusion

Though insulin therapy is often the most effective treatment for diabetes, the primary care providers, nurse practitioners and physician assistants who see most diabetic patients don’t have the time or training to make well-reasoned insulin dose adjustments. This means that millions of diabetics live with uncontrolled blood sugar concentrations. Our software is designed for the mid-level practitioners who care for most diabetic patients. By comprehensively analyzing meter data and delivering a 15-second insulin dose recommendation based on algorithms that are clinically proven to lower blood sugar levels, it will dramatically increase access to effective insulin therapy.

Diabetes took 5 million lives and cost more than $600 billion in 2015.
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