Noncommunicable disease prevention and control

NONCOMMUNICABLE
DISEASE PREVENTION
AND CONTROL: DIABETES
MELLITUS AS A CASE
STUDY
DR HAMZAT ZAHEED
ADEKUNLE
Saturday, March 13, 2021 1
ICARE MEDICAL CONSULT

ABBREVIATIONS
NCDS Noncommunicable Diseases
DM Diabetes Mellitus
OGTT Oral Glucose Tolerance Test
IFG Impaired Fasting Glucose
WHO World Health Organization
BMI Body Mass Index
GI Glycemic Index
FBS Fasting Blood Sugar
RBS Random Blood Sugar
CVD Cardiovascular Diseases
HTN Hypertension
CHO Carbohydrate

The four leading NCDS (cardiovascular diseases,
cancer, respiratory diseases, and diabetes) share
four risk factors: TOBACCO USE, HARMFUL USE OF
ALCOHOL, UNHEALTHY DIET, and PHYSICAL
INACTIVITY.
These in turn lead to other key
metabolic/physiological changes such as raised
blood pressure, overweight/obesity, raised blood
glucose, and higher cholesterol levels.

A group of metabolic diseases characterized by
HYPERGLYCEMIA resulting from defects in INSULIN
secretion, insulin action or both.
DIABETES MELLITUS

Type 1 DM:
an autoimmune condition that results from the body attacking its
own pancreas with antibodies resulting into inability of pancreas to
make insulin. The onset is usually below 30 years of age.
Type 2 DM:
this is characterized by high blood glucose, insulin resistance and
relative lack of insulin. The onset is usually after 30 years of age.
Gestational DM:
glucose intolerance or hyperglycemia first detected at any time
during pregnancy.
TYPES

RISK FACTORS
MODIFIABLE NON-MODIFIABLE
PHYSICAL INACTIVITY/LACK OF
EXERCISE
FIRST DEGREE FAMILY OF DM(FATHER,
MOTHER, SIBLINGS OR CHILDREN)
OVERWEIGHT/OBESITY PREVIOUS DIABETES IN PREGNANCY
DRUGS: STEROIDS(PREDNISOLONE) ADVANCING AGE
UNHEALTHY DIETS: HIGH FAT, HIGH
CALORIE DIET
HISTORY OF EXCESSIVE ALCOHOL
INTAKE
HISTORY OF HYPERTENSION
HISTORY OF BEING DIAGNOSED OR
BEING TREATED FOR ABNORMAL
CHOLESTEROL LEVELS

SIGNS AND SYMPTOMS.
ASYMPTOMATIC
EXCESSIVE THIRST
INCREASED HUNGER
FREQUENT
URINATION
UNEXPLAINED
WEIGHT LOSS
ABDOMINAL PAIN
BLURRED VISION
FATIGUE
SLOW HEALING
WOUND
TINGLING SENSATION
OR NUMBNESS IN
THE HAND OR FEET

WORLDWIDE BURDEN:
The number of patients with type 2 DM is increasing rapidly in both
developed and developing countries around the world.
In 1985, there were about 100-115 million people living with DM,
increased to 135 and 151 million in 1995 and 2000 respectively.
Currently, about 425 million people in the world are living with DM
(IDF data). A total of about 16 million people are living with diabetes
in the African Region and by 2045, an estimated 41 million people will
be affected.
WHY DIABETES
MELLITUS?

THE BURDEN IN NIGERIA AND LAGOS STATE :
Nigeria is home to 4 million people living with DM or a fifth of all DM
cases in sub-Saharan Africa.
In Lagos State, DM accounts for a sixth of all cases admitted into the
medical wards and one in six of these cases result in death.
Hyperglycaemic emergencies remain a major cause of concern in
Nigerians with DM. They account for 40% of all DM admissions in
hospitals within the state and are listed as on of the three
complications of DM associated with high case fatality rates.
WHY DIABETES
MELLITUS?

According to IDF, about 2 million undiagnoseddiabetes caseswere estimated in
Nigeria in 2013, with this responsible for over 40,000 deathsresultingfrom diabetes
and its complicationsin the country.
DM related kidney disease is assuming an increasingrole as a cause of CKD in
Nigeria. DM nephropathy accountsfor a sixth of all diagnoses in persons undergoing
dialysis.
Cardiovascular complicationsof DM such as stroke and peripheral disease have been
reported in 11% and 37% of persons with DM respectively in hospital settings in Lagos.
DM has also been notedto account for 2.1% of cases of heart failure.
Foot ulcerationis one complication of DM that is widelyreported with prevalence
rate of 9.5% and 4 in 10 cases result in death.Foot ulceration isreported to occur in
25% of all new cases of DM and is associated with an in-hospital mortalityrate of 43%
WHY DIABETES
MELLITUS?

