WORLD DIABETES DAY

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WORLD DIABETES DAY 14TH NOVEMBER 2012:

WORLD DIABETES DAY 14 TH NOVEMBER 2012

World Diabetes Day:

World Diabetes Day Started by the International Diabetes Federation (IDF) and WHO, the Day is celebrated on 14 November to mark the birthday of Frederick Banting who, along with Charles Best, was instrumental in the discovery of insulin in 1922, a life-saving treatment for diabetes patients

Diabetes Mellitus : a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both:

Diabetes Mellitus : a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both Consists of 3 types: 1) Type 1 diabetes 2) Type 2 diabetes 3) Gestational diabetes Complications : - Stroke - Heart attack - Kidney disease - Eye Disease - Nerve Damage

Diabetes Mellitus:

Diabetes Mellitus Type 1 Diabetes - cells that produce insulin are destroyed - results in insulin dependence - commonly detected before 30 Type 2 Diabetes - blood glucose levels rise due to 1) Lack of insulin production 2) Insufficient insulin action (resistant cells) - commonly detected after 40 - effects > 90% - eventually leads to β -cell failure (resulting in insulin dependence) Gestational Diabetes 3-5% of pregnant women in the US develop gestational diabetes

Testing ::

Testing : Fasting Plasma Glucose Test (FPG) - (cheap, fast) *fasting B.G.L. 100-125 mg/dl signals pre-diabetes *>126 mg/dl signals diabetes Oral Glucose Tolerance Test (OGTT) *tested for 2 hrs after glucose- rich drink *140-199 mg/dl signals pre- diabetes *>200 mg/dl signals diabetes 80 to 90 mg per 100 ml, is the normal fasting blood glucose concentration in humans and most mammals which is associated with very low levels of insulin secretion. A.K.A.: Glycated Hemoglobin tests A1C

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In type I diabetes mellitus, the body simply does not make insulin (5% of diabetics). In type II diabetes, either the body does not make enough insulin or the cells begin to resist it (95% of diabetics).

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DM : Leading cause of death and morbidity Morbidity implies the effects due to the disease, which reduce or mar the quality of life of the affected person. It causes blindness, heart attack, stroke, kidney failure and amputation. This ailment is affecting younger people also. In the past decade, the incidence among people in the 30's has jumped by 70%. It is up by 10% among under the 30's. This implies that these younger people will be struggling with amputations, blindness and heart disease at the prime of their life.

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Diagnosis of Diabetes is for life. Entails certain lifestyle and social restraints. Mounting therapeutic obligations Problems of employment and Insurance. Extreme care to be exercised in pronouncing such a diagnosis Delay in diagnosis raises the risk of tissue damage and long term complications

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There are currently 366 million people living with diabetes. This figure is set to rise to over 550 million by 2030. Diabetes is responsible for 4.6 million deaths a year - 1 every 7 seconds. Diabetes is among the top 10 causes of disability, resulting in life-threatening complications such as heart disease, stroke, lower limb amputations and blindness. 50% of people with diabetes are undiagnosed. 80% of people with diabetes live in low- and middle-income countries.

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PREVALENCE India had 19.4 million diabetics in 1995. India will have 57.2 million patients in 2025. India tops the list of diabetes in 1995 and 2025 also.

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Ten top countries – Number of adults with DM in Millions WHO Tech report 1985

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The Rising Prevalence of Diabetes In Developing Countries

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The rising prevalence of Diabetes world wide 4 million deaths per year related to DM. (9% of the global total.)

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Genetic Predisposition Environmental factors Sedentary life style Change in food habits Stress of Urban living Increase in population Increasing aging population (Longevity) High Ethnic susceptibility Factors for Rising of Diabetic Epidemic

Effects of Urbanisation:

Consumption of excess calories Reduction in complex carbohydrates with Increased consumption single sugars and fat. Availability of energy saving methods of transport and labour hence severely Reduced physical activity. Increased levels of stress. Effects of Urbanisation

Factors Responsible::

Unchangeable Modifiable Preventable Male Gender Dyslipidaemia Obesity F.H. of Diabetes mellitus Hypertension Smoking Ageing Diabetes Alcohol Viral infections Stress Sedentary life style Food habits Factors Responsible:

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Are obese ( BMI over  27). Those with a family history of DM (especially first degree). Those with diabetes developing during pregnancy (GDM). Mother of a big baby at birth (above 3.5 kg) – mother prone for diabetes. Low birth weight child (IUGR) – child can develop diabetes in future. Have a HDL cholesterol  35mg/dl and /or a triglyceride level  200mg/dl. On previous testing , had IFG or IGT. Are members of high risk ethnic population (South Asians) Poly cystic Ovarian Disease in Females

