the slide is presentation of World Health Day. It has a very concise information touching various aspects of diabetes with the latest statistics. We hope this will be useful to everyone.
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
World Health Day 2016
1. WORLD HEALTH DAY 2016
• DR M A PARANDE
ASSOCIATE PROFESSOR
DEPT OF COMMUNITY MEDICINE
BJGMC, PUNE
2. Diabetes
• Diabetes and its types
• Aim of WHD, Theme, slogan
• Problem- halt the rise
• Epidemiology of diabetes
• Clinical features and complications
• Diagnosis
• Prevention and Control
• Yoga and diabetes – Akurte Madam
3.
4. 100% Growth in Diabetes Patients
in India in the Last 15 YearsDiabetics in India up 100% to 63m in 13 years
Let us build a healthier India by defeating
diabetes : PM
GLOBAL HEALTH EMERGENCY OF 21ST CENTURY
WHO warns against diabetes epidemic
5. DIABETES
• First described in the Egyptian script(1500BCE)
• Diabetes(ancient Greek, first used 230BCE) :- a
passer through; siphon(owing to the excess of
urine passage in the patients)
• Milletus: ( latin) : sweetened with honey
• Madhumeha:( Honey urine): since it attracted
ants.
6. DEFINITION
Diabetes is a heterogeneous group of diseases,
characterized by a state of chronic
hyperglycemia, resulting from a diversity of
etiologies, environmental & genetic, often acting
jointly.
7. In diabetes, the cells' inability to utilize glucose gives rise to the ironic
situation of "starvation in the midst of plenty". The abundant,
unutilized glucose is wastefully excreted in the urine.
8. CLASSIFICATION (W.H.O)
1. Diabetes Mellitus
a) Insulin Dependent Diabetes Mellitus (Type 1)
b) Non-Insulin Dependent Diabetes Mellitus
(Type 2)
c) Malnutrition Related Diabetes Mellitus .
d )Other types (Secondary to Pancreatic,
Hormonal, drug induced, genetic & other
abnormalities.)
2. Impaired Glucose Tolerance.
3. Gestational Diabetes Mellitus.
9. Type 1 diabetes
• Autoimmune reaction against beta cells
of pancreas.
• Body can no longer produce the insulin.
• Can affect people of any age, but onset usually
occurs in children or young adults.
• Need insulin every day in order to control the
levels of glucose in their blood.
• Without insulin, a person with type 1 diabetes
will die.
10. Type 2 Diabetes
• Common
• Gradual onset
• Silent
• > 30 yrs.
• Mild
• Other diseases
11. INDIAN DIABETES
• LADA- Latent Autoimmune Diabetes of Adults
• Type 1.5
• Early start at 25 yrs, initial well controlled with
oral hypoglycaemic and then shifted to insulin
12. Gestational diabetes
• Blood sugar elevation during pregnancy
• usually resolves once the baby is born
• However, 25%-50% of women with gestational
diabetes will eventually develop type 2
diabetes later in life
• Patients with gestational diabetes are usually
asked to undergo an oral glucose tolerance
test about six weeks after giving birth
13. Theme - Diabetes
• Goal of World Health Day 2016:
• Scale up prevention
• strengthen care and
• enhance surveillance
22. Top 10 countries- expenditure on diabetes
India is nowhere in
top 10
23. Impaired Glucose Tolerance(IGT)
• 318 million(6.7% adults) have IGT(2015)
• 2040- Projected adults with IGT= 7.8% of
adults.
• 69.2% of them live in middle & low income
countries.
• IGT – Increased risk of developing type 2 DM
increased risk of CVS disorder in future.
25. SEAR and India
8.5% adults have diabetes
52.1% undiagnosed with diabetes.
Highest prevalence in Mauritius
India 2nd highest in prevalence in Diabetes.
