1. Diabetes Mellitus Introduction to Diabetes Epidemiology

2. Definition: A metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from one or more of the following: 1. Defects in insulin secretion (lack or absence). 2. Defects in insulin formation (structure or action). 3. Defects in insulin receptors (lack or abnormal).

3. Increasing mortality from diabetes mellitus J. Olefsky, JAMA 2001:285:628-632

4. Diabetes mellitus Diabetes mellitus was well known in ancient times, long before scientists and doctor began to investigate it The main features of the disease were recognized at that time, and may still be listed as: 1. Severe thirst 2. Excessive drinking 3. Frequent urination 4. Bodily wasting

5. Classification: 1. Diabetes Mellitus (DM): i-Insulin dependant diabetes Mellitus (IDDM, Type 1) ii- Non - insulin dependant diabetes Mellitus (NIDDM, Type 2) iii- Malnutrition – related diabetes mellitus (MRDM) iv- Other types (secondary to pancreatic, hormonal, drug induced, genetics and other abnormalities) 2. Impaired glucose tolerance (IGT) 3. Gestational diabetes mellitus (GDM) 4. Metabolic syndrome.

6. Epidemiology of diabetes Prevalence worldwide is increasing* Prevalence worldwide is increasing* 2.8% in 2000; 4.4% in 2030 worldwide 2.8% in 2000; 4.4% in 2030 worldwide 171 million in 2000; 366 million in 2030 171 million in 2000; 366 million in 2030 Greatest rise in developing world Greatest rise in developing world

7. Global Prevalence Estimates, 2000 and 2030 4.4 % 2.8 % Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.

8. Prevalence of Diabetes - 2007 246 Million

9. Prevalence of Diabetes - 2025 380 Million

11. DIAGNOSIS For non-pregnant individuals of any age, a diagnosis of diabetes can be made if at least one of the following is present: 1. The patient presents with classical signs and symptoms of diabetes ( and has FBS ≥ 140 mg/dL or RBS ≥ 200 mg/dL 2. A fasting plasma glucose concentration is ≥ 140 mg/dL on two or more occasions. 3. Following a standard oral glucose challenge (75 gms glucose for an adult or 1.75 gms/kg for a child), the venous plasma glucose concentration is ≥ 200 mg/dL at 2 hours and > 200 mg/dL at least one other time at ½, 1, 1 ½ hours. 4. Individuals with fasting plasma glucose values or OGTT values that are intermediate between normal and those considered diagnostic of diabetes are considered to have “impaired glucose to tolerances”.

12. Urine Glucose 1. Its presence is not diagnostic because glucosuria may occur when the renal threshold for glucose is decreased (as in pregnancy) or when there are other sugars and interfering substances in the urine. 2. Conversely, the absence of glucose in the urine does not rule -out diabetes in individuals with elevated renal thresholds. Glycosylated Hemoglobin (HbA 1C ). 1. Glycosylated hemoglobin concentrations generally reflect the mean blood glucose concentrations over the past one to two months and are almost always elevated in patients with diabetes. 2. Since 2012, any initial single test of HbA1C More than 6.5 is diagnostic..

14. Screening of diabetes: 1. Urine examination. 2. Blood sugar testing. Target population (high-risk population): 1. > 40 years. 2. +ve family history. 3. Obese. 4. Women who have had a baby > 4.5 Kg. 5. Women who show excess weight gain during pregnancy. 6. Premature atherosclerosis.

15. Management of Diabetes: 1. Maintain blood glucose as close as possible to normal values (drug therapy). 2. To maintain ideal body weight: A- Diets. B- Exercise. 3. Self care. 4. Blood glucose monitoring: A- Glycosylated hemoglobin. B- Home blood glucose monitoring. C- Routine lab. 6. Having a pocket card.

16. By managing the ABCs of diabetes, people with diabetes can reduce their risk for heart disease and stroke. A stands for A1C B stands for Blood pressure C stands for Cholesterol D stands for diet and lifestyle change E stands for exercise

17. UN World Diabetes Day (14 Nov) Joins AIDS as the only other disease granted a UN World Day (World Health Day, World Mental Health Day)