diabetes mellitus dr ubaid n p community medicine pariyaram medical college
TRANSCRIPT
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Diabetes Mellitus
Dr Ubaid N P
Community Medicine
Pariyaram Medical College
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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
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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)
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Insulin resistance syndrome(Syndrome X )
• Association of T2DM with: hyperglycemia,
hyperinsulinaemia,
dyslipidaemia ,
hypertension,
coronary artery disease & stroke
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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%
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Epidemiological determinants
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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
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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
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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
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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
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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)
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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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Thank You