EPIDEMIOLOGY OF DIABETES.pptx

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1. EPIDEMIOLOGY OF Sheral Samson BScN epidemiology of diabetes 1

2. s By the end of presentation, the learners will be able to: Briefly describe the disease “diabetes mellitus” Develop an epidemiological triangle of diabetes to explain the interaction among all the components of diabetes triad. Explain the natural history of diabetes mellitus. Discuss the levels of prevention and related modes of interventions applied for the prevention of diabetes mellitus. Give the global and national morbidity (prevalence & incidence) and mortality rate of diabetes mellitus . Survey the epidemiological study designs related to the diabetes mellitus. List some recommendations for the improvement of diabetes in Pakistan. OBJECTIVES: epidemiology of diabetes 2

3. DIABETES MELLITUS The name diabetes mellitus refers to these s/s: D iabetes , from the Greek diabainein, meaning “ to pass through ,” describes the copious urination M ellitus , from the Latin meaning “ sweetened with honey ,” refers to sugar in the urine . “Diabetes is a metabolic disorder, characterized by uncontrolled amount of glucose in the blood due to insufficient insulin or insulin resistant” epidemiology of diabetes 3

4. epidemiology of diabetes 4

5. RESULT FASTING BLOOD GLUCOSE HbA1C GLUCOSE TOLERANCE TEST RANDOM GLUCOSE TEST POST PRANDIAL {AFTER 2HRS} Normal 70-99 mg/dl Below 5.7% 70-140 mg/dl 70-140 mg/dl 70-140 mg/dl Prediabetes 100-125 mg/dl 5.7%-6.4% 140-199 mg/dl 140-199mg/dl 140-199 mg/dl Diabetes 126 mg/dl-higher 6.5%-above 200 mg/dl- Above 200 mg/dl-above 200 mg/dl-above epidemiology of diabetes 5

6. Complications of DM Cardiovascular disease Neuropathy Nephropathy Retinopathy Foot damage Skin conditions Hearing impairment Depression epidemiology of diabetes 6

7. EPIDEMIOLOGICAL TRIAD OF DIABETES MELLITUS AGENT refers to risk factor /cause HOST ENVIRONMENT refers to medium epidemiology of diabetes 7

8. Age Ethnicity Genetics-Autoantibodies Obesity High LDL diet Physical inactivity Placental hormones Stress, smoking Health condition; PCOs ENVIRONMENT Sedentary behavior Unhealthy lifestyle Socio-economic status Culture Heredity pregnancy Host Individual (genetically, nutritionally, anatomically, psychologically susceptible) AGENT EPI. TRIAD OF DIABETES epidemiology of diabetes 8

9. PRE-PATHOGENESIS PHASE PATHOGENESIS PHASE STAGE OF SUSCEPTIBILITY (at risk) Genes-autoantibodies(T1DM) Obesity High LDL diet Physical inactivity Stress, smoking Health condition; PCOs Placental hormones EARLY PATHOGENESIS LATE PATHOGENESIS STAGE OF SUBCLINICAL DISEASE PREDIABETES (pathological changes) Last for months to years Autoantibodies develop and damage the beta-cells (T1DM) Typically has no distinct sign or symptom except sole sign of high blood sugar Hypercholesterolemia, nicotine and stress hormones cause insulin resistance. Secretion of placental hormones cause insulin resistance in pregnant women(normally beta cells secrete extra insulin to cover up the secretion of placental hormones but in some ladies it can’t do so) STAGE OF CLINICAL DISEASE (clinical manifestations) HYPERGLYCEMIA- Polyuria Polyphagia Polydipsia Dry mouth Weight loss Fatigue Blurred vision Slow healing cuts or wounds Numbness or tingling Feet swelling STAGE OF TERMINATION Disease progress to complications; CVD RETINOPATHY-BLINDNESS FOOT DAMAGE-AMPUTATION NEPHROPATHY-CKD HEARING IMPAIREMENT NO RECOVERY COMPLICATIONS-ORGAN FAILURE-DEATH PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION HOST AGENT ENVIRONMENT epidemiology of diabetes 9

10. LEVEL RISK FACTORS DISEASE COMPLICATIONS MODE OF INTERVENTIONS PRIMORDIAL To keep body healthy, prevent body from occurrence of risk factors. Absent Absent Absent INDIVIDUAL AND MASS EDUCATION Educate to maintain normal body weight. Adoption of healthy nutritional habits and physical exercise. Childhood obesity prevention through education. Educate to maintain a nutritious diet. Girls in reproductive age or even in childhood maintain weight, take appropriate nutrition, and be physically active. epidemiology of diabetes 10

11. LEVEL RISK FACTORS DISEASE COMPLICATIONS MODE OF INTERVENTIONS PRIMARY To prevent the disease from occurrence by overcoming the risk factors. Present Absent Absent HEALTH PROMOTION Avoid sedentary behavior. Be physically active. Eat healthy and balanced diet; low saturated fats , a low added sugars and high fiber diet. SPECIFIC PROTECTION Aerobic exercises results in weight loss. Quit smoking. Immunomodulation to delay the occurrence of T1DM. epidemiology of diabetes 11