Globally, about 25% of patients with type 2 DM already have complications at
initial presentation due to the slowly progressive nature compared to type 1
DM
A profile of people with diabetes in Nigeria published in 2008 reported 35.5%
had retinopathy, 3.2% had nephropathy, 16% had diabetic foot ulcers, 59.2%
had peripheral neuropathy, 4.7% had stroke and 60.9% were hypertensive.
DM is associated with sexual dysfunction in men and women. 88% of diabetic
women living with DM reported sexual dysfunction in a hospital based
survey in Lagos. 35-90% of men with DM will present with erectile
dysfunction or impotence during their lifetime. Erectile dysfunction in
diabetic men occur as a result of nerve damage, narrowing of blood vessels
and muscle impairment.
WHY DIABETES
MELLITUS?

The World Health Organization recommendations
Random Blood Glucose Test
Fasting Blood Glucose Test
Oral GlucoseTolerance Test
Glycated Hemoglobin(HbA1C)Test
DIAGNOSIS OF DM
CRITERIA FOR THE SCREENING AND DIAGNOSIS OF DIABETES
TESTS PREDIABETES DIABETES
HbA1C 5.7-6.4%* ≥6.5%+
FBG/FPG 110-125mg/dL(6.1-6.9mmol/L)* ≥126mg/dL(7.0mmol/L)+
OGTT 140-199mg/dL(7.8-11mmol/L) * ≥200mg/dL(11.1mmol/L)+
RBG/RPG ≥200mg/dL(11.1mmol/L)++

Generally, the best form of prevention is getting tested
early as over 50% of DM is preventable . Regular monitoring
of blood glucose is of great benefit.
Avoid sedentary lifestyle
Refrain from excessive alcohol intake
Do not indulge in smoking and abuse of drugs
PREVENTION AND
MANAGEMENT

Physical exercise has been considered as one of the cornerstone in
the treatment of DM along with nutrition and medications.
Individuals with DM are encouraged to exercise to promote blood
glucose control and lessen the risk of CVD. Muscles use more glucose
while working than resting and this leads to greater glucose uptake
by muscle cells which eventually lowers blood glucose levels.
It is recommended that 150 minutes of moderate intensity exercise is
completed every week. This amounts to 30 minutes of exercise, 5
times a week.
EXERCISE AND
DIABETES MELLITUS

AEROBIC EXERCISES: Walking, Cycling, Jogging, Dancing, Brisk
walking, Swimming and many more.
STRENGHT EXERCISES: Exercise with free weights, Elastic
resistance bands and others .
FLEXIBILITY EXERCISES: Shoulder and Upper arm stretch, Calf
stretch and others.
BALANCE EXERCISES: Heel-to-toe walk, Standing on one foot.
FORMS OF EXERCISE

BENEFITS OF EXERCISE
ACHIEVING
IDEAL WEIGHT
CONTROL
REDUCING THE
RISK OF
DEVELOPING
CVD: HTN,
HEART ATTACK
REDUCING THE
RISK OF
DEVELOPING
SOME TYPES OF
CANCERS.
STRENGTHENING
BONES AND
MUSCLES.
IMPROVING
MENTAL HEALTH
AND MOOD.
IMPROVING THE
ABILITY TO DO
DAILY ACTIVITIES
AND PREVENT
FALLS IN OLDER
ADULTS.
INCREASING
CHANCES OF
LIVING LONGER.

Diet plays an important role in the management of type 2 diabetes.
Diet must be tailored to suit the nutritional needs of an individual
living with diabetes.
When planning a typical meal for a diabetic, the key things to
consider are the type of carbohydrates and the portion size of the
carbohydrate in the meal.
There is no one-size-fits-all diet for persons with diabetes as it is
expected to be individualized in order to promote health and reduce
the risk of developing chronic disorders.
DIABETES MELLITUS
AND NUTRITION

BENEFITS OF
NUTRITION
MAINTAIN HEALTHY NUTRITIONAL STATUS
THEREBY IMPROVING OVERALL HEALTH.
ENSURE THAT BLOOD GLUCOSE LEVEL AND HBA1C ARE
WITHIN TARGET RANGE OR NEAR NORMAL RANGES AS
POSSIBLE.
MAINTAIN A HEALTHY BODY MASS INDEX(BMI:
18.5 – 24.9).
PREVENT, DELAY AND TREAT THE ACUTE EFFECTS OF
INSULIN SUCH AS HYPOGLYCEMIA, AND LONG TERM
COMPLICATIONS SUCH AS FATTY LIVER DISEASE.

