1) Diabetes is a chronic metabolic disorder resulting from inadequate insulin production or secretion that causes hyperglycemia. The main types are type 1 (insulin dependent), type 2 (non-insulin dependent), gestational diabetes, and those associated with other conditions. 2) Bone turnover refers to the rate of bone resorption and formation, which can be estimated by biomarkers like urinary NTX and CTX. 3) India has a high prevalence of diabetes and is the diabetes capital of the world, with over 62 million diabetic individuals in 2015 and a projected number of 101 million by 2030. Obesity is a major risk factor for type 2 diabetes.

1. G.Aasritha William
VI-Pharm-D

2. “Diabetes is a chronic metabolic disorder resulting in hyperglycemia, a
consequence of either inadequate insulin production, inadequate
insulin secretion, or both”
*Type-1(insulin dependent):autoimmune destruction of pancreatic
β cells resulting in an inability to produce and secrete insulin
*Type-2(non-insulin dependent):insulin resistance, a relative
insulin deficiency as well or it maybe both
*Third category:gestational diabetes mellitus (GDM) is defined as the
onset or recognition of diabetes during pregnancy
*Fourth category:is associated with genetic disorders,pancreatic
diseases,drug and chemical use,infections
BONE TURNOVER:It refers to the total volume of bone that is both
resorbed and formed over a period of time. Bone turnover can be
estimated by measuring relevant bone biomarkers.
e.g.:Urinary collagen type 1 cross-linked N-telopeptide (NTX),Urinary or
serum collagen type 1 cross-linked C-telopeptide (CTX)
INTRODUCTION

3. SYMPTOMS
**Vaginal Infections is the most common symptom in women

4. WORLD OF DIABETES
Top 3 countries
1. INDIA
2. CHINA
3. USA
World
2015 415 million
2040 642 million
Estimated number of people with diabetes worldwide and per region in 2015&2040

5. INDIA’S DIABETES WAKE-UP CALL
India is Diabetes capital of world and every fifth
diabetic is an Indian
PREVALANCE OF DIABETES (IN%)
NUMBER OF DIABETES DEATHS
Source:WHO diabetes country profiles 2016

6. PREVALANCE OF DIABETES AND RELATED RISK FACTORS
STATISTICS ON
TYPES OF
DIABETES IN
INDIA
Source:WHO diabetes country profiles 2016

7. LINK BETWEEN DIABETES AND OBESITY
*Obesity causes inflammation, which can in turn lead to type 2 diabetes.
In obesity, extra fat triggers inflammation by releasing LTB4,
which binds to receptors on nearby macrophages and
activates them which promotes insulin resistance, a first step
in developing type 2 diabetes.

8. Krakauer JC et al., conducted a study on bone loss and bone turn over in
diabetes and concluded that in patients with diabetes, metabolic
effects of poor glycemic control lead to increased bone resorption
and bone loss.
According to Ying-Ying Wu, decreased bone turnover rate might explain
the increased bone fragility in patients with diabetes because,older
bone is not replaced by new bone with decreased bone turnover rate,
thus decreasing bone mechanical strength.
BONE LOSS AND DIABETES
Thiazolidinediones
(reduces the activity
of osteoblasts)
KIDNEY DAMAGE
Prevent osteoblasts
from making strong
bones.
Allows calcium to
leak out in urine
HIGH BLOOD SUGAR
REASONS
ORAL MEDICATIONS

9. ROCKY STROLLO et al.,conducted a 21-day randomized controlled trial
on overweight or obese patients with T2D. Patients were randomly
assigned 1:1 to the Ma-Pi 2 macrobiotic diet or a control diet based
on dietary guidelines for T2D. Serum sclerostin and circulating
markers of bone resorption (CTX) or bone formation (P1NP) were
measured.
RESULTS: Serum sclerostin increased significantly in the two groups
but Ma-Pi 2 diet group experienced a significantly greater
increase in sclerostin.
Serum CTX increased in the two groups ;
P1NP did not change significantly in the two groups.
Effect of diet induced weight loss on bone turnover in
patients with type-II DM

10. How to maintain strong bones with Diabetes?
EXERCISE DIET
Weight bearing
exercises.e.g.,
walking, jogging,
hiking, yard work,
weight training.etc..
Intake of calcium and
vitamins: D and K.
*By taking a supplement if needed or prescribed by
doctor

11. A winning plan to lower the risk of
Diabetes
Stay fit, stay healthy, enjoy life!

12. ROLE OF PHARMACIST
EDUCATING
IDENTIFYING FIGHTING
NON-
ADHERENCE
SUPPORTING
E-CARE
ENCOURAGING
OPPORTUNITY
KNOCKS
Better time for the pharmacist to embrace pharmaceutical care

13.  Provide Community based lectures on diabetes and its treatment.
 Control diabetes with
natural remedies
 Explaining injecting insulin &
how tough it can be?
 Creating roadblocks by
adequately assessing and
monitoring people with
diabetes

14. Bone loss plays a prominent role in the quality of life in
diabetes. Diabetes health is in our hands. Medication
alone cannot overcome diabetes. It is our responsibility to
manage and overcome it through our self care and by
taking support from the educating groups.
Managing diabetes is not a science, its an art!
CONCLUSION

15. So, it is very important for the leaders of our society to concentrate on it and
Diabetes being the foremost cause of all health related problems in our
country, it is important to create awareness among the public for a
successful nation.
“A WORLD FREE OF DIABETES IS NOT
OUR DREAM, IT’S OUR PLEDGE”

16. THANK
YOU
G. Aasritha William
1. Parfitt AM. Bone. 2004; 35(1):1-3.
2. http://www.nature.com/nrendo/journal/v12/n6/images_article/nrendo.2016.53-f1.jpg
3. http://timesofindia.indiatimes.com/india/Obesity-among-Indian-teens-
swells/articleshow/47932475.cms
4. Krakauer JC, McKenna MJ, Buderer NF et al. Bone loss and bone turnover in
diabetes. Diabetes 1995; 44(7): 775–782.
5. Okazaki R. [Management of osteoporosis in diabetes mellitus.] Nippon Rinsho2009; 67(5): 1003–1010.
Japanese.
6. http://www.everydayhealth.com/hs/type-2-diabetes-treatment-diet-exercise/bone-health-with-
diabetes/
REFERENCES