Diabetes MELLITUS

all about DM

1. D IABE TES MELLITUS presented by- Students if 6 th batc ims m oderator- K.agasya raj

2. INTRODUCTION Diabetes mellitus is not a single disease but a heterogenous gr. of diseases characterised by a state of chronic hyperglycemia resulting from diversity of etiologies,environmental & genetic factor acting jointly . The disease is characterised by metabolic abnormalities &long term complication involving the - 1.Eyes 2.Kidneys 3.Nerves 4.Blood vessels

3. AETIOLOGY Defective production or action of insulin;a hormone that control glucose,fat and a mino acid metabolism.

4. CLASSIFICATION Diabetes mellitus- Type1 or insulin dependent diabetes mellitus Type2 or non insulin dependent diabetes mellitus Malnutrition related diabetes mellitus Maturity onset diabetes of the young Other types(secondary to pancreatic,hormonal,drug induced, genetic) Impaired glucose tolerance Gestational diabetes mellitus

5. MAGNITUDE OF PROBLEM WORLDWIDE Diabetes is an iceberg disease currently the number of cases of Diabetes worldwide is around 387 million, of which more than 90% are Type 2 Diabetics

6. WORLDWIDE PREVALENCE OF DIABETES Global prevalence of Type 2 Diabetes in adults aged 25+ is 10%

7. Worldwide Prevalence by Region

8. MAGNITUDE OF DIABETES IN SOUTH EAST ASIA

9. MAGNITUDE OF PROBLEM IN INDIA India is the diabetes capital of the world

10. EPIDEMIOLOGICAL DETERMINANTS AGENT Main cause of diabetes mellitus is insulin deficiency Absolute-type1 Partial-type2 This is due to various factors- Pancreatic disorders Defects in insulin formation Destruction of beta cells Decreased insulin sensitivity Genetic defects A utoimmunity

11. 2.HOST FACTORS Age Sex Genetic factors Genetic markers~ a.Type1:HLA-DR3,HLA-DR4 b.Type2:not HLA associated Immune mechanisms Obesity Maternal diabetes

12. 3.ENVIRONMENTAL FACTORS Sedentary lifestyle Diet Dietary fiber Malnutrition Alcohol Viral infections Chemical agents Stress Others- a.Occupation b.Economic status c.education

13. SCREENING AND PREVENTION OF DIABETES URINE EXAMINATION Urine test for glucose is done 2 hours after a meal It has high specificity and low sensitivity therefore false negatives are common while false positives are rare It is used along with OGTT for screening BLOOD SUGAR TESTING Mass screening programmes use glucose measurements of fasting,post prandial or random blood sample For epidemiological purposes the 2 hr value after 75g oral glucose may be used alone or with fasting value

14. WHO recommendations for the diagnostic criteria for Diabetes and intermediate hyperglycaemia DIABETES Fasting plasma glucose 2 hr plasma glucose >=126mg/dl >200mg/dl IMPAIRED GLUCOSE TOLERANCE Fasting plasma glucose 2 hr plasma glucose <126mg/dl >=140mg/dl & <200mg/dl IMPAIRED FASTING GLUCOSE Fasting plasma glucose 2 hr plasma glucose 110 mg/dl to 125mg/dl <140mg/dl

15. PREVENTION AND CARE PRIMARY PREVENTION Population strategy High risk strategy SECONDARY PREVENTION To maintain blood glucose levels close to normal limits To maintain ideal body weight Treatment is based upon : Diet alone Diet and oral anti diabetics Diet and insulin

16. Glycosylated haemoglobin : It should be estimated every 6 months It provides a long-term index of glucose control Self care Home blood glucose monitoring TERTIARY PREVENTION Organisation of specialised diabetic clinics to provide diagnostic and management skills and for both clinical and epidemiological research

17. THANK YOU

18. IN A NUT SHELL

19. CLASSIFICATION TYPES AGE INCIDENCE GRADING OF RISK DM-1 < 30 yrs Less common Moderate DM-2 > 30 yrs Commonest High MRDM Young Rare Mild Others Any Common Moderate MODY Young Rare Mild IGT Any More common Moderate GDM Pregnancy Common High

20. Worldwide Prevalence by Region

21. INDIA 16.3 million 21.4 million Total 37.7 million

22. EPIDEMIOLOGICAL DETERMINANTS

23. SCREENING Always for high risk population Blood Sugar Urine Test HbA 1C level= > 9% TEST FINDINGS NORMAL FBS 70-100 mg/dl PPBS < 140 mg/dl RBS < 140 mg/dl DIABETES FBS > 125 mg/dl PPBS > 200 mg/dl RBS >200 mg/dl IGT FBS 111-125 mg/dl PPBS 140-200 mg/dl RBS <200 mg/dl

24. PREVENTION

25. BIBLIOGRAPHY Parks textbook of preventive and social medicine:23 rd edition Robbins pathological basis of disease:8 th edition www.idf.org www.wikipedia.org

26. THE END