Carbohydrates are primarily the direct cause of rise in blood glucose
levels. Both hyperglycemia and hypoglycemia are detrimental to our
health.
Glycemic Index(GI) is a measure of how quickly a carbohydrate is
digested and absorbed into the bloodstream after ingestion. This
concept is useful during meal planning for people living with
diabetes. The lower the GI the better the carbohydrate food.
It’s advisable for diabetic to focus regularly on the complex
carbohydrate which are high in fibre, nutrient dense with low-to-
medium GI.
DIABETES MELLITUS
AND CARBOHYDRATES

VARIETIES OF
CARBOHYDRATE FOODS
VARIETIES OF CARBOHYDRATE FOODS
TOP CLASS: LOW-TO-
MEDIUM GI
MIDDLE CLASS: MEDIUM
TO HIGH GI
LOW CLASS: HIGH GI
WHEAT
UNRIPE PLANTAIN
OATS
LOCAL/BROWN RICE
WATER YAM
WHITE RICE/BREAD
YAM, CASSAVA,
POTATOES
MAIZE PRODUCTS
REFINED FLOUR
PRODUCTS
NATURAL FRUITS
SWEETENED BEVERAGES:
CHOCOLATE DRINKS, SOFT
DRINKS
HONEY
TABLE SUGAR
SWEETENED
CONFECTIONARIES: CAKE

VARIETIES OF
CARBOHYDRATE FOODS
SOME CHO PORTION SIZES SUITABLE FOR
DIABETIC PER MEAL
CHO CATEGORIES COMMON “MODEL SIZES" FOR MEDIUM QUANTITY
SOLID
SEMI SOLID
GRAINS
BREAD
OTHERS
One fist size of ANY cooked CHO: wheat, eba ….
250mls of ANY semi solid CHO: pap, oat….
½ cup / one SERVICE SPOON of any beans inclusive.
2-4 slices / 50 naira worth of Agege bread
One mature length of unripe plantain, a wrap of
“eko” #30 worth or a wrap of moimoi #100 worth.

The recommended calorie intake for a healthy adult is 45-65% CHO, 20-25% fat
and 10-35% protein.
People living with diabetes are advised to consume medium sized CHO
portions regularly because total amount of CHO consumed has influence on
GI.
All fruits contain sugar and loads of vitamins and minerals and should be
taken in required quantities as part of healthy diet.
Vegetables contain mainly vitamins, mineral with high fibres which aid
digestion and reduce sugar absorption in the body thereby reducing the GI.
WHO recommends 25-35g (144/1000calories) of fibres daily and this is
equivalent to 3-5 servings of vegetables daily.
SERVING SIZE AND
PORTION SIZES

SERVING SIZE AND
PORTION SIZES

One serving of bread, grains and tubers: One slice of bread, half cup of
cooked rice, 6-10 tablespoon of cereal, two small potatoes
One serving of vegetables: Two hand full of raw vegetables or a cup of
full cooked vegetables.
One serving of fruit: One medium apple, orange or one mature length
banana.
One egg, one matchbox size of cheese, a deck card for fish and meat.
Oils and fats and sugars should be taken sparingly.
EXPLANATION

TAKE HOME NOTE
Eat variety of foods to get a wide array of nutrients daily.
Avoid overeating, eat moderate size of food regularly especially CHO portion.
No FEASTING! No FASTING!
Ensure you eat fruits cautiously
Avoid sugary foods and sweets, limit refined foods.
Limit intake of foods with high cholesterol such as egg yolk and organ meat, use lean cut of meat.
Meal spacing should between 4-5 hours apart.

TAKE HOME NOTE
INCLUDE
VEGETABLES(CUCU
MBER, GARDEN EGG)
AND NUTS(CASHEW
NUT, WALNUTS,
TIGER NUT) AS PART
OF YOUR SNACKS.
AVOID LATE NIGHT
MEAL PAST 8:00PM,
IF YOU MUST EAT
MAKE IT HALVE OF
THE DAYTIME
PORTION.
DRINK PLENTY
OF WATER PER
DAY.
KEEP TRACK OF
FBS AND RBS
WITH
GLUCOMETER AS
RECOMMENDED.

A LARGE PERCENTAGE OF NCDS ARE
PREVENTABLE THROUGH THE
REDUCTION OF THEIR FOUR MAIN
BEHAVIORAL RISK FACTORS: TOBACCO
USE, PHYSICAL INACTIVITY, HARMFUL
USE OF ALCOHOL AND UNHEALTHY
DIET.
CONCLUSION

JAZAKUMULLAHU
KHAERAN FOR THE
OPPORTUNITY
THANKS

Noncommunicable disease prevention and control

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