clinical features of dm
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8/6/2019 Clinical Features of DM
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8/6/2019 Clinical Features of DM
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DM: A clinical Syndrome
� Hyperglycemia� Insulin deficiency ± absolute or relative
� Abnormal metabolism of CHO, Fat, Protein
� Disturbance of water & electrolytes
� Acute metabolic decompensation
� Chronic morbidity ± Eye, Kidney, Nervous
System.
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Ep idemiology & Disease Burden
� 2000 - 150 million world wide� 2010 - 300 million worldwide
� Type 2 : Type I = 7:3
Prevalence:
� 0.19 % below 20 years
� 8.6% above 20 years
� 20.1% above 65 years
� Equal in both sexes, slightly greater in men
above 60 yrs.
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Classification of DM
� Based on Aetiology� Independent of Age of the individual
Typ e 1:
� 1A ± Immune destruction of B-Cells
� 1B ± Idiopathic destruction of B-Cells
Typ e 2
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Other s p ecific Ty p es:- Ty p e 3M ODY
Pancreatic Disease- Fibrocalculous Pancreatopathy
- Pancreatitis, Cystic disease
- Pancreatectomy
Endocrinopathy - Insulin antagonist
- Cushing¶s Syndrome
- Acromegally
- Hyperthyroidism
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Iatrogenic
- Corticosteroids, Thiazide, Phenytoin
Viral Infections
- Congenital rubella
- M umps
- Coxsackie ± B
Genetic Syndromes
- Down¶s Syndrome
- Turner¶s
- Klinefelter¶s
Gestational Diabetes
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Presenting features of DMW ide Spectrum:
Asymptomatic ------------- Acute ComplnHigh Index of SuspicionClassical Symptoms of Hyperglycemia
Thirst, Dry mouthPolyuriaW eight loss/ W eight gainTiredness, fatigue, irritability, apathyBlurring of visionHyperphasiaPruritus Vulvae, balanitis, boils,
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Clinical Ex amination
� No physical Signs except weight loss inType 1 D M
� Central obesity in 70% of type 2 D M
� HTN ± 50% of type 2 D M
� X anthelasma, Xanthemata
� Cataract
Target Organ Involvement.
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Criteria for the Diagnosis of DM
� Symptoms of D M & Random plasma glucose
more than or equal to 200 mg per dl.
� Fasting Plasma glucose more than or equal to
126 per dl.Two hour plasma glucose equal or more than
200 mg per dl during an oral glucose Tolerance
Test
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Im p aired Fasting Glucose ( IFG)
Fasting Plasma glucose: 100 ± 125 mg per dl.
Im p aired Glucose Tolerance (75 gm Glucose )
2 hr Post ± glucose plasma glucose: 140 ± 199
mg per dl.
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Screening of DM
Why Screening?� Large number of asymptomatic D M
� Type 2 D M may be present for upto a decade
before diagnosis.
� 50% of type 2 D M have one or more diabetic
complication at the time of diagnosis
� Treatment of Type 2 D M may favourably alter the
natural history
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Screen all above 45 yrs every 3 years
Screen high risk individuals at an earlier age
FM of type 2 D M
ObesityIFG or IGD or GD M
Hypertension, IHD, PVD, Dyslipidaemia
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