Diabetes mellitus DM, is a metabolic disorder of biomolecules characterized by chronic hyperglycemia due to defects in insulin synthesis or utilization or both DM requires lifelong therapy. A multidisciplinary approach is needed to control glycemia, as well as to limit the development of its devastating complications and manage such complications when they do occur. Increases cost of living and reduces life expectancy

1. Non-pharmacological
Management of Diabetes Mellitus
Dr Samson Ojedokun
Department of Chemical Pathology
LAUTECH Teaching Hospital Ogbomoso Nigeria
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2. Outline
• Introduction
• Prevalence
• Classifications
• Risk factors
• Pathophysiology
• Management
• Conclusion
• References
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3. Introduction
• Diabetes mellitus DM, is a metabolic disorder of biomolecules characterized
by chronic hyperglycemia due to defects in insulin synthesis or utilization or
both
• DM requires lifelong therapy. A multidisciplinary approach is needed to
control glycemia, as well as to limit the development of its devastating
complications and manage such complications when they do occur.
• Increases cost of living and reduces life expectancy
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4. Prevalence
• About 422 million people worldwide have diabetes, the majority living in
low-and middle-income countries, and 1.5 million deaths are directly
attributed to diabetes each year.
• Both the number of cases and the prevalence of diabetes have been steadily
increasing over the past few decades
• In the past 3 decades, the prevalence of type 2 diabetes has risen dramatically
in countries of all income levels.
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5. • It was reported that worldwide, 1 in 10 adults has diabetes.
• Data predicted that there would be a global increase in the number of adults with
diabetes from 537 million in 2021 to 786 million by 2045, a 46% rise.
• In 2015, diabetes was the sixth leading cause of death in lower-middle-
income countries.
• The WHO predicts diabetes to become the seventh leading cause of
death in the world by the year 2030.
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6. • The WHO estimated a 4.3% prevalence of diabetes in Nigeria in
2016, Some local studies conducted in Nigeria found a prevalence
between 0.8% and 11%. A previous study reported that about 4.7 -
6million Nigerians had type 2 diabetes
• It was estimated that diabetes killed more than 40,000 Nigerians in
2015 and there are millions who are diabetic but are yet to be
diagnosed and treated.
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7. Classifications
• The most common is type 2 diabetes, usually in adults,
• Type 2 diabetes mellitus consists of an array of dysfunctions characterized by
hyperglycemia and resulting from the combination of resistance to insulin action,
inadequate insulin secretion, and excessive or inappropriate glucagon secretion.
• Type 1 DM can occur at any age. Although it frequently arises in juveniles, it can
also develop in adults. Due mainly to absolute deficient in insulin production.
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8. Secondary diabetes
• Diseases of the pancreas that destroy the pancreatic beta cells (eg,
hemochromatosis, pancreatitis, cystic fibrosis, pancreatic cancer)
• Hormonal syndromes that interfere with insulin secretion (eg,
pheochromocytoma)
• Hormonal syndromes that cause peripheral insulin resistance (eg, acromegaly,
Cushing syndrome, pheochromocytoma)
• Drugs (eg, phenytoin, glucocorticoids, estrogens)
• Gestational diabetes
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9. Subtypes
• Severe autoimmune diabetes (SAID) - corresponding with type 1 diabetes and latent
autoimmune diabetes in adults (LADA
• Severe insulin-deficient diabetes (SIDD)
• Severe insulin-resistant diabetes (SIRD)
• Mild obesity-related diabetes (MOD)
• Mild age-related diabetes (MARD)
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10. Risk factors
• Age greater than 45 years
• Weight greater than 120% of desirable body weight
• Family history of type 2 diabetes in a first-degree relative (eg, parent or sibling)
• Hispanic, Native American, African American, Asian American, or Pacific Islander
descent
• History of previous impaired glucose tolerance (IGT) or impaired fasting glucose
(IFG)
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11. • Hypertension (130/80 mm Hg or above) or dyslipidemia (HDL cholesterol
level < 40 mg/dL or triglyceride level >150 mg/dL)
• History of gestational diabetes mellitus or of delivering macrosomic baby
• Polycystic ovarian syndrome (which results in insulin resistance)
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12. Pathophysiology
• Type 1 DM is the culmination of lymphocytic infiltration and destruction of
insulin-secreting beta cells of the islets of Langerhans in the pancreas. As beta-cell
mass declines to 80-90%, insulin secretion decreases until the available insulin is no
longer adequate to maintain normal blood glucose levels, hyperglycemia develops
and diabetes may be diagnosed.
• Exogenous insulin is needed to reverse this catabolic condition, prevent ketosis,
decrease hyperglucagonemia, and normalize lipid and protein metabolism.
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13. • Type 2 diabetes is characterized by a combination of peripheral insulin
resistance and inadequate insulin secretion by pancreatic beta cells.
• Insulin resistance, which has been attributed to elevated levels of free fatty
acids and proinflammatory cytokines in plasma, leads to decreased glucose
transport into muscle cells, elevated hepatic glucose production, and
increased breakdown of fat.
