Obesity n Ty2DM - cause or effect?

In the Name of God, Most Gracious, Most Merciful : 

In the Name of God, Most Gracious, Most Merciful

OBESITY & TYPE 2 DIABETES- CAUSE OR EFFECT? : 

OBESITY & TYPE 2 DIABETES- CAUSE OR EFFECT? By- Mohammad Sadiq Undergraduate Meenakshi Medical College & Research Institute

STUDY BACKGROUND : 

Type 2 Diabetes (= NIDDM / Adult onset diabetes) results from insulin resistance with a defect in compensatory insulin secretion. 1 Obesity is the most important factor causing insulin resistance. 1 While both obesity & lifestyle have long been established as risk factors in diabetes, their relevance in the Indian rural populace is still questionable. STUDY BACKGROUND 1 Umesh Masharani, Diabetes mellitus & hyperglycaemia, Current Medical Diagnosis and Treatment, 27:1032-1071; 2008.

AIM OF THE STUDY : 

To : Determine the prevalence of Type 2 diabetes mellitus (Ty2DM) in Meenakshi Medical College & Research Institute, Kanchipuram, Tamil Nadu, India. To identify the relationship between Ty2DM, obesity & lifestyle. AIM OF THE STUDY

MATERIALS & METHODS : 

Total number of cases reviewed: 200 Type of study: Cross sectional study. Method of sampling used: Random sampling. Screening test used: Random Blood sugar level. Confirmatory test used: Fasting blood sugar level. 1 Criteria for obesity: BMI. 2 MATERIALS & METHODS 1 Genuth S et al; Expert committee on the diagnosis & classification of diabetes mellitus. Follow up report on the diagnosis of diabetes mellitus. Diabetes care 26(11):3160-3167; Nov 2003. 2 Robert B Baron, Nutritional disorders, NIH Guidelines on obesity, CMDT 29:1085-1102; 2008.

STUDY : 

STUDY P ROFORMA

STUDY CRITERIA : 

Ty2DM: FBS = 126mg/dl on > 1 occasion Obesity: BMI = 30 STUDY CRITERIA INCLUSION CRITERIA TY – 2 DM : EXCLUSION CRITERIA Patients with causes of 2o hyperglycemia Hormonal tumours Pharmacological agents Liver disease Muscle disorders Adipose tissue disorders Insulin receptor disorders

KUPPUSAMY : 

KUPPUSAMY SCALE

OBSERVATIONS : 

PREVALENCE OF TY 2 DM OBSERVATIONS Total Cases: 200 Type 2 DM: 72 Prevalence: 360/1000 population (36%) 128 72 (As on 29/6/2008 in MMCRI)

OBSERVATIONS : 

Mean Age: 57.32 years OBSERVATIONS MEAN AGE / SEX

Slide 12: 

OBESE vs. NON OBESE DIABETICS n = 72 OBSERVATIONS

STATISTICAL ANALYSIS : 

STATISTICAL ANALYSIS

OBSERVATIONS : 

SOCIO ECONOMIC STATUS n = 72 OBSERVATIONS

OBSERVATIONS : 

CLINICAL PRESENTATION n = 72 OBSERVATIONS

DISCUSSION : 

DISCUSSION

DEFINITION : 

“Diabetes Mellitus is a syndrome with disordered metabolism and inappropriate hyperglycaemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate” 1 DEFINITION 1 Umesh Masharani, Diabetes mellitus & hyperglycaemia, Current Medical Diagnosis and Treatment, 27:1032-1071; 2008.

PATHOPHYSIOLOGY OF TY 2 DM : 

PATHOPHYSIOLOGY OF TY 2 DM

DISCUSSION : 

Epidemiology Carbohydrate & Fat metabolism : An overview Role of Insulin in fat metabolism Fat metabolism in diabetes Insulin resistance & Obesity Inferences – Obesity in Ty2DM – Cause or effect? “Non-obese and Obese stages” of diabetes DISCUSSION

DISCUSSION : 