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PREVALENCE OF COMPLICATIONS AT DIAGNOSIS 50% OF PATIENTS HAD COMPLICATIONS AT DIAGNOSIS ü 37% HAD RETINOPATHY ü 18 % HAD MICROALBUMINURIA ü 10% HAD PERIPHERAL NEUROPATHY . UKPDS

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Chronic complications of Diabetes. Mortality is increased by 200% Heart disease and stroke rate is 200% to 400%. Blindness 10 times more common in diabetes. Gangrene and amputation of lower limbs about 20 times more common than in non-diabetics. Second leading cause of fatal renal disease. Other chronic complication (neuropathy, infections and sexual dysfunctions) As a result of diabetes, hospitalisation expense increase by 2 to 3 folds (WHO expert committee on Diabetes mellitus.)

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DIABETES AND DEPRESSION Depression occurs at least 100% more frequently in patients with DM than in general population. Patients with depressive disorder have more than twice the risk of developing DM Type 2 compared to patients without Depression.

Management of DM:

The major components of the treatment of diabetes are: Management of DM

A. Diet:

Diet is a basic part of management in every case. Treatment cannot be effective unless adequate attention is given to ensuring appropriate nutrition. Dietary treatment should aim at: ensuring weight control providing nutritional requirements allowing good glycaemic control with blood glucose levels as close to normal as possible correcting any associated blood lipid abnormalities A. Diet

A. Diet (cont.):

The following principles are recommended as dietary guidelines for people with diabetes: Dietary fat should provide 25-35% of total intake of calories but saturated fat intake should not exceed 10% of total energy. Cholesterol consumption should be restricted and limited to 300 mg or less daily. Protein intake can range between 10-15% total energy (0.8-1 g/kg of desirable body weight). Requirements increase for children and during pregnancy. Protein should be derived from both animal and vegetable sources. Carbohydrates provide 50-60% of total caloric content of the diet. Carbohydrates should be complex and high in fibre. Excessive salt intake is to be avoided. It should be particularly restricted in people with hypertension and those with nephropathy. A. Diet (cont.)

Exercise :

Physical activity promotes weight reduction and improves insulin sensitivity, thus lowering blood glucose levels. Together with dietary treatment, a programme of regular physical activity and exercise should be considered for each person. Such a programme must be tailored to the individual’s health status and fitness. People should, however, be educated about the potential risk of hypoglycaemia and how to avoid it. Exercise

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Diabetes-specific education is required for healthcare personnel and people with diabetes. Diabetes self-management education is a critically important, fundamental and integral component of diabetes prevention and care and should be available and accessible to everyone. The primary barrier to access to education is shortage of qualified diabetes educators. Investment in diabetes education and diabetes prevention programmes will save money in the long term and deliver significant returns in quality of life for people with diabetes and people at high risk of diabetes.

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Type 2 diabetes is a common and serious global health problem, which, for most countries, has developed together with rapid cultural and social changes, ageing populations, increasing urbanisation, dietary changes, reduced physical activity, and other unhealthy behaviours. Lifestyle interventions and socially responsible policies can promote healthy living and help prevent type 2 diabetes. There is conclusive evidence that type 2 diabetes can be prevented through nutrition counselling, increasing physical activity and modest weight reduction Healthy nutrition and physical activity are not just a matter of personal choice. The causes of diabetes are complex and multi-faceted. All sectors of society have a responsibility to act.

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THE ECONOMIC BURDEN OF DIABETES India is the ‘ Diabetes Capital of the world’ A dubious distinction Can we afford it?

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Walk more , Eat less Sir George Alberti, President IDF Why are so many people suffering from DM in India ? Ethnic predisposition Indians are centrally fat. (fat around the waist) Due to lack of exercise Economic growth – prosperity - change in dietary habits and adopting of Western style fast food

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Strategies for primary prevention of macrovascular complications Life style modifications Diet Exercise Optimisation of body weight Cessation of smoking Reduction of mental stress Metabolic control of Diabetes Optimum control of Blood pressure Drug Therapy Aspirin Lipid lowering agents

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What are the new developments worldwide? Nothing new. 2000 years ago, Hippocrates said – no exercise obesity various illnesses. Relevant even today Primary Diabetes Mellitus is a lifestyle related disease. We cannot rely on drugs to correct lifestyle.

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