World diabetes day
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  • In 2010, it was estimated that over 300 million people worldwide were affected by diabetes. Within 20 years this number is expected to soar to about 500 million. This is an increase of more than 50%.Much of this increase will occur in the Indian and Asian subcontinents, due to a complex interplay of genetic, environmental and social factors, such as rural-urban migration and industrialisation.International Diabetes Federation. (2009). IDF Diabetes Atlas, 4th Ed. Brussels.
  • New in this edition:China takes the top spot, with India close behind. This is heavily influenced by the new study published in 2010. Our estimates are just under theirs at 90 million (compared to 91 million) and can be attributed to different age groups and a somewhat more conservative approach.Increases and changes in the position of countries relative to each other can be explained mostly by an ageing population and changes in urbanisation.Note, the BRIC countries are all in the top 10. Only the US is a high-income country.

Transcript

  • 1. Every year on November 14, World Diabetes Day brings diabetes to the attention of the world.
  • 2. November 14 is the birthday of Frederick Banting, one of the discoverers of insulin. (c) Banting House National Historic Site of Canada
  • 3. The global symbol for diabetes was developed during the Unite for Diabetes campaign. Why a circle? A positive symbol across cultures, the circle symbolizes life and health. Why blue? The colour blue reflects the sky that unites all nations. The blue border of the circle reflects the colour of the sky and the flag of the United Nations. The blue circle signifies the unity of the global diabetes community in response to the diabetes epidemic. http://www.diabetesbluecircle.org
  • 4. Diabetes Mellitus • The name “diabetes mellitus means sweet urine. It stems from ancient times when physicians would taste a patients urine as a part of a diagnosis.
  • 5. Definition • Hyperglycemia due to Absolute or relative deficiency of insulin.
  • 6. What is Diabetes? • A condition in which the body cannot make or cannot use insulin properly
  • 7. Diabetes • A fast growing disease • Diabetes is a major chronic disease affecting many individuals, for which very high growth rates are expected in the coming years. • Due to changes in lifestyles more human beings are becoming diabetic patients. • The number of diabetes cases is increasing day by day.
  • 8. The Impact of Diabetes: • • • • • Million lives are lost annually Millions of $ lost income and Productivity. 1 million amputation per year. Diabetes kills 1 person in every 8 seconds. Every 10 seconds, 2 people develop diabetes. -IDF Bulletin; November 2011.
  • 9. The Top 10s (number of people with diabetes)
  • 10. Why are We Concerned about Diabetes? Every 24 hours... • • • • • 3,600 new cases of diabetes are diagnosed 580 people die of diabetes-related complications 225 people have a diabetes-related amputation 120 people with diabetes progress to end-stage renal disease 55 people with diabetes become blind ADA -2002
  • 11. INDIAN SCENARIO High prevalence Life style changes further accentuate the high genetic predisposition Under diagnosed due to low awareness Perhaps occurs a decade earlier Non obese/lean Type II fairly common Treated less seriously as considered “Mild Disease”
  • 12. Demographics Current Age Distribution Classification of Diabetes Type 1 7.6% Type 2 90.6% Others 1.9% 50 25 0 <15 15-30 30-45 45-55 55-70 >70 Age Groups Current Mean Age Mean Age at Onset of Diabetes Mean Diabetes Duration 53.4 ± 13.0 (n= 2269) 43.6 ± 12.2 (n= 2251) 10.0 ± 6.9 (n= 2251) DiabCare Asia India
  • 13. Magnitude of the Problem • Diabetic retinopathy: most common cause of blindness before age 65 • Nephropathy: most common cause of ESRD • Neuropathy: most common cause of nontraumatic amputations • 2-3 fold increase in cardiovascular disease
  • 14. Risk Factors for Diabetes Mellitus • • • • • • • • • • • Family history of diabetes (i.e., parent or sibling with type 2 diabetes. Obesity (BMI > 25 kg/m2) Physical inactivity Mental Stress Race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) Previously identified with IFG, IGT, or an A1C of 5.7–6.4% History of GDM or delivery of baby >4 kg (9 lb) Hypertension (blood pressure 140/90 mmHg) HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) Polycystic ovary syndrome or acanthosis nigricans History of cardiovascular disease
  • 15. More Risk Factors • • • • • • • • • • Goals: Women < 35 Men < 40 Overweight (Abdominal) Over 45 years old Sedentary Lifestyle Non-White Race Family History of DB Family History of High BP History of High BP (self) High Cholesterol History of Gestational DB Delivered a baby > 9 lbs.