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14. ©emedicine
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15. Management
• Presentation
• Diagnosis
• Treatment
• Pharmacologic
• Non-pharmacological
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16. Presentation
• Polydipsia
• Polyuria
• Nocturia
• hyperphagia
• Tiredness, fatigue, lethargy
• Weight loss
• Blurry vision
• Pruritus vulvae, balanitis
• Mood change, irritability, difficulty concentrating, apathy
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17. Diagnosis
• Glycemia
• Normal
• Impaired (prediabetes)
• Diabetes
• Symptomatic
• Random Plasma glucose or 2hrs PP ≥11.1mmol/l
• Fasting plasma glucose ≥7.0mmol/l
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18. • Asymptomatic (Pre-diabetes)
• IFG; FBG ≥6.0mmol/l but < 7.0mmol/l
• IGT; FBG < 7.0mmol/l and 2hrs PP 7.8 – 11.1mmol/l
• HBA1C 5.7−6.4% (39−47 mmol/mol)
• OGTT
Indication: FBG 6.1 – 7.0mmol/l
• IFG 6.1 – 6.92hrs <7.8
• IGT <7.0 2hr 7.8 – 11.0
• Diabetes ≥7.0 2hrs ≥ 11.1
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19. WHO Diagnostic Criteria
• Diabetes: FPG ≥126 mg/dL (7.0 mmol/L) OR OGTT 2-hour PG ≥200 mg/dL
(11.1 mmol/L)
• Impaired fasting glucose (IFG): FPG 110 mg/dL to 125mg/dL (5.7 to 6.9mmol/L)
AND OGTT 2-hour PG < 140mg/dL (< 7.8mmol/L)
• Impaired glucose tolerance (IGT): FPG < 126 mg/dL (< 7.0 mmol/L) AND
OGTT 2-hour PG 140mg/dl to 200mg/dl (≥7.8 and < 11.1mmol/L)
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20. Treatment
• Pharmacologic
• Involve mainly the use of OHA and Insulin therapy.
• Non-pharmacological
• Non-pharmacological management mainly involves diet and lifestyle
modification
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21. • In new cases of DM, adequate glycemic control can be obtained by non-
pharmacologic control in approximately 50% while 20-30% will require OHA or
insulin.
• Regardless of etiology, the choice of treatment is determined by the adequacy of
residual B-cell function which varies in the patient.
• The goals are to eliminate symptoms and to prevent, or at least slow, the
development of complications.
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22. • Microvascular (ie, eye and kidney disease) risk reduction is accomplished
through control of glycemia and blood pressure
• macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk
reduction, through control of lipids and hypertension, smoking cessation
• metabolic and neurologic risk reduction, through control of glycemia.
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23. Patient Education:
• With each healthcare system encounter, patients with diabetes should be
educated about and encouraged to follow an appropriate treatment plan.
• Adherence to diet and exercise should continue to be stressed throughout
treatment because these lifestyle measures can have a large effect on the
degree of diabetic control that patients can achieve.
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24. Healthy Diet:
• Carbohydrate 45-60%
• Sucrose up to 10%
• Fat <35%
• Polyunsaturated <10%
• Monounsaturated 10-20%
• Saturated <10%
• Protein 10 -15%
• Fruit/vegetables 5 portions daily
• Salt, not more than 6g sodium daily
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25. Weight management:
• Reduction of energy intake
• Increase energy expenditure
• Modest weight losses of 5-10%
• Risk factor reduction greater with losses of 10-15% of body weight
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26. Mediterranean-style diet
• Esposito et al reported greater benefit from a low-carbohydrate, Mediterranean-
style diet than from a low-fat diet in patients with newly diagnosed type 2 diabetes
mellitus.
High-protein versus high-carbohydrate diet
• A study by Larsen et al concluded that the long-term therapeutic effect of
a high-protein diet is not superior to that of a high-carbohydrate diet in the
treatment of type 2 diabetes mellitus
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27. Exercise/physical activity:
• Walking, gardening, swimming or cycling
• Adult 18-64yrs 2.5hrs weekly buildup or 75mins vigorous exercise
• Aerobic (moderate-intensity) 10mins daily or 30mins at least 5days
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28. Alcohol:
• Both beneficiary and harmful just as with CVDs
• It reduces hypoglycemia awareness by suppressing gluconeogenesis due to its
high-calorie content.
• Not to exceed 14U women and 21 U men weekly
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29. Bariatric Surgery
• In morbidly obese patients, bariatric surgery has been shown to improve
diabetes control and, in some situations, normalize glucose tolerance. It is
certainly a reasonable alternative for carefully selected patients.
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30. Conclusion
• For people living with diabetes, lifestyle modification are primary preventive
tools pivotal to reducing long term complications and avoiding side effects
of pharmacological therapy.
• There is a globally agreed target to halt the rise in diabetes and obesity by
2025 and this could be achieve through advocacy and awareness on the of
unhealthy lifestyle.
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31. References
• Davison's Principles & Practice of Medicine, 22nd Edition pg 797-836
• World Health Organization, diabetes mellitus https://www.who.int/health-
topics/diabetes#tab=tab_12022
• World Health Organization 2022 World Diabetes Day
https://www.afro.who.int/countries/nigeria/news/stakeholders-call-increased-access-diabetes-
education#:~:text=The%20World%20Health%20Organization%20(WHO,use%20and%20harmf
ul%20use%20of
• Diabetes Mellitus, Medscape e-library https://emedicine.medscape.com/article/117739-
overview#a2
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32. Thank you all
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