Diabetes
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Diabetes

Diabetes

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    Diabetes Diabetes Presentation Transcript

    • INCIDENCE OF MACROVASCULAR COMPLICATIONS IN NEWLY DIAGNOSED DIABETICS Dr. Awadhesh Kumar sharma,SR MEDICINE,MLB,MEDICALCOLLEGE JHANSI Department of Medicine M.L.B. Medical College, Jhansi
    • What is Diabetes?
      • Normally, blood sugar (glucose) levels are kept in the normal range by the release of insulin from the islet cells of the pancreas
      • Insulin helps glucose enter the cells.
      • Diabetes occurs when the body doesn’t produce enough insulin or the body can’t use it properly. This results in sugar (glucose) building up within the bloodstream
      • Diagnosed by blood test
        • Fasting glucose > 125mg/dl
        • Random blood glucose > 200mg/dl
    • Body lacks insulin or is unable to use insulin effectively Diabetes Pancreas Cannot Produce Enough Insulin Muscle and Fat Cells Cannot Use Insulin Effectively
    • Diagnosis Criteria
      • One test is not enough!
      • The diagnosis must be done by a physician.
      * FBG blood test is done after fasting 8 hours. ** GTT results are repeated after 2 hours. A person drinks a 75 mg glucose solution before test. 100 mg for Pregnant women. Normal Pre diabetes Diabetes Fasting Blood Glucose Test (FBG)* Less than 100 Between 100 - 125 More than or equal to 126 Glucose Tolerance Test (GTT) ** Less than 140 Equal to or more than 140 but less than 200 More than or equal to 200
    • Epidemiology Diabetes is an ‘iceberg” disease. According to recent estimation the prevalence of diabetes mellitus in adult is 4% worldwide and it means that over 14.3 million persons are affected. At present the prevalence of DM is estimated to be 0.19% in people < 20 years old and 8.6% in people > 20 years. In individuals > 65 years old the prevalence of DM estimated to be 20.1%. The prevalence is similar in men and women through out most age ranges but its slightly greater in men more than 60 years.
    • It is projected that disease prevalence will be 5.4% by year 2025 with global diabetic population reaching 300 million. Of the close to 77% of global burden of disease is projected to occur in developing countries. The most recent study, National Urban Diabetes Survey carried out in six cities found age standardized prevalence rate of 12% for diabetes and 14% for IGT. At present total no diabetic patient in India is about 33 million and may increase upto 80 million by 2030.
    •  
    • Risk Factors for the Development of Type 2 Diabetes
      • Family history of diabetes
      • Obesity
        • Especially central
      • Hypertension
      • High triglycerides
      • Low HDL-C
      • Elevated glucose
      • Ethnicity other than Caucasian
      • Vascular disease
      • History of gestational diabetes
      • History of baby weighing > 9 lbs
      • Sedentary lifestyle
    • Complications of Diabetes
        • Eye disease
          • Retinopathy (non proliferative / proliferative)Macular edema
        • Nephropathy
        • Neuropathy
          • Sensory and motor (Mono or polyneuropatyhy)
          • Autonomic neuropathy
      • The deadly triangle of morbidity and mortality in the diabetic population are
      • Coronary artery disease
      • Cerebrovascular disease
      • Peripheral vascular disease
      • Coronary artery disease is leading cause of mortality followed by cerebrovascular disease.
        • Gastrointestinal (Gastro paresis and diarrhea)
        • Genitourinary (uropathy/ sexual dysfunction)
        • Dermatologic
        • Infectious
        • Cataracts
        • Glaucoma
      Vascular Non-Vascular Microvascular Macrovascular
    • Complications of Diabetes Retinopathy: 25x End-Stage Kidney Disease: 17x Heart Disease: 2-4x Foot/Leg Amputations: 5x Stroke: 2-6x
    • Macrovascular complication of diabetes Diabetes mellitus is the most prevalent, chronic non communicating disorder and risk of complication increases with function of duration of hyperglycemia. It involves various organs especially kidney, heart, blood vessels, eye, brain. Clinical manifestation of macrovascular disease is atherosclerosis.
    • Insulin resistance diabetes mellitus Hypertension Obesity Hyperinsulinemia Diabetes Dyslipidemia Small, dense LDL Inflammation Hypercoagulability Insulin Resistance Atherosclerosis
    • Our Study
      • Aims and objectives
      • To study the incidence of macrovascular complications in DM in newly diagnosed patient (diagnosed within 6 months)
      • Material & Methods
      • The study will include diabetes mellitus patients new cases which is diagnosed within 6 months.
      • Sources of cases
        • OPDs in MLB Medical College
        • Patient admitted in wards
        • Patients admitted in ICCU.
      • Criteria of selection
      • Any volunteer who fulfils the criteria of diagnosis of DM new cases (diagnosed within 6 months) will be included in study.
      • Method of study
      • Name
      • Age and sex
      • Residence
      • History
        • H/o present illness
        • Past history
        • Personal history
        • Family history
        • H/O risk factors
      • Anthropometry
        • Height
        • Weight
        • BMI
        • Waist circumference
      • General examinations
        • Pulse
          • Radial
          • Dorsalis pedis
        • BP
          • Brachial BP
          • Ankle BP
          • Ankle brachial index
      • Systemic examinations
        • Detailed CVS examination
        • Detailed CNS examination
        • Detailed peripheral vascular systemic examination
      • INVESTIGATION
      • General investigation
        • Hemoglobin
        • S. creatinine
        • Micral test
        • 24 hr urinary protein
      • Lipid profile
        • Total cholesterol
        • HDL cholesterol
        • LDL cholesterol
        • VL/DL cholesterol
        • HDL/LDL ratio
      • Specific investigations for macrovascular disorders
      • ECG
        • Routine ECG
        • With long lead II & V1
        • Double speed ECG
        • Tread Mill Test (TMT)
      • X-ray chest PAV
      • Echo cardiography
      • Duplex imaging of carotids
        • Carotid intimal medial thickness
      • NCCT
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      • Diabetes control starts knowing patient’s A1c levels.
      • Good diabetes control avoids or delays complications.
      • A1c test every 3 months.
      • A1c < 7% is the goal
      Diabetes Control
      • meal plan (always eating healthy)
      • exercise moderately (eg. walking 30 minutes a day)
      Diabetes Self-management what a person with diabetes should do by her/himself to maintain control
    • Diabetes Self-management
      • monitor glucose levels frequently
      • take medications properly
      • take care of eyes, feet, teeth and skin
    • Remember the values of good control If a person with diabetes keeps these values between medical check ups, means a good diabetes control
      • A1c test
      < 7 %
      • Blood Pressure
      < 130/80
      • LDL cholesterol
      < 100
      • Conclusion
      • The following conclusions can be drawn from the present study :-
      • The average age of newly diagnosed type-2 diabetes mellitus patients was 40-60 years.
      • Incidence of cardiovascular disease in newly diagnosed type-2 DM found to be 40%.
      • Incidence of cerebrovascular complications were found to be 10% in newly diagnosed type-2 DM.
      • Incidence of peripheral vascular disease was found to be 8% in newly diagnosed type-2 DM.
      • Incidence of macrovascular complications were more in those having risk factors like hypertension, dyslipidemia, obesity, smoking and family history of diabetes.
    • THANK YOU