  • 16. Something went wrong…………………… 2.5 million years 50 years
  • 17. Types of Diabetes Mellitus Type 1 Type 2 Gestational DM
  • 18. Type 1 Diabetes Mellitus • Formerly known as “juvenile onset” or “insulin dependent” diabetes • Most often occurs in people under 30 years of age, but may occur at any age. • Peak onset between ages 11 and 13
  • 19. Type 1 Diabetes Mellitus Etiology and Pathophysiology • Progressive destruction of pancreatic  cells • Autoantibodies cause a reduction of 80% to 90% of normal  cell function before manifestations occur
  • 20. Type 1 Diabetes Mellitus Etiology and Pathophysiology • Causes: – Genetic predisposition – Exposure to a virus
  • 21. Type 1 Diabetes Mellitus Onset of Disease • Manifestations develop when the pancreas can no longer produce insulin – Rapid onset of symptoms – Present at ER with impending or actual ketoacidosis
  • 22. Type 1 Diabetes Mellitus Onset of Disease • • • • • • Weight loss Polydipsia (excessive thirst) Polyuria (frequent urination) Polyphagia (excessive hunger) Weakness and fatigue Ketoacidosis
  • 23. Type 1 Diabetes Mellitus Onset of Disease • Diabetic ketoacidosis (DKA) – Life-threatening complication of Type 1 DM – Occurs in the absence of insulin – Results in metabolic acidosis
  • 24. Type 2 Diabetes Mellitus • Formerly known as “adult onset” or “ Non insulin dependent Diabetes”. • Accounts for >90% of patients with diabetes • Usually occurs in people over 30 years old • 80-90% of patients are overweight
  • 25. Risk Factors for Type 2 Diabetes • Age  Obesity • Race/ethnicity  Physical inactivity • Previous gestational diabetes (GDM)  Impaired fasting glucose levels • Family history of diabetes  Impaired glucose tolerance (IGT)  Body fat distribution Can be modified
  • 26. What Happens in Type 2 DM Stomach empties 50% faster than normal Pancreas can’t make enough insulin Type 2 Diabetes Liver puts too much sugar into the blood Muscle cells and other tissues are resistant to insulin
  • 27. Type 2 Diabetes Mellitus Onset of Disease • Gradual onset • Person may go many years with undetected hyperglycemia • Marked hyperglycemia (27.6 – 55.1 mmol/L)
  • 28. Clinical Manifestations Type 2 Diabetes Mellitus • • • • • Non-specific symptoms Fatigue Recurrent infections Prolonged wound healing Visual changes
  • 29. Classification of Diabetes Type I DM Type II DM Aetiology Autoimmune (- cell destruction) Insulin resistance and -cell dysfunction Peak age 12 years 60 years Prevalence 0.3% 6% (>10% above 60 years) Presentation Osmotic symptoms, weight loss (days to weeks), DKA Patient usually slim Osmotic symptoms, diabetic complications (months to years). Patient usually obese Treatment Diet and insulin Diet, exercise (weight loss), oral hypoglycemics, Insulin later
  • 30. Gestational Diabetes • Develops during pregnancy • Detected at 24 to 28 weeks of gestation • Associated with risk for cesarean delivery, perinatal death, and neonatal complications
  • 31. Gestational Diabetes • Develops during pregnancy • Detected at 24 to 28 weeks of gestation • Associated with risk for cesarean delivery, perinatal death, and neonatal complications
  • 32. Secondary Diabetes • Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels – Cushing syndrome (e.g. steroid administration) – Hyperthyroidism – Parenteral nutrition
  • 33. CLINICAL PRESENTATION
  • 34. If you have any of the following symptoms you can be a DIABETIC Excessive Thirst (POLYDIPSIA)
  • 35. Excessive Hunger (POLYPHAGIA)
  • 36. Excessive Urination
  • 37. WEIGHT LOSS
  • 38. FATIGUE
  • 39. LIFE STYLE BALANCE INTERVENTION  WEIGHT LOSS GOAL.  PHYSICAL ACTIVITY GOAL.  DIETARY MODIFICATION.
  • 40.  150 mins / week moderate exercise.  Intensity to brisk walking.  Minimum 3 times/week.  Minimum 10 mins per session.  Maximum 75mins per session  Evidence based, effective, feasible.  Suitable for long term maintenance.
  • 41. Preferred food choices