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Dm 2
 

Dm 2

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  • The total number of deaths due to diabetes was estimated at 1,017,209 in 2007. The number of women dying from diabetes-related deaths far exceeded those of men in the older age groups.

Dm 2 Dm 2 Presentation Transcript

  •  
  • EPIDEMIOLOGY OF DIABETES
  • PROBLEM STATEMENT
  • 2007
  • 2025
  • Causes of the rise
  •  
  • NUMBER OF DEATHS ATTRIBUTABLE TO DIABETES BY AGE GROUP, SOUTH-EAST ASIAN REGION, 2007 Number of deaths
    • Huge losses in the form of foregone economic growth
    • (relatively a greater problem in poorer countries)
    • 2005 – 2015, WHO predicts net losses in national income from diabetes & cardiovascular disease of some -
      • ID557 billion in China
      • ID303 billion in the Russian Federation
      • ID336 billion in India
    Disease Burden on the World Economy
  • PROBLEM STATEMENT- INDIA
    • India leads the world, about 20% of the total diabetic population, “diabetes capital of the world”.
    • “ Asian Indian Phenotype ” - unique clinical & biochemical abnormalities in Indians:
    • Madras Diabetes Research Foundation & MV Diabetes Specialities Centre, Chennai.
    • National prevalence (20-79 yrs) in
      • 2007 was 6.2%
      • Predicted- 7.6% in 2025
    • Diabetes type 1 incidence (0-14 yrs)
    • 2007 is 4.2 per 100,000 children per year
    • IGT: national prevalence (20-79 yrs)
      • 2007 is 5.4%
      • 2025 might go upto 6.1%
  • Number of people with diabetes (20-79 yrs)
    • Mortality rates:
      • The age adjusted mortality rates :
        • 1.5 – 2.5 times higher than in the general population
      • Deaths attributable to diabetes as percentage of all deaths 2007:
        • Males 9.7%
        • Females 15.5%
    • Mean health expenditure 2007 - USD 47
      • Diabetes related complications are
        • coronary artery disease, peripheral vascular disease,
        • neuropathy, retinopathy, nephropathy.
    • People with diabetes are likely to develop
  • Prevalence in CHENNAI
    • 1989 to 2004, the prevalence increased significantly by 72.3% ( P <0.001)
    • IDDM incidence 10.5% per 100,000 children (10-12yrs)
  • WHO Classification of Diabetes Mellitus
    • Type 1 : Insulin Dependent Diabetes Mellitus (IDDM)
    • Type 2 : Non- Insulin Dependent Diabetes Mellitus (NIDDM)
    • Malnutrition-related Diabetes Mellitus
    • Other Types:
      • Pancreatic
      • Hormonal Imbalance
      • Liver related
      • Drug induced
    • Impaired Glucose Tolerance
    • Gestational Diabetes mellitus
  • Type 1 IDDM
    • Caused by complete deficiency of Insulin
    • resulting from Beta cell destruction
    • Onset : Abrupt and usually >30yrs of age
    • Idiopathic : 10 % of all IDDM
    • Auto Immunity:
      • IDDM is 90% immune mediated
      • Islet cell antibodies, Insulitis
      • Associated with other autoimmune diseases such as Hashimoto’s thyroiditis, Addison’s disease & pernicious anaemia
    • Genetic susceptibility:
      • 18 regions of the genome linked with type 1 diabetes risk, IDDM1 to IDDM18
      • IDDM1, which contains the HLA (Human Leukocyte Antigens) genes that encode immune response proteins.
    • Environmental Factors:
      • Viral infections – congenital Rubella, Mumps, Measles and coxsackie B virus
      • Exposure to cow’s milk - Albumin from cow’s milk may react with islet cells of pancreas, leading to their destruction
    • OGTT :
      • Increased fasting blood glucose (>120mg/dl)
      • Post prandial blood glucose (>200mg/dl)
  • Type 2 NIDDM
    • High blood glucose due to insulin resistance
    • and relative insulin deficiency
    • Little tendency towards ketoacidosis
    • Increasingly diagnosed in children in parallel
    • to rising obesity rates
    INSULIN RESISTANCE
  • METABOLIC SYNDROME: Defined as a clustering of atherosclerotic cardiovascular disease risk factors and a systemic proinflammatory state.
  • Monogenic Forms of Diabetes
    • Rare forms, accounting for about 1 – 5 % of all cases
    • Mostly the gene mutation is inherited; in others its spontaneous.
    • They are Neonatal DM and MODY
    • Neonatal DM :
      • first 6 months of life, do not produce enough insulin,
      • one in 100,000 to 500,000 live births
      • Permanent neonatal diabetes mellitus (PNDM)
      • Transient neonatal diabetes mellitus (TNDM).
      • Intrauterine growth retardation
  • Maturity Onset Diabetes of Young
    • Onset prior to age 25,
    • a family history of diabetes in multiple
    • successive generations
    • Impaired β-cell function & insulin resistance
    • and late β-cell failure
    • Mutations in 10-12 different genes
