Diabetes Mellitus Dr Ubaid N P Community Medicine Pariyaram Medical College

Introduction A heterogeneous group of diseases, characterized by a state of chronic hyperglycemia, resulting from a diversity of etiologies, environmental and genetic acting jointly Insulin – hormone that controls glucose, fat and amino acid metabolism

Classification 1.Diabetes Mellitus(DM) a) Type 1 (IDDM) b) Type 2 (NIDDM) c) Malnutrition related diabetes mellitus(MRDM) d) Other types (2° to pancreatic, hormonal, drug induced, genetic & other abnormalities) 2. Impaired glucose tolerance(IGT) 3. Gestational diabetes mellitus(GDM)

Insulin resistance syndrome (Syndrome X ) Association of T2DM with: hyperglycemia, hyperinsulinaemia, dyslipidaemia, hypertension, coronary artery disease & stroke

Problem statement Iceberg disease Out of global of 347 million cases, more than 90% is T2DM 37.7million cases in India (2004) Asians more vulnerable Prevalence 10%

Epidemiological determinants

Agent Insulin deficiency – partial or absolute a)Pancreatic disorders b)Defect in formation of insulin c)Destruction of beta cells d)Decreased insulin sensitivity e)Genetic defects f)Auto immunity

Host factors a)Age b)Sex c)Genetic factors d)Genetic markers: HLA-B8 & B15, DR3 & DR4 e)Immune mechanisms f)Obesity g)Maternal diabetes

Environmental risk factors a)Sedentary lifestyle b)Diet c)Dietary fibres d)Malnutrition e)Alcohol f)Viral infections – mumps, rubella, cocksackie B4 g)Chemical agents – alloxan, streptozotocin, Valcor h)Stress i)Others – social class

Screening for diabetes 1.Urine examination 2.Blood sugar examination Target population: a)Those in the age group 40 & over b)Family history of DM c)Obese d)Women with newborn weighing more than 4.5kg e)Women with excess weight gain during pregnancy f)Patients with premature atherosclerosis

WHO recommendations for the diagnostic criteria for diabetes & intermediate hyperglycemia Diabetes Fasting plasma glucose or 2- h plasma glucose ≥126 mg/dl (≥7 mmol/l) >200 mg/dl (>11.1 mmol/l) Impaired Glucose Tolerance(IGT) Fasting plasma glucose or 2- h plasma glucose <126 mg/dl (<7 mmol/l) ≥140mg/dl to <200 mg/dl (≥7.8 mmol/l & <11.1mmol/l) Impaired Fasting Glucose (IFG) Fasting plasma glucose or 2- h plasma glucose 110mg/dl to 125 mg/dl (6.1 to 6.9 mmol/l) <140mg/dl (<7.8 mmol/l)

Prevention & Care 1.Primary prevention (a) Population strategy – Primordial (b) High risk strategy 2.Secondary prevention - Glycosylated haemoglobin - Self care - Home blood glucose monitoring 3. Tertiary prevention

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