|Year : 2016 | Volume
| Issue : 3 | Page : 317-318
Global burden of diabetes: action for anesthesia
Sukhminder Jit Singh Bajwa1, Sanjay Kalra2, Manash Baruah3
1 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
2 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
3 Department of Endocrinology, Excel Center (Unit of Excel Care Hospitals), Guwahati, Assam, India
|Date of Submission||02-Mar-2015|
|Date of Acceptance||29-Jul-2015|
|Date of Web Publication||31-Aug-2016|
Sukhminder Jit Singh Bajwa
House No-27-A, Ratan Nagar, Tripuri, Patiala - 147 001, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bajwa SJ, Kalra S, Baruah M. Global burden of diabetes: action for anesthesia. Ain-Shams J Anaesthesiol 2016;9:317-8
| Introduction|| |
The Lancet recently reported on the Global Burden of Disease 2010 (GBD) in a series of landmark epidemiological articles that discuss the causes of morbidity and mortality in people of both sexes, of all age groups, based on data from 187 countries. This seminal treatise has major significance for anesthesia, as it gives us a bird's eye view of the comorbid conditions one can expect in critical care and anesthesia practice. The increasing prevalence of diabetes mellitus (DM) has significant impact on anesthesiology practice as it can directly and indirectly impact the outcome in surgical patients. A strong need is felt among endocrinologists and anesthesiologists to work in unison so as to manage the increasing number of surgical patients with DM. A universal consensus on therapeutic management strategies in surgical diabetic patients is mandatory between these two specialties to counter this ever-increasing burden of DM. As such, a strong need is felt to highlight the impact of the DM epidemic in the practice of diabeto-anesthesia . This communication highlights the global burden of diabetes, as reported by GBD 2010, while emphasizing the surgical and medical aspects of the disease that may impact anesthesia care in times to come ,,. (http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-leading-causes-and-risks-region-heat-map?metric = YLL).
Disability and mortality
The GBD describes a 13.5% increase in all-cause mortality from 1990 to 2010 (46 511 200 to 52 769 700 deaths). This increase is due to the steep rise of 30% in deaths from noncommunicable disease (NCD) – 26 560 300 in 1990 to 34 539 900 in 2010. Metabolic NCDs include diseases such as ischemic heart disease (IHD), stroke, DM, hypertensive heart disease, and chronic kidney disease (CKD). Diabetes, which was ranked 15th in the global list of causes of death in 1990, rose to ninth position in 2010 (12th in men and sixth in women). CKD has jumped from the 27th to the 18th rank over two decades, whereas IHD and stroke have maintained their top two slots . (http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-leading-causes-and-risks-region-heat-map?metric = YLL).
DM is the biggest endocrine driver for GBD. It directly led to 1 281 300 deaths in 2010, a 92.7% increase from 1990. This is one of the steepest increases experienced for any disease in medical history . CKD due to DM led to 178 300 mortalities in 2010, a change of 94.1%. Other diseases closely linked with diabetes also reported high increases: 34.9% for IHD and 26.0% for cerebrovascular disease.
Years of life lost, years of life lived with disability, and disability-adjusted life years are convenient methods of assessing disability due to various conditions. On the basis of the years of life lost yardstick, diabetes has risen from 27th to 19th place in the list of diseases causing maximum disability. During the same time period (1990–2010), IHD climbed from fourth to first rank, stroke from fifth to third, and CKD from 32nd to 24th place (http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-2010-leading-causes-and-risks-region-heat-map?metric = YLL).
The number of years lived with disability has gone up for diabetes: the incidence of uncomplicated DM, diabetic foot, CKD due to DM, and diabetic neuropathy has risen by 54.2, 47.1, 61.5, and 62.6%, respectively. Worst trends have been noted for amputation due to DM (an increase of 130.9%) and vision loss due to DM (a rise of 368.6%) .
The relative importance of diabetes has risen to the fifth–seventh rank as a cause of both disability and mortality in the age groups above 55 years in both sexes. GBD also measures the sequelae of disease. Uncomplicated DM affects 3.30% of all individuals, with no sex variation. The prevalence of diabetes in 2010 was estimated to be 227 588 000. Diabetic neuropathy is present in 1.91% of all people (1.83% of men and 2.00% of women) .
Disease is preceded by risk factors. The major risk factors that lead to death and disability-adjusted life years have been quantified by GBD, and include many factors related to DM.
High blood pressure was the most important risk factor for death in 2010 (up from fourth position in 1990), whereas high BMI, high fasting plasma glucose, and high total cholesterol were at sixth, seventh, and 15th positions (as compared with 10th, ninth, and 14th positions in 1990, respectively) .
Dietary habits such as use of tobacco (#2), alcohol (#3), low fruit intake (#5), high sodium intake (#11), low nuts and seeds intake (#12), low vegetable use (#17), low whole grain use (#16), and high processed meat intake (#22) add to the risk of death and disease .
Implications for anesthesia
What this implies for anesthesiologists is that diabetes will be a frequent (and not an innocent) bystander in both operation theaters and ICUs. Complications of diabetes, especially IHD and stroke, will be encountered more often in the years to come. The task of anesthesiologists will be cut out as they may have to manage an increasing number of patients with renal compromise, visual challenges, and neuropathy besides patients with IHD and stroke.
Diabetic foot is frequently encountered in modern day anesthesiology practice and will remain an important surgical entity in the times to come. Besides surgical and medical complications, there are sociobehavioral concerns as patients with diabetic foot and uncontrolled diabetes invariably present for amputation of a part or whole of the foot. The postamputation quality of life is difficult to imagine at a large scale, especially in developing countries.
Risk factors that modify anesthetic practice and are associated with increased risk of adverse outcomes such as high blood pressure, high BMI, high fasting plasma glucose, and high total cholesterol will be a common occurrence in preanesthetic clinics as well. Preanesthetic clinic services have to be geared up so as to thoroughly evaluate such a large number of complicated cases requiring appropriate and judicious planning for perioperative anesthetic management.
ICUs manage a bulk of critically ill diabetic patients throughout the globe . As such, the work of intensivists is expected to increase considerably in the years to come as hyperglycemia is an independent predictor of morbidity and mortality in critically ill patients . This can be a detrimental clinical and public health concern in resource-challenged nations, which are already facing an acute shortage of intensivists and other supporting staff for ICU. Diabetes is also responsible for an increase in incidence of other comorbidities, which can have a huge impact on the outcome of critically ill patients.
Anesthesia as a specialty can equip itself to handle the global burden of disease, including diabetes and other metabolic NCDs, by incorporating the latest diagnostic and therapeutic advances and technology in its ambit. Operative and critical care settings have to be upgraded to manage such a global burden of diabetes in terms of both manpower and equipment. Use of appropriate preventive and management strategies, such as continuous glucose monitoring system and insulin analogs, and choice of glycemia-friendly anesthesia regimes in the operation theater and ICU, can help in optimizing clinical outcomes in patients with diabetes .
India is emerging as a new diabetic capital, and as such an acute need is felt to document and publish operative and critical care national statistics for diabetes and its related complications so as to possibly design some new therapeutic regimens and modify our existing treatment strategies. Good coordination among anesthesiologists, intensivists, and endocrinologists is the need of the hour so as to achieve the desired outcome in the challenging future marred by the global burden of diabetes. The existing facilities should be strengthened and traditional setups should be upgraded so as to tackle this rapidly increasing epidemic for the future of mankind.
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