2. DISCOVERY OF DIABETES
Indian Findings
Diabetes is mentioned in Indian medical texts dated
nearly 2500 years old
Described it as Madhu Meha
It meant Honey Urine
Found that its victims passed large amounts of sugar
laden urine which attracted ants
2
3. FIRST REPORT ON DIABETES IN INDIA
500-400 BC Charaka & Sushruta
Recognised 2 type of diabetes
1. Krisha - lean diabetic (type 1)
2. Sthula – obese diabetic(type-2)
Noted that diabetes runs in family.
Described polyuria & glycosuria
(honey like urine)
Described basics of treatment of
diabetes(physical activity, diet etc.)
Noted that lean diabetes is difficult to
manage
3
4. A polyuric state was
described in an
Egyptian papyrus
dating from c. 1550 bc
, discovered by Georg
Ebers .
Aretaeus was the first
to use the term “
diabetes, ” from the
Greek word for a
syphon.
4
5. WHAT IS DIABETES MELLITUS ?
The term diabetes mellitus describes a metabolic cum
vascular syndrome of multiple etiology, characterized by
chronic hyperglycemia with disturbances of
carbohydrate, fat & protein metabolism resulting from
defect in insulin secretion, insulin action or both leading
to changes in the vasculature of both small blood
vessels (Microangiopathy) & large blood vessels
(Macroangiopathy).
5
7. PROBLEM STATEMENT
Iceberg Disease
Increased prevalence in newly industrialized
and developing countries.
Disease acquired in the most productive period
of their life.
Indian population has increased susceptibility to
DM.
7
8. PROBLEM STATEMENT(CONTD.)
Undiagnosed & inadequately treated patients develop
multiple chronic complications.
Lack of awareness about interventions for prevention
and management of complications.
8
9. GLOBAL BURDEN
According to the World Health
Organization (WHO) and the
International Diabetes Federation (IDF),
diabetes is reaching epidemic
proportions and is a leading cause of
death worldwide.
9
12. GLOBAL BURDEN (CONTD.)
Approximately 5.1 million people aged between
20 & 79 years died from diabetes in 2013,
accounting for 8.4% of global all-cause mortality
among people in this age group.
The prevalence of type 2 diabetes is rising at an
alarming rate throughout the world believed to
be due to increases in longevity, obesity and
sedentary lifestyles.
12
14. IDF REGIONS AND GLOBAL PROJECTIONS OF THE NUMBER OF
PEOPLE WITH DIABETES (20-79 YEARS),2013 AND 2035
IDF
REGION
2013
MILLIONS
2035
MILLIONS
INCREASE
%
Africa 19.8 41.4 109%
Middle East and
North Africa
34.6 67.9 96%
South-East Asia 72.1 123 71%
South and Central
America
24.1 38.5 60%
Western Pacific 138.2 201.8 46%
North America and
Caribbean
36.7 50.4 37%
Europe 56.3 68.9 22%
World 381.8 591.9 55%
14
15. At a Glance 2013 2035
Total world population (billions) 7.2 8.7
Adult population (20-79 years, billions) 4.6 5.9
Diabetes and IGT (20-79 years )
Diabetes
Global prevalence (%)
Comparative prevalence (%)
Number of people with diabetes (millions)
8.3
8.3
382
10.1
8.8
592
IGT
Global prevalence (%)
Comparative prevalence (%)
Number of people with IGT (millions)
6.9
6.9
316
8.0
7.3
471
15
16. AT A GLANCE 2013
Type 1 DIABETES IN CHILDREN (0-14 years )
Total child population (0-14 years, billions) 1.9
Number of children with type 1 diabetes (thousands) 497.1
Number of children with type 1 diabetes per year
(thousands)
79.1
Annual increase in incidence (%) 3 16
18. TOP 10 COUNTRIES/TERRITORIES FOR PREVALENCE (%) OF
DIABETES (20-79 YEARS), 2013 AND 2035
Country/Territory 2013 (%)
Tokelau 37.5
Federated States of
Micronesia
35.0
Marshall Islands 34.9
Kiribati 28.8
Cook Islands 25.7
Vanuatu 24.0
Saudi Arabia 24.0
Nauru 23.3
Kuwait 23.1
Qatar 22.9
Country/Territory 2035 (%)
Tokelau 37.9
Federated States of
Micronesia
35.1
Marshall Islands 35.0
Kiribati 28.9
Cook Islands 25.7
Saudi Arabia 24.5
Vanuatu 24.2
Nauru 23.3
Kuwait 23.2
Qatar 22.8
18
19. TOP 10 COUNTRIES/TERRITORIES FOR NUMBER OF PEOPLE WITH
DIABETES (20-79 YEARS),2013 AND 2035
Country/Territory 2013 (Millions) Country/Territory 2035 (Millions)
China 98.4 China 142.7
India 65.1 India 109.0
USA 24.4 USA 29.7
Brazil 11.9 Brazil 19.2
Russian Federation 10.9 Mexico 15.7
Mexico 8.7 Indonesia 14.1
Indonesia 8.5 Egypt 13.1
Germany 7.6 Pakistan 12.8
Egypt 7.5 Turkey 11.8
Japan 7.2 Russian Federation 11.2
19
21. AT A GLANCE 2013 2035
Total population (millions)
Adult population(20-79 years, millions)
1,460
883
1,777
1217
Diabetes (20-79 years )
Regional prevalence (%)
Comparative prevalence (%)
Number of people with diabetes (millions)
8.2
8.7
72.1
10.1
9.4
123.0
IGT (20-79 years )
Regional prevalence (%)
Comparative prevalence (%)
Number of people with IGT(millions)
2.7
2.9
24.3
3.2
3
38.8
Type 1 diabetes (0-14 years )
Number of children with
type 1 diabetes (thousands)
Number of newly diagnosed
cases per year (thousands)
77.9
12.5
-
- 21
22. Although the South-East Asia Region comprises only
seven countries, it is one of the most populous
Regions.
