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NCD-
DIABETES MELLITUS
MPH
Group 1
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HEENA DIXIT/ DIABETES MELLITUS

Diabetes Mellitus
• Diabetes is heterogeneous group of diseases
- chronic hyperglycemia
- environmental and genetic action
• Cause- Defective production or action of
insulin- controls glucose, fat and amino acid
metabolism.
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Diabetes…..
• Long term disease
• Variable clinical manifestations and progression
• Complications
- Cardiovascular
- Renal
- Neurological
- Ocular and
- Others such as intercurrent infections.
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Clinical classification of diabetes by
WHO
1. Diabetes mellitus
1.1 type 1 or IDDM
1.2 type 2 or NIDDM
1.3 Malnutrition Related Diabetes Mellitus/MRD
1.4 other types ex. Secondary to pancreatic, hormonal,
drug induced, genetic and other abnormalities
2. Impaired Glucose Tolerance/IGT
3. Gestational Diabetes Mellitus/GDM
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1.1 Type 1 diabetes/IDDM
• Severe form of the disease
• Individuals less than 30 years of age
• Immune mediated in over 90% of cases
• Idiopathic in less than 10% cases
• The rate of destruction of pancreatic beta cells is
quite variable
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Type 1 diabetes/IDDM…….
• Ketosis in its untreated state
• Mostly in children, > in 10-14 years, occasionally
occur in adults
• Catabolic disorder in which circulating insulin is
virtually absent, plasma glucagon is elevated and
the pancreatic beta cells fail to respond to all
insulinogenic stimuli
• Exogenous insulin is therefore required to reverse
the catabolic state, prevent ketosis, reduce the
hyperglucagonemia and reduce blood glucose.
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1.2 Type 2 diabetes/NIDDM
• Type 2 diabetes- more common. It is often
discovered by chance
• Gradual in onset, middle aged and elderly,
frequently mild, slow to ketosis.
• Complicated by the presence of other disease
processes.
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3. GDM
• Gestational diabetes is hyperglycemia with
blood glucose values above normal but below
those diagnostic of diabetes, occurring during
pregnancy
• Women and their children with GDM are at an
increased risk of complications during
pregnancy and at delivery
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2. IGT
• IGT describes a state intermediate- at risk
group- between diabetes and normality
• It can only be defined by the OGTT.
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Insulin resistance syndrome/syndrome
X
• In obese patients with type 2 diabetes-
• Hyperglycemia,
• Hyperinsulinemia,
• Dyslipidemia,
• Hypertension,
• Leads to coronary artery disease and stroke,
• May result from a genetic defect producing insulin
resistance.
• Initiate atherosclerosis.
• Latter being exaggerated by obesity.
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Problem statement world
• Diabetes is an iceberg disease
• More than 80% diabetes deaths occur in low and
middle income countries.
• The global prevalence of diabetes in 2014 was
estimated to be 8.5% in adults aged 18plus years
• CHD and stroke are more common in diabetics than
in the general population.
• The IDDM registry at chennai india reported an
incidence of 10.5 per 100000 children in the age
group of 10-12 years.
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Problem statement world…..
• Microvascular complications like diabetic renal
disease and diabetic retinopathy and neuropathy
• In fact, diabetes is listed among the 5 most
important determinants of the cardiovascular
disease epidemic in asia
• Lower limb amputation are at least 10 times
more common in diabetic than in non diabetic
individuals
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Problem Statement India
• The population in india has an increased
susceptibility to diabetes
• This propensity was demonstrated by multiple
surveys of migrant indians residing in fiji,
singapore, south africa, uk and usa
• The rates of diabetes in migrants from the indian
subcontinent have consistently shown to exceed
those of the local population
• National programme for prevention and control
of NCDs are operational in india and it includes
diabetes and diabetes registry.
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Natural history epidemiological
determinants
1. Agent
1.1 pancreatic disorders
1.2 defects in the formation of insulin
1.3 destruction of beta cells
1.4 decreased insulin sensitivity
1.5 genetic defects
1.6 autoimmunity
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determinants
2. Host factors
2.1 age
2.2 sex
2.3 genetic factors
2.4 genetic markers
2.5 immune mechanisms
2.6 obesity
2.7 maternal diabetes
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determinants
3. Environmental risk factors
3.1 sedentary lifestyle
3.2 diet
3.3 dietary fiber
3.4 malnutrition
3.5 alcohol
3.6 viral infections
3.7 chemical agents
3.8 stress
3.9 other factors
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Summary of strength of evidence on
lifestyle factors and risk of developing
type 2 diabetes
Evidence Decreased risk Increased risk
Convincing - Voluntary weight loss in
overweight and obese
people
- Physical activity
- Overweight and obesity
- Abdominal obesity
- Physical inactivity
- Maternal diabetes
including GDM
Probable - Non Starch
Polysaccharides(NSP)
- Saturated fats
- IUGR
Possible - omega3 fatty acids
- Low glycemic index
foods
- Exclusive breast feeding
for 1st 6 months of life
- Total fat intake
- Trans fatty acids
insufficient - Vitamin E
- Chromium
- Magnesium
- Excess alcohol
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Screening for diabetes
• In the past, the commonest approach to diabetes
screening was a preliminary, semi quantitative test
for glucose in a urine sample, followed by an OGTT
for those found to have glycosuria
• The underlying assumption is that early detection
and effective control of hyperglycemia in
asymptomatic diabetics reduces morbidity.
1. Urine examination
2. Blood sugar testing
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The WHO recommendations for the
diagnostic criteria for diabetes and
intermediate hyperglycemia
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Clinical Manifestations
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Complications

Management
Non-pharmacological
• Dietary advices
• Exercise
• Weight loss
• Obesity management
• Reduce Alcohol
• Quit smoking
Pharmacological- Antidiabetics

Prevention and care
1. Primary prevention
1.1 population strategy
1.2 high risk strategy
2. Secondary prevention
2.1 glycosylated haemoglobin
2.2 self care
2.3 home blood glucose monitoring
3. Tertiary prevention
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Individual interventions in diabetes
with evidence of efficacy
Interventions with evidence of efficacy Benefit
Lifestyle interventions for preventing type
2 diabetes in people of high risk
Reduction in incidence
Metformin for preventing type 2 diabetes
for people at high risk
Reduction in incidence
Glycemic control in people with HbA1c
greater than 9%
Reduction in microvascular disease
BP control in people whose pressure is
higher than 130/80mmHg
Reduction in macrovascular and
microvascular disease
Annual eye examinations Reduction in serious vision loss
Foot care in people with high risk of ulcers Reduction in serious foot disease
ACE inhibitor use in all people with
diabetes
Reduction in nephropathy and reduction
in cardiovascular disease
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National Diabetes Control Program
Introduction
• Started on 7th five year plan
• Started in Tamilnadu,
Jammu and Kashmir
• Karnataka
Program could not expand due
to paucity of funds
Objectives
• Primary prevention by IEC
programs and health
education
• Secondary prevention by
early diagnosis and early
treatment to reduce
morbidity and mortality
• Prevention of acute
complications
• Rehabilitation for physically
handicapped.

References
• K.Park 25th
• Mahajan and Gupta 4th edition
• Text Book of AFMC
• Google search/WHO links

THANK YOU FOR YOUR PATIENCE
LISTENING
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