28/1000 population (2000) 1 Projected 44/1000 (2030) 1 Obese diabetics – 57.9% (rural natives) 2 Our results!!! DISCUSSION 1 Sarah Wild et al, Global prevalence of diabetes estim for 2000 & projections for 2030, Diabetes Care, 27(5):1047-1053; May 2004. 2 Fransisco Perez Bravo et al, Applied nutritional investing prevalence of ty 2 diab and obesity in rural Mapuche population from Chile, Nutrition 17(3):236-238; Mar 2001. EPIDEMIOLOGY

CARBOHYDRATE METABOLISM : 

CARBOHYDRATE METABOLISM Peter A Mayes et al, Overview of metabolism, Harper Biochem 26/e 15:122-129, 2003

FAT METABOLISM : 

FAT METABOLISM Peter A Mayes et al, Overview of metabolism, Harper Biochem 26/e 15:122-129, 2003

INSULIN IN FAT METABOLISM : 

INSULIN IN FAT METABOLISM Kathleen M Bothan et al, Lipid transp & storage, Harper Biochem 26/e 25:205-218; 2003

FAT METABOLISM IN DIABETES : 

FAT METABOLISM IN DIABETES William F Ganong, Endocrine functions of the pancreas & regulation of carbohydrate metabolism, Review of Med Physiology 21/e 19:336-358, 2003

EFFECTS OF INSULIN DEFICIENCY : 

EFFECTS OF INSULIN DEFICIENCY William F Ganong, Endocrine functions of the pancreas & regulation of carbohydrate metabolism, Review of Med Physiology 21/e 19:336-358, 2003

DISCUSSION : 

Epidemiological data 1 Role of obesity? Visceral vs. subcutaneous fat Role of adipokines 2 Genetic basis – Calpain -10 (chr 2) 3,4 DISCUSSION 1 Umesh Masharani, Diabetes mellitus & hyperglycaemia, CMDT 27:1032-1071; 2008 2 J Denis Mc Garvy, Lipid metabolism I util & storage of energy in lipid form, Devlin Biochem 5/e 16:693-725; 2004 3 Holdst JJ et al, Role of incretin hormones in the regulation of insulin secretion in diabetic & non-diabetic humans. Am J Physiology Endocrino Metab 287(2):E199-206; Aug 2004 4 Stumvoll M et al, Clin feat of insulin resistance & beta cell dysfunc & the rel to Ty 2 diab, Clin Lab Medicine, 21(1):31-51; Mar 2001 INSULIN RESISTANCE & OBESITY

ROLE OF ADIPOKINES : 

ROLE OF ADIPOKINES William F Ganong, Endocrine functions of the pancreas & regulation of carbohydrate metabolism, Review of Med Physiology 21/e 19:336-358, 2003

INFERENCES : 

INFERENCES Glucose to Acetyl CoA needs Insulin. Acetyl CoA to Fatty acid needs Insulin .Insulin is primarily an anabolic hormone Ty2DM is characterised by Insulin resistance. Lipolysis occurs in Ty2DM. Leptin produced by adipose tissue ? insulin resistance. OBESITY & Ty2DM – Cause or Effect?

INFERENCES : 

INFERENCES Ty2DM - NON OBESE STAGE Insulin resistance Accelerated catabolism Starved populace ? Lipolysis Depletion of fat in adipose tissue Non-obese diabetics ? Acetyl CoA ? Ketone bodies DKA

INFERENCES : 

INSULIN RESISTANCE INFERENCES Ty2DM - OBESE STAGE Non-obese Diabetics Adipose tissue produces Leptins Insulin resumes its anabolic role ? Fatty acid synthesis Obese Diabetics

SUMMARY : 

SUMMARY Prevalance of Ty2DM Relevance of this study Genetic basis of Insulin resistance Role of Obesity & Lifestyle Looking ahead…

Slide 32: 

Prof.T.Gunasagaran, Vice Chancellor, Meenakshi University Dr.Ganapathy, Dean, MMCH & RI Prof.M.Chandrasekar, Professor & HOD, Department of Physiology Prof.L.Pari, Professor & HOD, Department of Internal Medicine Professors & Assistant Professors, Departments of Physiology & Internal Medicine Ms.Bhuvaneshwari, Statistician, Department of Community Medicine Patients Family & Friends ACKNOWLEDGEMENTS

Slide 33: 

… and miles to go before I sleep, And miles to go before I sleep…