India- 77.2million prediabetes
26. Comparison
REGION Prevalence No of people
suffering from
diabetes(millio
ns)
Undiagnosed
diabetes
Mean diabetes
related
expenditure
per person
with DM
World 8.8% 415 46% 1622
SEAR 8.5% 78.3 51% 92.9
India 8.7% 69.2 52% 94.9
31. RISK FACTORS FOR TYPE 2 D.M.
• Family history
• Obesity (BMI >25 kg/m2)
• Habitual physical inactivity
• Race/ethnicity
• Previously identified IGT or IFT.
• History of GDM or delivery of baby >4 kg
• Hypertension (130/85)
• HDL cholesterol level <40 mg/dL and/or a triglyceride
level >150 mg/dL .
• Polycystic ovarian syndrome or acanthosis nigricans.
• History of vascular disease
34. Classification BMI
(kg/m2)
Risk of co-morbidities
Waist circumference
< 90 cm (men)
< 80 cm (women)
≥ 90 cm (men)
≥ 80 cm (women)
Waist Hip ratio
<0.95(men) >0.95(men)
<0.85(women) >0.85(women)
Underweight <18.5 Low (but risk of
other clinical
problems increased)
Average
Normal range 18.5-22.9 Average Increased
Overweight ≥23
At risk 23.0-24.9 Increased Moderate
Obese I 25-29.9 Moderate Severe
Obese II ≥ 30.0 Severe Very severe
35. Clinical features
•Increased urine output(polyuria)
•Increased thirst and dehydration(polydipsia)
•Weight loss despite of increased appetite
•Fatigue, nausea and vomiting
•Recurrent infections
•Blurred vision
37. Investigations
• Fasting blood glucose Retina examination
• Post prandial Kidney function test
• BP ECG
• HbA1C Foot examination
38. Diagnostic Criteria for Pre diabetes
and Diabetes in Nonpregnant Adults
Normal High Risk for Diabetes Diabetes
FPG <110 mg/dL
IFG
FPG ≥110-125 mg/dL
FPG ≥126 mg/dL
2-h PG <140 mg/dL
IGT
2-h PG ≥140-199 mg/dL
2-h PG ≥200 mg/dL
Random PG ≥200 mg/dL +
symptoms*
A1C <5.5%
5.5 to 6.4%
For screening of prediabetes†
≥6.5%
Secondary‡
rule of “thirds” – about one third of prediabetic people will develop diabetes in the next
five years, one third will remain prediabetic, while one third will revert to normal
Normal
Complications
Death
Prediabetes - the harbinger of
future diabetes
39. Diagnostic Criteria for Gestational
Diabetes
Test Screen at 24-28 weeks gestation
FPG, mg/dL >92
1-h PG*, mg/dL ≥180
2-h PG*, mg/dL ≥153
3-h PG*, mg/dL
≥140
*Measured with an OGTT performed 2 hours after 75-g oral glucose load.
43. The glycemic index - is a tool that
allows you to see how the fruits,
vegetables and other
carbohydrates you eat affect your
blood sugar levels.
Glycemic Index Reference Range
• High Glycemic Index 70-100
• Moderate Glycemic Index 50-70
• Low Glycemic Index <50
47. Be physically active
Modern smoking
continous sitting >
2hrs= 1 cigarette
smoking
TV watching – 1hr=
2% wt gain/yr
48. Take the stairs rather than the elevator, park at the far end of the
parking lot, walk while talking on the phone, or walk to your co-
worker’s desk rather than emailing him or her.
52. NPCDCS
• Diabetes, CV Diseases and stroke
• Involvement of primary health care staff
• CHC- Basic investigations
• DH- and tertiary care hospital
• URBAN- Screening > 30 YRS, yearly basis, all
pregnant mothers
53. Diabetes clinic in SGH-EVERY Wednesday -2-4pm
H1N1 vaccine- all diabetics
Screening camp – daily from 1st April to 7th April
Poster competition and exhibition- 6th April
54.
55.
56. • Health care partner
• Knowledge
• Motivate- healthy life style
• Lead by example
• Be a change agent