12. LEVEL RISK FACTORS DISEASE COMPLICATION MODE OF INTERVENTIONS SECONDARY To prevent the further progression of disease and prevention of diabetic complications. Present Present Absent EARLY DIAGNOSIS Classic signs of hyperglycemia; high sugar level, increase thirst, increase hunger, dehydration and so on. Fasting plasma glucose test Oral glucose tolerance test HbA1C TREATMENT Administer insulin Lifestyle changes. Adjusting diet and staying active Monitoring and maintaining glucose levels Manage high blood pressure Treat dyslipidemia Smoking cessation epidemiology of diabetes 12

13. LEVEL RISK FACTORS DISEASE COMPLICATION MODE OF INTERVENTIONS SECONDARY Present Present Absent Medications; metformin Recognition of symptoms associated with hypoglycemia. Attending periodic checkups. Routine checking of blood sugar, of urine for proteins and ketones, of blood pressure, visual acuity and weight should be done . The foot should be examine for any defective blood circulation , loss of sensation and the health of the skin. epidemiology of diabetes 13

14. LEVEL RISK FACTOR DISEASE COMPLICATION MODE OF INTERVENTIONS TERTIARY Prevent the worsening of complications and rehab patient. Present Present Present COMPLICATIONS LIMITATIONS: Screening of patients with diabetes for  diabetic retinopathy  to prevent progression to blindness through prompt treatment Prevent recurrence or further complications through appropriate medication. Appropriate diabetic foot care to avoid further damage or foot complications or to preventing from spreading further; wear appropriate shoes, never go barefoot, keep toenails trimmed. CVD patients take high HDL, low LDL, high fiber diet, 30 minutes brisk walk. epidemiology of diabetes 14

15. LEVEL RISK FACTOR DISEASE COMPLICATION MODE OF INTERVENTIONS TERTIARY Present Present Present People, especially older ones, with diabetic complications such as autonomic neuropathy, cardiovascular disease should avoid exercising outdoors on very hot and humid days. REHABILITATION: Follow-up to ensure adherence to medication regimen, monitor changes, and assist them in maintaining independence in daily life. Participate in social gathering. Attain glycemic control. Patient education is important to help people with diabetes enhance self care. Psychological support Exercises Other behavior modifications(physically active, healthy diet, smoking cessation) epidemiology of diabetes 15

16. HEALTH INDICATORS RELATED TO DIABETES MELLITUS MORBIDITY RATE Morbidity rate can be measure by: Incidence rate Prevalence YEAR PREVALENCE INCIDENCE 2009 285million - 2014 422million 137million 2017 451million 29million 2019 463million(9.3%) 12million 2021 537million (10.5%) 74million IDF estimated that prevalence of diabetes will be projected to 643million and 783million(12.2%) by the years 2030 and 2045, respectively. INTERNATIONAL DIABETES FEDERATION epidemiology of diabetes 16

17. GLOBAL RANKING WITH DIABETIES 2019 2021 RANK# COUNTRY PREVALANCE RANK# COUNTRY PREVALANCE 1. China 116 million 1. China 141 million 2. India 77 million 2. India 74 million 3. America 31 million 3. Pakistan 33 million 4. Pakistan 19 million 4. America 32 million INTERNATIONAL DIABETES FEDERATION epidemiology of diabetes 17

18. YEAR PREVALANCE INCIDENT RATE 2015 7 million - 2016 26.3% - 2017 7.5 million (6.9%)…18 TH RANK - 2019 19 million……………..4 TH RANK 11.5 million 2021 33 million…………....3 RD RANK 14 million PAKISTAN PREVALANCE AND INCIDENCE INTERNATIONAL DIABETES FEDERATION epidemiology of diabetes 18

19. MORTALITY RATE 2019 2020 2021 GLOBALLY 4.2 million or 11.3% - 6.7 million or 12.2% PAKISTAN RANK # 35 WORLDWIDE IN 2020 - 63852 deaths or 4.37% or 52.4/100000 - LIFE EXPECTANCY 2020 GLOBALLY T1 DM;70.96 &T2DM;75.19 PAKISTAN 67.27 INTERNATIONAL DIABETES FEDERATION epidemiology of diabetes 19

20. HEALTH EXPENDITURE 2017 2019 2021 GLOBALLY USD 850 billion USD 917 billion USD 966 billion PAKISTAN - - PKR 145.97 billion INTERNATIONAL DIABETES FEDERATION epidemiology of diabetes 20

21. STUDY DESIGNS # 01 Outcomes of Gestational Diabetes Mellitus in Pakistani Mothers: An Experience of a Tertiary Care Hospital Samina   Naseem Khattak, Abid Hussain Shah, Ayesha Imran, Muhammad Irfan Khattak, Khurram Mansoor & Asma Naveed Memon Vol. 11 no. 4 (2021) epidemiology of diabetes 21

