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Diabetes Mellitus

Diabetes Mellitus. Dr. Santosh K. Yatnatti Assistant professor Department of Community Medicine. Problem statement. Diabetes is an iceberg disease 422 million cases globally 2014 1.5 million deaths globally 2014 80% in low and middle income countries

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Diabetes Mellitus

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  1. Diabetes Mellitus Dr. Santosh K. Yatnatti Assistant professor Department of Community Medicine

  2. Problem statement • Diabetes is an iceberg disease • 422 million cases globally 2014 • 1.5 million deaths globally 2014 • 80% in low and middle income countries • Environemental factors predominent cause for developing DM

  3. Classification • Diabetes Mellitus • Type I DM (Insulin Dependent) • Type II DM (Non-Insulin Dependent) • Malnutrition related DM • Secondary/ other types of diabetes associated with certain conditions • Impaired Glucose Tolerance (IGT) • Gestational DM

  4. Type 1 Diabetes Mellitus • Constitutes 5-10% of DM diagnosis • Age of onset usually <30 years and most <20 years • Signs and symptoms occur when 90% of beta cells are destroyed resulting in severe or complete insulinopenia • 3 “Ps”-polyuria, polydipsia, and polyphagia • Ketonuria-DKA PRONE • Rapid weight loss • Hyperglycemia (ADA criteria)

  5. Type 1 causes and treatment • Suspected causes • Genetic predisposition • Immunologic • Environmental • Idiopathic • Treatment • Insulin

  6. Type 2 Diabetes Mellitus • Constitutes 90-95% of DM diagnosis • Age of onset usually >30 years • Signs and symptoms usually mild or absent at time of diagnosis • Occurs due to defects in insulin function • Insulin resistance/no islet cell antibodies • Decreased insulin secretion (rarely DKA) • Hepatic glucose overproduction • May be multifactorial

  7. Type 2 causes and treatments • Suspected causes • Genetic predisposition - 90% with family history • Strongly associated with obesity (80-90%) • Strongly associated with sedentary lifestyle • IRS/ Syndrome X association • Treatments • Diet (80% of patient will need weight loss) • Exercise • Medications

  8. Differences between Type 1 and Type 2

  9. Differences between Type 1 and Type 2

  10. Gestational DM • 2-4% during second or third trimester • Onset of DM with pregnancy • More common in older women with family history of DM • Occurs due to placental hormone changes that effect insulin function (greater resistance) • Screening usually occurs during the 24th-28th week in high risk patients • Higher chance of developing NIDDM (30-50%) and IGT

  11. Malnutrition Related Diabetes Mellitus • Usually seen in developing countries • Age of onset usually 10-40 years • Hyperglycemia exists without ketosis • Malnutrition as a causal factor is unknown • Usually require insulin

  12. Secondary Diabetes Mellitus • DM occurs as a result of another problem (primary) • Diseases- pancreatic, hormonal • Conditions • Medications • Thiazides • Diuretics • Beta blockers • Steroids • Hyperglycemia is diagnostic for DM • Treatment of the primary cause may resolve the DM but lifestyle modifications and medications may be needed as well

  13. Impaired Glucose Tolerance • Higher than normal plasma glucose but lower than the diagnostic values for DM • Precursor for Type II • Only about 25% develop into type II and rest go back to normal • Patients are more susceptible to macrovascular diseases. • Must educate regarding risks and need for lifestyle modifications

  14. Diagnosis of Diabetes • Polydipsia – Increased thirst • Polyuria – Increased frequency of urination • Fatigue • Polyphagia – Increased Fatigue • Weight Loss • Abnormal Healing • Blurred Vision • Increased occurrence of infections

  15. Natural History of Type 2 Diabetes Impaired glucose tolerance Undiagnosed diabetes Known diabetes Insulin resistance Insulin secretion Postprandial glucose Fasting glucose Microvascular complications Macrovascular complications Adapted from Ramlo-Halsted BA, Edelman SV. Prim Care. 1999;26:771-789 17

  16. Agent factors • Pancreatic disorders – inflammatory, neoplastic, cystic fibrosis • Defects in the formation of insulin • Destruction of beta cells • Decreased insulin sensitivity- ↓ monocyte and adipocyte insulin receptors • Genetic defects • Autoimmunity

  17. Host factors • Age • Sex • Genetic factors -90% in type II & 50% in type I • Genetic markers: HLA B8 & B15, HLA DR3 & DR4 • Immune mechanism • Obesity • Maternal Diabetes

  18. Environmental risk factors • Sedentary lifestyles • Diet • Dietary fibre • Malnutrition • Alcohol • Viral infections • Chemical agents • Stress • Other factors

  19. CRITERIA FOR DIAGNOSIS OF DM • Symptoms of DM plus random blood glucose conc> 200mg/dl • Fasting plasma glucose > 126mg/dl • Two hour plasma glucose > 200mg/dl during an oral GTT

  20. PREVENTION AND CONTROL • LEVELS OF PREVENTION: • Primordial prevention • Primary Prevention • Secondary Prevention • Tertiary Prevention

  21. PRIMORDIAL PREVENTION • This is prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared. • We direct efforts to discourage children from adopting harmful lifestyles like SMOKING,JUNK FOOD EATING.

  22. Primary Prevention • Population strategy • High risk strategy

  23. Why the primary prevention? “There is an urgent need to take the prevention of cardiovascular disease more seriously. The only sensible strategy is the population approach to primary prevention.”

  24. Secondary prevention The purpose of secondary prevention activities such as screening is to identify asymptomatic people with diabetes. Is there an effective intervention that may retard the progression of disease or the severity of its complications?

  25. Aim of treatment • To maintain blood glucose levels • To maintain ideal body weight • To prevent complications • Treatment • Diet • Exercise • Drugs • Monitoring • Self care

  26. Self care • Compliance to drug and diet • Self monitoring of urine and blood glucose levels • Self administration of insulin • Abstinence from alcohol • Maintaining optimum weight • Regular check ups • Recognition of hypoglycemia • Self care of hands and foot

  27. Screening approaches Population screening Selective screening Opportunistic screening

  28. Tertiary prevention Includes actions taken to prevent and delay the development of acute or chronic complications. Acute complications: such as hypoglycemia, severe hyperglycemia and infections. Chronic complications: such as atherosclerosis, retinopathy, nephropathy, neuropathy and foot problems.

  29. Effective interventions Strict metabolic control, education and effective treatment. Screening for complications in their early stages when intervention is more effective.

  30. Obstacles and barriers for prevention Economic problems: unavailability of needed resources. Socio-cultural problems. Lack of data, knowledge and skills.

  31. Summary

  32. Questions • 1. Explain the epidemiology of Diabetes mellitus in detail • 2. Classify Diabetes Mellitus • 3. Mention the Risk factors for Diabetes mellitus • 4. Describe the preventive and control measures for Diabetes Mellitus

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