Dr. Awadhesh Sharma Study of Microvascular & Macrovascular Complications  in Prediabetics (Impaired Glucose Tolerance)” De...
What is pre-diabetes? Pre-diabetes is a condition where blood sugar levels are higher than normal, but not yet high enough...
 
<ul><li>Global Burden </li></ul><ul><li>Worldwide, 230 million people have diabetes and in 2003, more than 300 million peo...
Diagnosis Criteria   <ul><li>One test is not enough! </li></ul><ul><li>The diagnosis must be done by a physician. </li></u...
Why We Worry About Prediabetes? <ul><li>Predicts high risk for development of diabetes </li></ul><ul><li>Predicts high ris...
Risk of Cardiovascular Disease Is Elevated Prior to Diagnosis of T2DM % with CVD *MI=myocardial infarction. Adapted from: ...
<ul><li>Does everyone with pre-diabetes develop type 2 diabetes? </li></ul><ul><li>Although people with pre-diabetes are a...
Symptoms of Prediabetes <ul><li>Symptoms of diabetes appear when the levels of glucose are either very high or very low. <...
Risk Factors for the Development of S Prediabetes <ul><li>Family history of diabetes </li></ul><ul><li>Class of obesity </...
<ul><li>RISK FACTORS THAT CAN BE MODIFIED </li></ul><ul><ul><ul><li>Overweight and obesity </li></ul></ul></ul><ul><ul><ul...
<ul><li>NON-MODIFIABLE  RISK FACTORS </li></ul><ul><ul><ul><ul><ul><li>Increasing age  </li></ul></ul></ul></ul></ul><ul><...
Body Mass Index (BMI)   <ul><li>18.5 - 24.9 = NORMAL </li></ul><ul><li>25  - 29.9 = OVERWEIGHT </li></ul><ul><li>30  &  MO...
<ul><li>The normal values are: </li></ul><ul><li>WOMEN  = 34”  or  95 CM </li></ul><ul><li>MEN = 37” or  100 CM </li></ul>...
Sedentary Lifestyles   <ul><li>Lack of exercise </li></ul><ul><li>The comforts of modern living </li></ul>
Increase of Lipids (Fats) in the Blood <ul><ul><ul><li>A person is at risk of developing diabetes if, </li></ul></ul></ul>...
High Blood Pressure <ul><li>A person is at risk of developing diabetes if blood pressure is  140/90  mm Hg or more. </li><...
Our Study
<ul><li>Aims and objectives </li></ul><ul><li>To study microvascular and macrovascular complications in prediabetes </li><...
Material & Methods   The study entitled  “ Study of Microvascular & Macrovascular Complications in Prediabetics (Impaired ...
 
 
 
 
 
 
 
 
 
 
 
 
 
<ul><li>Results </li></ul><ul><li>The following conclusions  can be drawn from the present study :- </li></ul><ul><ul><li>...
How we manage ?
Health Physical Activity + Sound Nutrition Good Health
Health The first part of our equation is activity Get moving, find something you enjoy
Health The second part of the equation is nutrition   Your body needs the right fuel to help it work well.
How Can You Help   Reduce   Your Risk of Diabetes? Eat foods low in  fat & calories. If overweight, lose weight.    Physi...
Encourage people to change habits . Use the pyramid guide to educate people to eat healthy.
Is drug therapy useful in patients with pre-diabetes? Drug therapy is not recommended by the ADA due to the limited effica...
THANK YOU
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Prediabetes Awadhesh Med