Adults in India alone account for 86% of the Region’s
adult population of 883 million.
Current estimates indicate that 8.2% of the adult
population, or 72.1 million people, have diabetes, 65.1
million of whom live in India.
22
23. Mauritius has the highest prevalence of diabetes
among adults in the Region, at 14.8%, followed by
India at 9.1%.
The South-East Asia Region has one of the highest
estimates of prevalence of type 1 diabetes in
children, with 77,900 affected. In 2013, an
estimated 12,600 children under the age of 15 in
the Region developed type 1 diabetes.
India accounts for the majority of the children with
type 1 diabetes.
23
24. With 1.2 million deaths in 2013, this Region has the
second highest number of deaths attributable to
diabetes of any of the seven IDF Regions.
India is the largest contributor to regional mortality,
with 1.1 million deaths attributable to diabetes in
2013.
24
30. At present, type 1 diabetes cannot be prevented. The
environmental triggers that are thought to generate the
process that results in the destruction of the body’s
insulin-producing cells are still under investigation.
There is a lot of evidence that lifestyle changes
(achieving a healthy body weight and moderate
physical activity) can help prevent the development of
type 2 diabetes
30
31. Obesity, particularly abdominal obesity, is linked to
the development of type 2 diabetes.
Physical activity is one of the main pillars in the
prevention of diabetes. Increased physical activity
is important in maintaining weight loss & is linked to
reduced blood pressure, reduced resting heart rate,
increased insulin sensitivity, improved body
composition and psychological well-being.
A balanced and nutritious diet is essential for
health. A healthy diet reduces risk factors for
cardiovascular diseases.
31
32. OTHER BEHAVIORS TO CONSIDER INCLUDE
Smoking: a well-established risk factor for many chronic
diseases, including diabetes and its complications..
Stress and depression: There is evidence of a link
between depression & diabetes.
Sleeping patterns: Both short (<6h) and long (>9h)
sleep durations may be associated with a higher risk of
developing type 2 diabetes. Sleep deprivation may impair
the balance of hormones regulating food intake and
energy balance. Long sleep durations may be a sign of
sleep-disordered breathing or depression and should be
treated appropriately..
32
33. The primary prevention of diabetes, childhood obesity
and other related disorders can be done by the
promotion of health & reduction of risk factors
through the individual & on a community basis.
33
34. THERE ARE TWO APPROACHES :
1. Population approach: Aims to bring about
important changes in the health of a large
percentage of the population. Based on promoting
healthy lifestyles that are effective in the prevention
of T2DM.
2. High risk approach: Identification of those
who may be at higher risk, the measurement of
risk and intervention to prevent the development of
T2DM in affected individuals.
34
35. Five simple tools for Identifying risk category for T2DM
1 Age above 40 years High: Positive family history with
one or two risk factors.
Moderate: Increased Age with
sedentary lifestyle & increased waist
circumference.
Low: Presence of any 1 risk factor.
2 Positive family history of diabetes
3 Increased abdominal fat (Waist
circumference )
Male ≥ 90cms
Female ≥ 85cms
4 Pre-diabetes
5 Sedentary lifestyle
Published by M. V. Hospital for Diabetes & Diabetes Research Centre (WHO
Collaborating Centre for Diabetes)
35
36. Targeting pre-diabetes for life-style interventions
is another approach because trials have shown the
benefits of prevention or delay for people with
prediabetes (Venkat et al. 2002).