    • People with MODY
      • are generally not overweight
      • do not have other risk factors for type 2 diabetes,
      • may have only mild or no symptoms
      • (discovered on routine tests)
  • IMPAIRED GLUCOSE TOLERANCE
    • Is an intermediate state of dysglycemia
    • Has an intermediately raised glucose level after 2 hours, but less than would qualify for type 2 diabetes mellitus.
    • The fasting glucose may be either normal or mildly elevated.
    Venous blood Capillary blood Fasting <120 <120 2hrs after glucose load 120-180 140-200
    • Due to a severe malnutrition.
    • On Starvation, there is nothing that the insulin can act upon.
    • The body slowly reduces its production due to Negative Feedback control.
    • A fasting glucose that is higher than the upper limit of normal, but not high enough to be classified as diabetes mellitus.
    • a pre-diabetic state, associated with insulin resistance & increased risk of cardiovascular pathology, although of lesser risk than IGT
    • There is a 50% risk over 10 years of progressing to overt diabetes
    Malnutrition related Diabetes Mellitus Impaired Fasting Glucose
  • Effect of Diabetes on the Pregnant Woman Effect of Diabetes on the Foetus Gestational Diabetes Mellitus
    • A condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy, affecting 3-10% of pregnancies
    • The hormones produced during pregnancy increase a woman's resistance to insulin, resulting in impaired glucose tolerance
  • TYPE 3 DIABETES
    • A new diabetic condition referred to as type 3 diabetes , which simply means that one has both type 1 and type 2 diabetes.
    • Type 1 to Type 3:
    • Type 2 to Type 3:
    Need more insulin
  • NATURAL HISTORY Epidemiological Determinants
    • AGENT
    • HOST FACTORS
    • ENVIRONMENTAL RISK FACTORS
  • AGENT
    • PANCREATIC DISORDERS
      • Infections, Tumors , Obstructions, Removal
    • DEFECTS IN FORMATION OF INSULIN
    • BETA CELL DESTRUCTION
    • DECREASED INSULIN SENSITIVITY
      • Decreased adipocyte & monocyte insulin receptors
    • AUTOIMMUNITY
    • GENETIC DEFECTS
      • Mutation in insulin gene
      • Mutations in insulin receptor gene :
      • Donohue syndrome, Rabson-Mendenhall syndrome, Type A insulin resistance
  • HOST FACTORS
    • AGE
    • SEX
    • GENETIC FACTORS
    • GENETIC MARKERS
    • IMMUNE MECHANISMS
    • OBESITY
    • MATERNAL DIABETES
  • AGE & SEX
    • NIDDM – usually middle years of life
    • Malnutrition related DM - young people, worse prognosis
    • In south east Asia, an excess of male diabetics.
    • GENETIC FACTORS
    • GENETIC MARKERS
    • Inheritance factor for IDDM is small
    • NIDDM has a concordance in twin studies of 80-90%, suggesting a strong genetic component.
    • Family History:
      • 25 - 33% of type 2 diabetics have family members with diabetes.
      • A first-degree relative poses 40% risk of developing diabetes
    • IDDM is associated with HLA B8 and B15 & more strongly with HLA-DR3 and DR4
    • NIDDM is not HLA associated
    • Type-2 diabetics
    • mutation in a zinc transporter SLC30A8, which is involved in regulating insulin secretion.
    • IMMUNE MECHANISMS
    • HORMONAL IMBALANCES
    • Glucagonomas
    • Pheochromocytomas
    • Cushing syndrome
    • Acromegaly
  • ROLE OF OBESITY IN DM
    • 80 - 95% of the increases in type 2 diabetes are due to obesity.
    • Apple-shaped abdomen is associated with
      • insulin resistance and diabetes,
      • heart disease, high blood pressure, stroke,
      • unhealthy cholesterol levels.
    • Number of Insulin receptors are reduced in the adipose tissue
    • Waist circumferences
      • > 35 inches in women
      • >40 inches in men
      • specifically associated with a greater risk
    • Metabolic syndrome
    • No role in IDDM
  • Effect of weight loss on fasting blood glucose
  • ENVIRONMENTAL RISK FACTORS
    • Sedentary lifestyle
    • Diet
    • Dietary fibre
    • Malnutrition
    • Alcohol
    • Viral infections
    • Chemical agents
    • Stress
    • Other factors
  • LIFESTYLE
    • Lack of exercise alters the interaction between insulin & its receptors
  • DIETARY FACTORS
    • DIETARY FIBRE
    • Rich in NSP, Reduces blood glucose
    • Min Daily intake of 20g of fibre
    • MALNUTRITION
    • PEM (Partial beta cell failure)
    • ALCOHOL
    • Damages Liver & Pancreas
    • Promotes Obesity
    .
    • GnT-4a ENZYME
    • Mutations affecting the enzyme GnT-4a glycosyltransferase disrupts insulin production
  • Other Factors
    • Smoking
    • According to a 2006 study, smokers are more than twice as likely to develop diabetes as people who have never smoked.
    • Passive smoking
  • SOCIAL FACTORS
  •