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Prediabetes Awadhesh Med

  1. 1. Dr. Awadhesh Sharma Study of Microvascular & Macrovascular Complications in Prediabetics (Impaired Glucose Tolerance)” Department of Medicine MLB Medical College, Jhansi
  2. 2. What is pre-diabetes? Pre-diabetes is a condition where blood sugar levels are higher than normal, but not yet high enough to be diagnosed as diabetes. Pre-diabetes is a key factor in the development of type 2 diabetes. However, n ot everyone with pre-diabetes goes on to develop type 2 diabetes. Pre-diabetes is characterized by disturbance in blood sugar levels as measured by impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Patients can have one or both of these conditions to be considered pre-diabetic.
  3. 4. <ul><li>Global Burden </li></ul><ul><li>Worldwide, 230 million people have diabetes and in 2003, more than 300 million people were estimated to have pre-diabetes. By 2025, it is estimated that approximately 500 million people will have pre-diabetes. </li></ul><ul><li>Southeast Asia currently has the highest number of people with pre-diabetes.  By 2025, it is estimated that Southeast Asia will continue to have the highest prevalence of pre-diabetes (13.5 percent), followed by Europe (10.9 percent). </li></ul>
  4. 5. Diagnosis Criteria <ul><li>One test is not enough! </li></ul><ul><li>The diagnosis must be done by a physician. </li></ul>* 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
  5. 6. Why We Worry About Prediabetes? <ul><li>Predicts high risk for development of diabetes </li></ul><ul><li>Predicts high risk for development of atherosclerotic vascular disease </li></ul><ul><li>Both are largely preventable through lifestyle and pharmacologic interventions </li></ul>
  6. 7. Risk of Cardiovascular Disease Is Elevated Prior to Diagnosis of T2DM % with CVD *MI=myocardial infarction. Adapted from: Hu F, et al. Diabetes Care. 2002;25:1129-1134.
  7. 8. <ul><li>Does everyone with pre-diabetes develop type 2 diabetes? </li></ul><ul><li>Although people with pre-diabetes are at an increased risk for developing type 2 diabetes, not everyone goes on to develop the disease. </li></ul><ul><li>Large clinical outcomes trials have demonstrated that: </li></ul><ul><li>Between 29 percent and 55 percent of people with pre-diabetes develop type 2 diabetes over the course of three years. </li></ul><ul><li>In other trials of longer duration, these rates increased to between 43 percent and 68 percent over six years. </li></ul>
  8. 9. Symptoms of Prediabetes <ul><li>Symptoms of diabetes appear when the levels of glucose are either very high or very low. </li></ul><ul><li>Many persons with diabetes and all those with pre-diabetes do not have symptoms. </li></ul><ul><li>The most common symptoms are: </li></ul><ul><ul><li>Fatigue, tiredness or lack of energy </li></ul></ul><ul><ul><li>Excessive constant thirst or hunger </li></ul></ul><ul><ul><li>Frequent need to urinate </li></ul></ul><ul><ul><li>Skin wounds that do not heal or heal very slowly </li></ul></ul><ul><ul><li>Blurred vision </li></ul></ul>
  9. 10. Risk Factors for the Development of S Prediabetes <ul><li>Family history of diabetes </li></ul><ul><li>Class of obesity </li></ul><ul><ul><li>Especially central </li></ul></ul><ul><li>Hypertension </li></ul><ul><li>High triglycerides </li></ul><ul><li>Low HDL-C </li></ul><ul><li>Elevated glucose </li></ul><ul><li>Ethnicity other than Caucasian </li></ul><ul><li>Vascular disease </li></ul><ul><li>History of gestational diabetes </li></ul><ul><li>History of baby weighing > 9 lbs </li></ul><ul><li>Sedentary lifestyle </li></ul>
  10. 11. <ul><li>RISK FACTORS THAT CAN BE MODIFIED </li></ul><ul><ul><ul><li>Overweight and obesity </li></ul></ul></ul><ul><ul><ul><li>Sedentary lifestyle </li></ul></ul></ul><ul><ul><ul><li>An increase of lipids (fats) in the blood </li></ul></ul></ul><ul><ul><ul><li>High blood pressure </li></ul></ul></ul>
  11. 12. <ul><li>NON-MODIFIABLE RISK FACTORS </li></ul><ul><ul><ul><ul><ul><li>Increasing age </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Family History: Inheritance </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Background of Gestational diabetes </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Race/Ethnic group </li></ul></ul></ul></ul></ul>
