Published on March 6, 2014
DIABETES DR.MAHESWARI JAIKUMAR
DIABETES - A CHRONIC DISEASE • Diabetes is one of the major causes of premature illness and death worldwide • Diabetes prevalence is increasing in every country in the world, and the toll is climbing in terms of human lives as well as the costs to society.
• Diabetes is a metabolic disease which is characterized by high blood sugar levels. • It can be caused either due to the lack of insulin (type 1 diabetes) or because the body’s cells fail to respond to the insulin produced (type 2 diabetes).
• Some of the common symptoms of diabetes are hunger, frequent urination and increased thirst. While type 1 diabetes is usually genetic, type 2 diabetes is caused more by lifestyle factors. • It is one of the common ‘lifestyle diseases’ which is plaguing people in the developed countries and often has a causal link to heart diseases, hypertension and obesity.
DIABETES MORTALITY • 4.8 million people died due to diabetes in 2012 and half of all people who die of diabetes are under the age of 60. • Worldwide, only half of all people with diabetes are diagnosed,1 so a significant number already have serious medical complications associated with hyperglycaemia by the time they see a doctor.
GLOBAL SCENARIO • Prevalence is 4% (1995) which will be 5.4% in 2025, 2% -5% in Western communities and developing countries as 10% or even 20%.
INDIAN SCENARIO Prevalence of range from 2.1% in 1972 to 12.4% in 2001 . In Southern India studies showed a 40% increased in prevalence over a period of 6 years
MAGNITUDE OF THE PROBLEM • Is a chronic disease and need life long treatment • Heart disease in diabetes is 21.4% • Neuropathy 17.5%
• Peripheral Vascular Disease (6.3% - 30%) • Retinopathy 19.0% • Microalbumina 26.3%
• India is experiencing a rapid health transition with a rising burden of Non Communicable Diseases (NCDs). • Overall, NCDs are emerging as the leading causes of death in the country accounting for over 42% of all deaths (Registrar General of India). • NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss in potentially productive years (aged 35–64 years) of life.
CAUSES 1.HOST FACTORS 2.ENVIRONMENTAL FACTORS
HOST FACTORS 1.Age (Middle age) 2.Gender (Male) 3.Genetic factors (Family history) 4.Obesity 5.Pregnancy
OBESITY -ASSESSMENT 1.BODY MASS INDEX. 2.PONDERAL INDEX. 3.BROCCA INDEX. 4.LORENT’Z FORMULA. 5.CORPULENCE INDEX.
1.BODY MASS INDEX (Quetelet’s index) BMI = Weight (Kg) Height2 (m)
2.PONDERAL INDEX. Height (Cm) Cube root of body weight (Kg)
3.BROCCA INDEX. (HEIGHT – 100) = Expected weight
4.LORENT’Z FORMULA • Ht (cm) -100 - Ht (cm)-150 2 (women) or 4 (men)
5.CORPULENCE INDEX ACTUAL WEIGHT DESIRABLE WEIGHT (This should not exceed 1.2)
NATIONAL DIABETES CONTROL PROGRAMME • Based on these alarming figures Government of India started National Diabetes Control Programme on pilot basis during 7th Five year plan in 1987 in some districts of Tamil Nadu, J & K and Karnataka
• In 1995-96 12 lakhs was allocated • In 1997-98 one crore was allocated
PROGRAMME • GOI started National Diabetes Control Programme on pilot basis during 7th Five year plan in 1987 in some districts of Tamil Nadu, J & K and Karnataka. Due to paucity of funds in subsequent years this programme could not be expanded further in remaining years.
OBJECTIVES • 1.Prevention of diabetes through identification of high risk subjects and early intervention in the form of health education • 2. Early diagnosis of disease and appropriate treatment morbidity and mortality with reference to high risk group
3.Prevention of acute and chronic metabolic, cardiovascular, renal and ocular complication of the disease 4. Provision of equal opportunity for physical attainment and scholastic achievement for the diabetic patients 5. Rehabilitation of those partially or totally handicapped diabetes people.
• The ultimate aim is to integrate control of diabetes into that of hypertension and heart diseases. • Risk factors for diabetes are included in the integrated disease surveillance project 2004
SCREENING FOR DIABETES 1. URINE EXAMINATION. 2.BLOOD SUGAR TESTING.
PREVENTION (Primary) 1.PRIMARY PREVENTION (population Strategy) A. B. C. D. Nutritional habits. Maintenance of body weight. Physical exercise. Avoidance of sweet food
• HIGH RISK STRATEGY A. Avoidance of over nutrition & obesity. B. Subjects at risk should avoid diabetogenetic drugs. C. Reduce factors promoting atherosclerosis.
SECONDARY PREVENTION A. Proper management of diabetes. B. Self care. C. Home blood glucose monitoring.
TERTIARY PREVENTION A. Prevention of complications – Cardiomyopathy, Retinopathy, Neuropathy, Nephropathy etc. B. Epidemiological researches- Registers for diabetes.
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