An effective delivery of lifestyle intervention to pre-
diabetics will ensure that most future cases of
diabetes are targeted.
36
37. Methods of Creating Awareness (Never be a One Time but a
Regular Ongoing program)
Methods Channels
Awareness
Campaigns/programs
1. Distribution of pamphlets, manuals, cards
2. Advertisements in magazines, newspapers &
other commonly read books.
3. T.V, Radio, Media
4. Health education curriculum in schools,
workplaces.
5. Lectures in various places like, Public meetings,
religious gatherings.
6. Awareness programs by lecture & counseling in
schools, colleges, offices, women’s organizations
Exhibitions/Fair
Seminars/Conferences
Rallies/Walks
Folk Arts
(Developed from WHO Collaborating Centre for Diabetes, Chennai)
37
38. The major components of the treatment of diabetes are:
MANAGEMENT OF DM
• Diet and ExerciseA
• Oral hypoglycaemic
therapyB
• Insulin TherapyC 38
42. Diet is a basic part of management in every case.
Treatment cannot be effective unless adequate
attention is given to ensuring appropriate nutrition.
Dietary treatment should aim at:
◦ Ensuring weight control
◦ Providing nutritional requirements
◦ Allowing good glycaemic control with blood glucose levels
as close to normal as possible
◦ Correcting any associated blood lipid abnormalities
A. DIET
42
43. The following principles are recommended as dietary
guidelines for people with diabetes:
Dietary fat should provide 25-35% of total intake of
calories but saturated fat intake should not exceed 10% of
total energy. Cholesterol consumption should restrict to
300 mg or less daily.
Protein intake can range between 10-15% total energy
(0.8-1 g/kg of desirable body weight). Protein should be
derived from both animal and vegetable sources.
A. DIET (CONT.)
43
44. DIET (CONT.)
Carbohydrates provide 50-60% of total caloric content
of the diet. Carbohydrates should be complex and high
in fibre (25 gram of fibre / 1000 calorie for diabetics is
optimum).
Excessive salt intake is to be avoided. It should be
particularly restricted in people with hypertension and
those with nephropathy.
44
46. DRUG TREATMENT FOR DIABETES
Diabetes is a chronic condition that requires
continuing medical care and self-management
in order to minimize the risk of complications and
mortality. The goals of treatment are,
1. To achieve optimal glycemic control;
2. To reduce other cardiovascular risk factors,
including hypertension, hyperlipidemia, and
overweight and obesity; and
3. To diminish complications such as heart
disease, peripheral vascular disease, renal
disease, and neuropathy. 46
48. Patients should be educated to practice self-
care. This allows the patient to assume
responsibility and control of his / her own
diabetes management. Self-care should
include:
◦ Blood glucose monitoring
◦ Body weight monitoring
◦ Foot-care
◦ Personal hygiene
◦ Healthy lifestyle/diet or physical activity
◦ Identify targets for control
◦ Stopping smoking
SELF-CARE
48
49. CONCLUSION
We must identify patients at highest risk
(prediabetes)
Modest lifestyle changes are most
effective
Sustain interventions
Increase opportunities for community
programs to support prevention
Delaying or preventing type 2 diabetes is
cost-effective and will help turn the tide on
the diabetes epidemic.
49
50. REFRENCES
American diabetes association 2010.
IDF Diabetes Atlas 6th edition.
Misra A, Rastogi K, Joshi SR. Whole Grains and
Health: Perspective for Asian Indians. Journal of
Association of Physicians of India, 2009, 57:155–
162.
Mohan D, Raj D, Shanthirani CS, Datta M, Unwin
NC, Kapur A, Mohan V. Awareness and knowledge
of diabetes in Chennai— the Chennai Urban Rural
Epidemiology Study [CURES-9]. Journal of
Association of Physicians of India, 2005, 53:283–
287.
50
51. Mohan V, Deepa M, Anjana RM, Lanthorn H, Deepa
R. Incidence of Diabetes and Pre-diabetes in a
Selected Urban South Indian Population (Cups -
19). Journal of Association of Physicians of India,
2008, 56:152–157.
Mohan V, Deepa M, Farooq S, Narayan KM, Datta
M, Deepa R. Anthropometric cut points for
identification of cardiometabolic risk factors in an
urban Asian Indian population. Metabolism Clinical
and Experimental, 2007, 56:961–968.
51
53. COMPARATIVE PREVALENCE
The comparative prevalence has been calculated by
assuming that every country and region has the
same age profile (the age profile of the world
population has been used).
This reduces the effect of the differences of age
between countries and regions, and makes this figure
appropriate for making comparisons.
The comparative prevalence figure should not be
used for assessing the proportion of people within a
country or region who have diabetes.
53
