Aetiology and management of Diabetes.

1. Diabetes Mellitus Dr. Gopalrao Jogdand, M.D. Ph.D. Professor & Head Department of Community Medicine

2. Information related to Diabetes is found as early as 1552 B.C. Description of the disease is found in Ayurveda. 1889 Mehring and Minkowski created diabetic dog by removing its pancreas 1921 Banting, Best, Collip & McLeod identify insulin & treat successfully depancreatised dog Historical Background

3. Best and Banting

4. Global: currently there are 150 million cases of D.M. Highest No. of cases exist in China and India. 30 million cases are found in SEAR. Rates increasing - set to double over next 15 years (2025). Increasing incidence parallels that of obesity (e.g. Massachusetts: 1958 - 0.9%; 1995 - 3%) Prevalence

5. Pancreas

6. Aetiology of Diabetes

7. Type 1 Diabetes Insulin Dependent Diabetes Mellitus Used to be called juvenile onset diabetes Most commonly begins during childhood Cells that produce insulin in the pancreas have been destroyed by the immune system Accounts for about 15% of people with diabetes Need daily injections of insulin to survive Clinical Classification

8. Previously called as maturity onset D.M. Pancreas does not produce adequate quantity of insulin or the cells do not uptake insulin. Generally occurs in those over the age of 40 years. Exhibits familial tendency. 30 to 40% patients need insulin therapy. Type II Diabetes

9. W.H.O. Classification

10. Host factors: Age- Type I diabetes is common in children and young adults. Type II diabetes incidence increase with the age, common over the age of 40 years. Sex- In SEAR males suffer more than females. Genetic factors- In identical twins the concordance rate is 90% indicating a strong genetic link. Epidemiology

11. Evidence of genetic predisposition is proved by the presence of genetic markers i.e. HLA DR3 and DR4. Defective immune response leading to destruction of islet of Langerhan’s cells. Obesity- Central obesity is considered as a risk factor for DM. Continued….

12. Sedentary life style. High saturated fat intake in diet. Malnutrition- Partial failure of β cells activity. Excessive intake of alcohol. Viral infections involving glandular tissues i.e. Mumps and Rubella. Chemical agents- Alloxan, streptozotocin, and cyanide. Environmental stress. Environmental factors

13. In the community: DM surveys consist of multiphasic screening i.e. Urine examination followed by blood sugar testing. Applied to high risk individuals, family H/O DM, obese and overweight, age over 40 years. Individual level: Suspected patients showing signs of DM i.e. polyuria, polydipsia and polyphagia should be screened for Diabetes. Screening For Diabetes

14. Principles of Diabetes Control: Controlling the blood sugar either by oral anti-diabetic drugs or insulin. Dietary modification. Exercise promotion. Management of Diabetes

15. Diabetic ketoacidosis and Diabetic coma. Diabetic Occulopathy. Diabetic Nephropathy. Hypertension. Stroke or myocardial infarction. Diabetic foot. Complications

16. Diabetic foot

17. Primary Prevention a. Population strategy: There is hardly any scope for this strategy in IDDM. However this can be adopted for NIDDM in which one can practice Primordial prevention. b. High risk strategy: Since NIDDM is linked to life style parameters, persons at risk can be identified and life style modification can be attempted, Prevention & Control

18. Adequate treatment: aim of the treatment is to maintain the blood glucose level within normal limits. Monitoring the blood glucose level: estimation of Hb% by glycosylated hemoglobin method which gives insight into the blood glucose maintenance for previous three months. Self care. Secondary Prevention

19. Establishment of specialty clinics (Diabetic clinic). Prevention of co-morbidities. Follow up of the patients. Tertiary Prevention

20. Thank You