Download DM - Department of Community Medicine ACME Pariyaram

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)
b)
c)
d)
e)
f)
Pancreatic disorders
Defect in formation of insulin
Destruction of beta cells
Decreased insulin sensitivity
Genetic defects
Auto immunity
Host factors
a)
b)
c)
d)
Age
Sex
Genetic factors
Genetic markers: HLA-B8 & B15, DR3
& DR4
e) Immune mechanisms
f) Obesity
g) Maternal diabetes
Environmental risk factors
a)
b)
c)
d)
e)
f)
Sedentary lifestyle
Diet
Dietary fibres
Malnutrition
Alcohol
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
Thank You