1. Diabetes is a chronic disease characterized by high blood sugar levels resulting from defects in insulin production or insulin action. It is classified into type 1, type 2, and other types and can cause complications affecting the eyes, kidneys, nerves, and blood vessels. 2. The magnitude of the diabetes problem is large worldwide and especially in India and Southeast Asia. India has a high number of cases and is considered the diabetes capital of the world. 3. Risk factors for diabetes include genetic factors, age, obesity, and lifestyle factors like diet and physical activity. Screening involves blood and urine tests, and prevention focuses on lifestyle changes, routine checkups, and treatment to control blood sugar levels.

1. presented by-
Students if 6 th batc ims
moderator-
K.agasya raj

2. INTRODUCTION
 Diabetes mellitus is not a single disease but a heterogenous gr. of
diseases characterised by a state of chronic hyperglycemia resulting
from diversity of etiologies,environmental & genetic factor acting
jointly.
 The disease is characterised by metabolic abnormalities &long
term complication involving the -
1.Eyes
2.Kidneys
3.Nerves
4.Blood vessels

3. AETIOLOGY
Defective production or
action of insulin;a hormone
that control glucose,fat and
amino acid metabolism.

4. CLASSIFICATION
 Diabetes mellitus-
1. Type1 or insulin dependent diabetes mellitus
2. Type2 or non insulin dependent diabetes mellitus
3. Malnutrition related diabetes mellitus
4. Maturity onset diabetes of the young
5. Other types(secondary to pancreatic,hormonal,drug induced,
genetic)
 Impaired glucose tolerance
 Gestational diabetes mellitus

5. MAGNITUDE OF PROBLEM
WORLDWIDE
 Diabetes is an iceberg disease
 currently the number of cases of Diabetes
worldwide is around 387 million, of which more
than 90% are Type 2 Diabetics

6. WORLDWIDE PREVALENCE OF
DIABETES
 Global prevalence of Type 2 Diabetes in adults
aged 25+ is 10%
0
10000000
20000000
30000000
40000000
50000000
60000000
70000000
80000000
NAC
SACA
EUR
MENA
AFR
SEA
WP

7. Worldwide Prevalence by Region
0
10
20
30
40
50
60
70
80
2003
2025International Diabetes Federation (IDF) data

8. MAGNITUDE OF DIABETES IN
SOUTH EAST ASIA
CASES in 1000s
BANGLADESH BHUTAN
INDIA MALDIVES
MAURITIUS NEPAL
SRILANKA
undiagnosed cases in
1000s

9. MAGNITUDE OF PROBLEM
IN INDIA
 India is the diabetes capital of the world
total no of cases
in urban area in rural area
estimated TMR due to
diabetes

10. EPIDEMIOLOGICAL DETERMINANTS
1.AGENT
 Main cause of diabetes mellitus is insulin deficiency
o Absolute-type1
o Partial-type2
 This is due to various
factors-
 Pancreatic disorders
 Defects in insulin formation
 Destruction of beta cells
 Decreased insulin sensitivity
 Genetic defects
 Autoimmunity

11. 2.HOST FACTORS
 Age
 Sex
 Genetic factors
 Genetic markers~
a.Type1:HLA-DR3,HLA-DR4
b.Type2:not HLA associated
 Immune mechanisms
 Obesity
 Maternal diabetes

12. 3.ENVIRONMENTAL FACTORS
 Sedentary lifestyle
 Diet
 Dietary fiber
 Malnutrition
 Alcohol
 Viral infections
 Chemical agents
 Stress
 Others-
a.Occupation
b.Economic status
c.education

13. SCREENING AND PREVENTION
OF DIABETES
URINE EXAMINATION
 Urine test for glucose is done 2 hours after a meal
 It has high specificity and low sensitivity therefore false
negatives are common while false positives are rare
 It is used along with OGTT for screening
BLOOD SUGAR TESTING
 Mass screening programmes use glucose measurements
of fasting,post prandial or random blood sample
 For epidemiological purposes the 2 hr value after 75g
oral glucose may be used alone or with fasting value

14. WHO recommendations for the diagnostic
criteria for Diabetes and intermediate
hyperglycaemia
DIABETES  Fasting plasma
glucose
 2 hr plasma
glucose
 >=126mg/dl
 >200mg/dl
IMPAIRED
GLUCOSE
TOLERANCE
 Fasting plasma
glucose
 2 hr plasma
glucose
 <126mg/dl
 >=140mg/dl &
<200mg/dl
IMPAIRED
FASTING
GLUCOSE
 Fasting plasma
glucose
 2 hr plasma
glucose
 110 mg/dl to
125mg/dl
 <140mg/dl

15. PREVENTION AND CARE
 PRIMARY PREVENTION
 Population strategy
 High risk strategy
 SECONDARY PREVENTION
 To maintain blood glucose levels close to normal
limits
 To maintain ideal body weight
 Treatment is based upon:
 Diet alone
 Diet and oral anti diabetics
 Diet and insulin

16.  Glycosylated haemoglobin:
 It should be estimated every 6 months
 It provides a long-term index of glucose control
o Self care
o Home blood glucose monitoring
 TERTIARY PREVENTION
Organisation of specialised diabetic clinics to provide
diagnostic and management skills and for both clinical and
epidemiological research

18. IN A NUT SHELL

19. CLASSIFICATION
TYPES AGE INCIDENCE GRADING OF RISK
DM-1 < 30 yrs Less common Moderate
DM-2 > 30 yrs Commonest High
MRDM Young Rare Mild
Others Any Common Moderate
MODY Young Rare Mild
IGT Any More common Moderate
GDM Pregnancy Common High

20. Worldwide Prevalence by Region
0
10
20
30
40
50
60
70
80
2003
2025International Diabetes Federation (IDF) data

21. INDIA
Type-1
Type-2
2003 Data
Rural
Urban
16.3 million21.4 million
Total 37.7 million

22. EPIDEMIOLOGICAL DETERMINANTS
Factors
Agent Host Environmental
Physical Chemical Biological SocialPancreatic Abnormality
Insulin decrease
Destruction of β
cells
Decrease insulin
sensitivity
Age
Sex
Genetics
Immunity
Obesity
Maternal Diabetes

23. SCREENING
Always for high risk population• Blood Sugar
• Urine Test
• HbA 1C level= > 9%
TEST FINDINGS
NORMAL
FBS 70-100 mg/dl
PPBS < 140 mg/dl
RBS < 140 mg/dl
DIABETES
FBS > 125 mg/dl
PPBS > 200 mg/dl
RBS >200 mg/dl
IGT
FBS 111-125 mg/dl
PPBS 140-200 mg/dl
RBS <200 mg/dl
Qualitative
Quantitative
Ketone Bodies

24. PREVENTION
• EducationPrimordial
• Life style
• Habit
• Diet
Primary
• Routine check up
• Treatment
• Self care
Secondary
• Diabetic clinic
• Skilled treatment
Tertiary

25. BIBLIOGRAPHY
• Parks textbook of preventive and social
medicine:23rd edition
• Robbins pathological basis of disease:8th
edition
• www.idf.org
• www.wikipedia.org

26. THE END