Diabetes

Diabetes is recognized as the world’s fastest growing chronic condition and is recognized as a global epidemic with the potential to cause a worldwide healthcare crisis…..

Prevalence 2017 425 million adults with diabetes 2045 estimate 629 million Prevalence in SA 9% 1 in 2 adults with diabetes is undiagnosed 2/3 of people with diabetes are of working age 2/3 of people with diabetes life in urban areas Around 8% of woman live with diabetes worldwide / 1 in 11 adults has diabetes

Epidemiology Type 2 diabetes 90 to 95% of diabetes population Dramatic increase in Sub Saharan Africa ..2045 with 156% Ageing population Disturbing trends parallel obesity pandemic Younger people diagnosed with Type 2 Increase in Gestational diabetes

People who die < 60 years

Definition of diabetes A condition characterized by hyperglycemia due to: *Defects in insulin production *Autoimmune or other destruction of beta cells *Insulin insensitivity *Impaired action of insulin on target tissues

Risk factors Type 2 Age > 35 years Genetically Member of high risk group History of IFG or IGT Vascular disease History of gestational diabetes History of delivering macrosomic babies Hypertension Dyslipidaemia

Abdominal obesity Overweight Polycystic ovary disease Acanthosis nigricans Skin tags Schizophrenia Lifestyle

Clinical Features Type 2 Excessive thirst Drinking excessive amounts of fluids Passing large amounts of urine Extreme tiredness Weight changes Blurred vision Lack of concentration/poor memory/moodiness Infections / itchiness / skin rashes Numbness/ tingling/ pins and needles in hands and feet

Broad Classification of Diabetes

Diagnosis Anyone with diabetes?

Diagnostic Criteria: Fasting BG

Random BG

HbA1c

BMI

Ethnic Specific BMI Cut Points White European Asian Population Classification < 18.5  kg/m2    <18.5 kg/m2 Underweight 18.5-24.9 kg/m2 18.5- 23 kg/m2 ‘Normal’ 25-29.9  kg/m2     23-27.5 kg/m2 Overweight 30  kg/m2  ≥27.5  kg/m2 Obese

Waist Circumference

Cornerstones of Diabetes Rx Physical Activity Nutrition Medication

Reduction in HbA1c of 1%

Monitoring

Blood glucose levels Target HbA1 c Target FPG Target PPG Table I: Average Fasting and Post-prandial glucose levels in relation to HbA1C Target HbA1 c Target FPG Target PPG Target for people who can achieve it (without too much hypoglycaemia) < 6.5 % 4.0-7.0 mmol/l < 8 mmol/l Target for most people with diabetes <7% 4 - 7 mmol/L < 10 mmol/l < 8 % < 12 mmol/l The targets in mmol/L are from the Canadian Diabetes Association Clinical Practice Guidelines. The targets in mg/dl are from the American Diabetes Association Clinical Practice Guidelines. However, it is important that targets be individualized for people with diabetes depending on their specific needs. For example, the targets for young children or the elderly may be different from the average person. Amod et al. (SEMDSA), JEMDSA 2017 Volume 22(1) Chapter 8 Page S35

Interpretation of HbA1c Mean blood glucose (mmol/l) 6 7.0 7 8.6 8 10.2 9 11.8 10 13.4 11 14.9 12 16.5

Nutrition

Exersice Improve insulin sensitivety Improve blood glucose control Lowers insulin requirements Improves circulation Lowers blood pressure Increase weight loss Improves cholestrol levels Lowers stress levels Decrease risk of heart disease

Increase physical fitness Enhances sense of well being Reduces the risk of osteoporosis Patient must discuss exercise with doctor before he/she start. Different forms of exercise Find one that you enjoy Always carry fast acting glucose when exercising

Pharmacological Treatment Decrease symptoms of hyperglycaemia without episodes of HYPOGLYCAEMIA Limit adverse effect of treatment Maintain quality of life and psychological well-being Prevent or delay the onset of complications

Acute Complications Hypoglycaemia Hyperglycaemia Diabetes Ketoacidosis Hyprosmolar non-ketotic coma

Chronic complications The prevalence of retinopathy, nephropathy and neuropathy increased with the longer duration of the hyperglycaemia and was highest in those with poor control. In macrovascular disease hyperglycaemia appears to have a lesser effect than boold pressure control, dyslipidaemia and smoking.

Micro vascular complications Retinopathy Nephropathy Neuropathy

Macrovascular complications Cardio Vascular disease Cerebro Vascular Disease Peripheral Vascular Disease

The End and Thank You !!