22. ABSTRACT: Objective : To assess the incidence and outcome of gestational diabetes mellitus (GDM) during pregnancy among sample of Pakistani population . Study Design and Setting : This was an analytic case-control prospective study carried out at two centers (CMH Kharian and PNS Shifa Hospital Karachi) from 1st Jan till 30th July 2021. Methodology Previously healthy mothers were divided into three groups according to their risk of elevated glucose levels gestational diabetes mellitus (GDM) during pregnancy. Associations between GDM eminence (exposure variable) and pregnancy-related, fetal, and neonatal outcomes were reviewed (i.e., mode of delivery, preterm baby, pregnancy-induced hypertension, and fetal macrosomia , stillbirth, premature delivery etc. One way ANOVA was employed to compare the significant differences in different dependent variables amongst three groups. P Values of <0.05 were considered substantial . Results: A total of 120 patients were divided into 3 groups Group 1 (uncontrolled sugar group) who could not achieve adequate sugar control, Group II (adequate sugar control group) and Group III as control group (Non-Diabetic). The mean age in our population was 24 (+ 4.15) years most of study population 70% of mothers were under 25 years of age. The majority (95%) of deliveries in the control group ( Euglycemic ) were uneventful, but poor fetal outcomes were noted in groups 1 2 (documented to have elevated blood sugars,) especially in the group with Uncontrolled Sugar. GDM was positively associated with preterm birth, stillbirth and macrosomia . Conclusion : GDM is a prevalent disease in Pakistan and needs and has association with poor pregnancy outcomes. Urgent attention requires at individual and state level to reduce morbidity and mortality. epidemiology of diabetes 22

23. STUDY DESIGNS # 01 Prospective Study Of Cigarette Smoking, Alcohol Use, And The Risk Of Diabetes In Men Eric B. Rimm , June Chan, Meir J. Stampfer , Graham A. Colditz and Walter C. Willett BMJ: British Medical Journal Vol. 310, No. 6979 (Mar. 4, 1995) , pp. 555-559 (5 pages) Published By: BMJ epidemiology of diabetes 23

24. ABSTRACT Objective —To examine the association between smoking, alcohol consumption, and the incidence of non-insulin dependent diabetes mellitus in men of middle years and older. Study Design and setting : Cohort questionnaire study of men followed up for six years from 1986. The health professionals' follow up study being conducted across the United States. Subjects —41 810 male health professionals aged 40-75 years and free of diabetes, cardiovascular disease, and cancer in 1986 and followed up for six years. Main outcome measure —Incidence of non-insulin dependent diabetes mellitus diagnosed in the six years. Results —During 230 769 person years of follow up 509 men were newly diagnosed with diabetes. After controlling for known risk factors men who smoked 25 or more cigarettes daily had a relative risk of diabetes of 1.94 (95% confidence interval 1.25 to 3.03) compared with non-smokers. Men who consumed higher amounts of alcohol had a reduced risk of diabetes (P for trend <0.001). Compared with abstainers men who drank 30.0-49.9 g of alcohol daily had a relative risk of diabetes of 0.61 (95% confidence interval 0.44 to 0.91). Conclusions —Cigarette smoking may be an independent, modifiable risk factor for non-insulin dependent diabetes mellitus. Moderate alcohol consumption among healthy people may be associated with increased insulin sensitivity and a reduced risk of diabetes. epidemiology of diabetes 24

25. Give mass education about all levels of preventive measures especially Lifestyle modification (healthy diet , physical activity, normal BMI & exercise). Excess resources to those who cannot afford the treatment. Diabetes programs must offer accessible information , and must be delivered in a format that is understand. Promoting primary prevention and awareness all over Pakistan using screening methods such as RISK ASSSESMENT OF PAKISTAN INDIVIDUALS FOR DIABETES (RAPID) Implementing a nationwide diabetes care programs including registrations, treatment, and referral protocols …Diabetic Registry of Pakistan(DROP) RECOMMENDATIONS FOR THE IMPROVEMENT OF DIABETES IN PAKISTAN epidemiology of diabetes 25

26. References International Diabetes F ederation(IDF) Atlas 10 th edition (2021) https://diabetesatlas.org/#:~:text=Diabetes%20around%20the%20world%20in%202021%3A,%2D%20and%20middle%2Dincome%20countries . Prevalence of diabetes in Pakistan(15 may). MMI https://mmi.edu.pk/blog/prevalence-of-diabetes-in-pakistan / Stephen.R.daneils (2011).”The Natural History of Diabetes”. The J ournals of Pediatrics. https:// www.jpeds.com/article/S0022-3476(10)01017-6/fulltext William Herman. Et al (2015). “Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care  ”.American Diabetes Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512138 / Alberti KG, Zimmet PZ.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation . Diabetic medicine. 1998 Jul;15(7):539-53. Katherine Zeratsky.(2020). “ Does alcohol and tobacco use increase the risk of diabetes ?”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/diabetes/faq-20058540#:~:text=Tobacco%20use%20can%20increase%20blood,Katherine%20Zeratsky%2C%20R.D.%2C%20L.D . epidemiology of diabetes 26

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