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


A STUDY ON TYPE II DIABETES :The Enigma prevails… A STUDY ON TYPE II DIABETES By- Mohammad Sadiq Meenakshi Medical College & Research Institute


REVIEW OF LITERATURE :An estimated 246 million people worldwide are affected by diabetes. With a further 7 million people developing diabetes each year, that number is expected to hit 380 million by 2025. The most life-threatening consequences of diabetes are heart disease and stroke, which strike people with diabetes more than twice as often as they do others. More than 65 percent of deaths in diabetes patients are attributed to heart and vascular disease.  In people with diabetes, cardiovascular complications occur at an earlier age and often result in premature death. REVIEW OF LITERATURE


REVIEW OF LITERATURE :More than 60 percent of non-traumatic lower-limb amputations in the U.S. occur among people with diabetes. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. Life expectancy for people with type 2 diabetes may be shortened by 5 to 10 years.  Diabetes Mellitus is a lifestyle related illness with obesity being the most important environmental risk factor for Ty 2 DM. REVIEW OF LITERATURE


AIM OF THE STUDY :To determine: The prevalence of Type 2 Diabetes mellitus in Meenakshi Medical College & Research Institute, Kanchipuram. The relationship between Type 2 DM & systemic HT. The relationship between Type 2 DM & IHD. AIM OF THE STUDY


MATERIALS & METHODS :Total number of cases reviewed: 200 Type of study: Cross sectional type of case control study. Method of sampling used: Random sampling. Screening test used: Random Blood sugar level. Confirmatory test used: Fasting blood sugar level. MATERIALS & METHODS


STUDY PROFORMA :Name Age/Sex MRD no. BMI Socioeconomic class STUDY PROFORMA RBS DM – Y/N Old/New case SHT – Y/N DKA – Y/N FBS/PPBS Presenting Complaint


STUDY CRITERIA :FBS = 126mg/dl on more than one occasion STUDY CRITERIA TY – 2 DM : 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


INCLUSION CRITERIA :Systemic HT: SBP = 140; DBP = 90 mm Hg IHD: ECG evidence of ischaemia during pain/stress testing. Positive criteria: 1mm (0.1mV) horizontal/downsloping ST segment depression (beyond baseline) measured 80 milliseconds after the J point. Stress testing: Bruce protocol was followed. Obesity: BMI = 30 INCLUSION CRITERIA


OBSERVATIONS :PREVALENCE OF TY 2 DM OBSERVATIONS (As on 29/6/2008 in MMCRI)


OBSERVATIONS :MEAN AGE/SEX Mean Age: 57.32 years OBSERVATIONS


Slide 12:OBESE vs NON OBESE DIABETICS OBSERVATIONS


OBSERVATIONS :SOCIO ECONOMIC STATUS OBSERVATIONS


OBSERVATIONS :CLINICAL PRESENTATION OBSERVATIONS


OBSERVATIONS :SYSTEMIC HYPERTENSION & TYPE 2 DM OBSERVATIONS


OBSERVATIONS :IHD & TYPE 2 DM 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” DEFINITION


CLASSIFICATION :TYPE I CLASSIFICATION TYPE II Idiopathic Immune mediated Non obese Obese


PATHOPHYSIOLOGY OF TY 2 DM :PATHOPHYSIOLOGY OF TY 2 DM


PATHOPHYSIOLOGY OF TY 2 DM :Genetic Environmental factors (Obesity most important??!!!) Life style illness??!!! Adipokines – Leptin & Adiponectin TNF – a, Resistin Glycemic index (Hyperglycaemia) PATHOPHYSIOLOGY OF TY 2 DM


SYSTEMIC HT & Ty 2 DM :Coincidence? Common risk factors? Younger hypertensives? Effect on lipid profile? SYSTEMIC HT & Ty 2 DM


IHD & Ty 2 DM :Effect of altered lipid profile on coronary circulation Mean age till onset Primary prevention Asymptomatic diabetes & Silent MI IHD & Ty 2 DM


CONCLUSION :Significance of our study Case load Routine screening Lifestyle disease? Effect of obesity? Relationship with IHD & SHT Impact on therapeutics CONCLUSION


BREAKING THE LINK :People with diabetes can take some steps to lower their risk of heart disease and stroke. Learn the diabetes "ABCs." A = A1C, or hemoglobin A1c test, which measures average blood glucose over the past 3 months B = Blood pressure C = Cholesterol Target ranges are as follows: A  A1C < 7 percent   Check at least twice a year. B  Blood Pressure < 130/80 mmHg   Check at every doctor's visit.  C  Cholesterol-LDL < 100 mg/dl   Check at least once a year. BREAKING THE LINK


UNRAVELLING THE ENIGMA :Patient education is critical. Lifestyle changes are valuable in appropriate cases. Health care team education is vital. Routine screening of FBS Aggressive management of SHT & Dyslipidemia. Primary prevention for IHD What next? UNRAVELLING THE ENIGMA


THANK YOU :THANK YOU