  12. 13. Body Mass Index (BMI) <ul><li>18.5 - 24.9 = NORMAL </li></ul><ul><li>25 - 29.9 = OVERWEIGHT </li></ul><ul><li>30 & MORE = OBESITY </li></ul><ul><li>Persons with BMI >25 have risk of Diabetes </li></ul><ul><li>BMI combines height and weight measurements </li></ul><ul><li>Read the result in a BMI chart. </li></ul>
  13. 14. <ul><li>The normal values are: </li></ul><ul><li>WOMEN = 34” or 95 CM </li></ul><ul><li>MEN = 37” or 100 CM </li></ul><ul><li>HIGHER VALUES = HIGH RISK OF DIABETES </li></ul>Waist Circumference (WC) It is a simple measurement at waist level
  14. 15. Sedentary Lifestyles <ul><li>Lack of exercise </li></ul><ul><li>The comforts of modern living </li></ul>
  15. 16. Increase of Lipids (Fats) in the Blood <ul><ul><ul><li>A person is at risk of developing diabetes if, </li></ul></ul></ul><ul><ul><ul><li>The levels of HDL are low </li></ul></ul></ul><ul><ul><ul><li>The levels of LDL are high </li></ul></ul></ul><ul><ul><ul><li>The levels of TRIGLYCERIDES are high </li></ul></ul></ul>Lipids Normal Values Total Cholesterol Less than 200 mg/dl <ul><li>LDL cholesterol </li></ul>Less than 100 mg/dl <ul><li>HDL cholesterol </li></ul>Men: Higher than 45 mg/dl Women: Higher than 55 mg/dl Triglycerides Less than 150 mg/dl
  16. 17. High Blood Pressure <ul><li>A person is at risk of developing diabetes if blood pressure is 140/90 mm Hg or more. </li></ul><ul><li>A person with diabetes has more risk of complications if blood pressure is 130/80 mm Hg or more. </li></ul>
  17. 18. Our Study
  18. 19. <ul><li>Aims and objectives </li></ul><ul><li>To study microvascular and macrovascular complications in prediabetes </li></ul>
  19. 20. Material & Methods The study entitled “ Study of Microvascular & Macrovascular Complications in Prediabetics (Impaired Glucose Tolerance) ” was conducted in the department of Medicine of M.L.B. Medical College, Jhansi from the period of June 2006 to September 2009. The cases were patients coming to Medicine OPD and in the emergency being admitted in the Medicine ward as cases of impaired glucose tolerance or prediabetes. Fifty patients of prediabetes were included in the study which are selected from Medicine OPD and those who admitted in the Medicine ward.
  20. 34. <ul><li>Results </li></ul><ul><li>The following conclusions can be drawn from the present study :- </li></ul><ul><ul><li>Annual progression to diabetes inprediabetics was 5% per year. </li></ul></ul><ul><ul><li>Majority of them (prediabetics) suffered from cardiovascular complications i.e. 20%. </li></ul></ul><ul><ul><li>Incidence of cerebrovascular complications is 6%. </li></ul></ul><ul><ul><li>Incidence of peripheral vascular disease is 8%. </li></ul></ul><ul><ul><li>Incidence of retinopathy is 8%. </li></ul></ul><ul><ul><li>Incidence of nephropathy in the form of microalbuminuria is 4%. </li></ul></ul><ul><ul><li>Incidence of complications is more in subjects having multiple risk factors. </li></ul></ul>
  21. 35. How we manage ?
  22. 36. Health Physical Activity + Sound Nutrition Good Health
  23. 37. Health The first part of our equation is activity Get moving, find something you enjoy
  24. 38. Health The second part of the equation is nutrition Your body needs the right fuel to help it work well.
  25. 39. How Can You Help Reduce Your Risk of Diabetes? Eat foods low in fat & calories. If overweight, lose weight.  Physical activity Stop smoking! Limit alcohol to 1-2 drinks per day. Take your medications regularly.
  26. 40. Encourage people to change habits . Use the pyramid guide to educate people to eat healthy.
  27. 41. Is drug therapy useful in patients with pre-diabetes? Drug therapy is not recommended by the ADA due to the limited efficacy of treatment versus lifestyle modification, potential for adverse drug reactions, lack of data supporting reduction of microvascular or macrovascular complications of diabetes in this patient population, and insufficient assessment of the cost-effectiveness of drug treatment. However, not all patients are able to implement lifestyle modifications due to physical or other limitations, and based on limited data available, drug therapy may be a reasonable option to delay onset of type 2 diabetes and provide a cardiovascular benefit (TRIPOD and STOP-NIDDM data).
  28. 42. THANK YOU

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