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Diabetes Diagnosis and Classification
- 1. Dr. Vivek Arya MD, DM(Endo.), SGPGI, Lucknow Asst. Prof. Smt. NHL Medical College & VS Hosp. Formerly Asst. Prof. Nizam’s Institute, Hyderabad Formerly, Chief Consultant and Head, Belhoul Apollo Hospital, DUBAI Senior Consultant Endocrinologist & SAL/Sterling/Shalby/Apollo/Nidhi Hospital Investigating Type 2 Diabetes & ADA EASD recommendations enter for ndocrine Disease and Diabetes
- 2. (Answer: detect sugar) What do these pictures have in common?
- 7. Prevalence of retinopathy by deciles of the distribution of FPG, 2hrPPG and HbAlc National Health And Nutritional Epidemiologic Survey (NHANES III).
- 11. What do the terms impaired fasting glycaemia AND impaired glucose tolerance imply ?
- 17. GDM Criteria *2 or more criteria met = positive diagnosis (cutoff points in mg/dl) † 1 or more criteria met = positive diagnosis 140 - 140 145 3 hours 155 ≥ 140 155 165 2 hours 180 - 180 190 1 hour 95 ≥ 126 95 105 Fasting Carpenter and Coustan* World health Organization † American Diabetes Association* National Diabetes Data Group*
- 20. Type 1 Diabetes Insulitis
- 21. Pathogenesis of Type I DM Environment ? Viral infe..?? Genetic HLA-DR3/DR4 Severe Insulin deficiency ß cell Destruction Type I DM Autoimmune Insulitis (GAD,ICA IAA)
- 22. LADA(Latent Autoimmune Diabetes of the Adult)
- 25. Pathogenesis of Type 2 DM Environment Low Birth Weight Obesity Genetic ß cell defect Genetic ß cell exhaustion Type 2 DM Insulin resistance Relative Insulin Def. May require Insulin Secretory Defect
- 26. Physical Activity on the decline…………..
- 27. Physical Activity on the decline…………..
- 28. The economic driving factors…… Adam Drewnowski and SE Specter. Poverty, obesity, and diet costs. Am J Clin Nutr 2004;79:6 –16 40/- per kg 90/- per kg … Consumer Price Index shifts favour unhealthy products
- 31. McDonaldisation
- 36. Type 2 or MODY Autosomal dominant Polygenic / Heterogen Inheritance rare frequent Obesity minimal considerable Role of environment beta cell dysfunction beta cell dysfunction + insulin resistance Patho-physiology child-young middle - old Age of onset MODY Type 2 DM
- 40. Adapted from F Karpe
- 56. Thank you Dr. Vivek Arya MD, DM(Endo.), SGPGI , Lucknow Asst. Prof. Smt. NHL Medical College & VS Hosp. Formerly Asst. Prof. Nizam’s Institute, Hyderabad Formerly, Chief Consultant and Head, Belhoul Apollo Hospital, DUBAI Senior Consultant Endocrinologist & SAL/Sterling/Apollo/Shalby/Nidhi Hospitals, Ahmedabad Mobile : 98795 37973 Phone : 2929 8877 enter for ndocrine disease and Diabetes
- 60. The Concept of the Metabolic Syndrome
- 64. Prevalence of the Metabolic Syndrome Men 19 18 13 Men (n=279) 8 7 6 Women (n=289) IDF % ATPIII % EGIR % IDF EGIR ATPIII 14.7 2.7 22.1 11 11.9 20.2 17.4 IDF EGIR ATPIII 20.9 0 41.8 16.3 14 0 7 Women
- 65. BMI vs WHR in relation to CHD risk Yusuf S et al. Lancet 2005;366:1640-9
- 66. Klein S et al. NEJM 2004;350:2549-2557
Notas del editor
- Glucose monitoring systems have come a long way. In the past, ants were utilized to detect diabetes. High concentration of sugar spilled into the urine would attract these insects. So, we can call it the ANTcient method. Currently, there are faster and more effective methods, which include continuous wireless transmission of the blood glucose readings from the sensor on the skin to the portable receiver. The quality of this modern technology has significantly improved diabetes management.
- Implications for the menu of items offered…
- 1 can of sugary pop per day in excess of what they need will put on 3 stone in weight over childhood
- Type 2 diabetes is up to 6 times more common in people of South Asian descent and 3 times more common in those of African and African-Caribbean descent, compared with the white population More than one quarter of people of Asian origin aged over 40 years suffer from diabetes Diabetes National Service Framework: Standards – Department of Health 2001; Audit Commission – Testing Times (2000)