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Diabetes Mellitus (DM)

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Introduction.....

Diabetes mellitus as a non communicable disease which is significant health problem.

The prevalance rate is rising all over the world.

Diabetes mellitus is characterized by hyperglycemia and disturbance of carbohydrate, fat and protein metabolism that is associated with absolute or relative deficiency of insulin action or insulin secretion.

Chronic hyperglycemia leads to number of complications such as,

  • Cardiovascular,
  • Renal,
  • Neurological,
  • Ocular,
  • Others as recurrent infections.

Prevalence of adult diabetes was around 4.2% in the year 2000 and it is likely to rise to 5.4% by the year 2025.

Double in 30 years.

Treble in 30 years.

  1. Clinical classification of Diabetes Mellitus;
  2. Insulin dependent diabetes mellitus (IDDM) or type 1
  3. Non-insulin dependent diabetes mellitus (NIDDM) or type 2
  4. Malnutrition related diabetes mellitus (GDM)
  5. Gestational diabetes mellitus (GDM)
  6. Impaired glucose tolerance (IGT) and impaired Fasting Glucose

Other types due to secondary causes;

  • Pancreatic hormonal
  • Drug induced
  • Genetic
  • Other abnormalities

IDDM (Type 1);

  • IDDM is the severe form of disease.
  • Its onset is typically abrupt and is usually seen in individuals.
  • It is lethel unless proper diagnosed and treated.

NIDDM (Type 2);

  • NIDDM is much more common than IDDM.
  • It is typically gradual onset.
  • Occurs mainly in the middle aged and elderly.
  • Proportion of NIDDM is over 85%.
  • Frequently mild.
  • Slow ketosis.

Malnutrition related diabetes mellitus (MRDM);

  • MRD develops in young persons who were low birth weight babies and infants.
  • Who were malnourished
  • When they grow as adults they develops insulin resistant diabetes.
  • Such adults below 30 years with BMI less than 18.5 are more prone to get diabetes.

Gestational diabetes mellitus (GDM);

  • It is first recognized as diabetes during pregnancy.
  • After delivery some women revert to normal.
  • About 30% of pregnant women have gestational diabetes mellitus.

  • Impaired glucose tolerance (IGT) and impaired fasting glucose;
  • Fasting plasma glucose(FPG) 111-125 mg/dl is called IGF.
  • 2 hours post load glucose 140-199 mg/dl impairs glucose tolerance.

Prediabetes;

  • HbA1c:5.7 to 6.4 percent
  • Fasting: 100 to 125 mg/dl
  • 2 hours after meal:140 mg/dl to 199 mg/dl

Type 1 or 2 diabetes;

  • HbA1c:6.5 percent or higher
  • Fasting:126 mg/dl or higher
  • 2 hours after a meal:200 mg/dl or higher

Risk factors for diabetes mellitus;

Agent factors:

  • The main cause of diabetes mellitus insulin deficiency which is absolute in IDDM and partial in NIDDM.
  • This may due to pancreatic disorders.
  • Inflammatory, neuroplasticity and other disorder such as cystic fibrosis.

Host factors;

Age:

  • Diabetes may occur at any age.
  • NIDDM usually occur in the middle years and old age life.
  • Malnutrition related diabetes affects mostly in young age.
  • IDDM also affects the age below 30 years.

Sex:

  • The prevalence of diabetes is higher in men than women.
  • Rural and urban distribution:
  • Urbanization leads to increased risk of diabetes because of altered diet, obesity, physical inactivity and stress.

Economic status:

  • Diabetes is more prevalent in higher income groups because of unhealthy life style and physical inactivity leading to problem of obesity.
  • Family history:
  • It is a strong risk factor and indicates genetic predisposition. Persons who has family history needs to observe precaution and undergo regular check-ups.

Environmental factors;

  • Sedentary life style:
  • It is appear to be an important risk for the development of NIDDM.
  • Diet:
  • Unhealthy food pattern and specially junk food.

Malnutrition:

  • PEM in early infancy and childhood may result in partial failure of beta cell function. When they grow up as adults suffer from metabolic disorders including insulin resistant diabetes. Specially their BMI is less than 18.5 are more prone to get diabetes.
  • Viral infections:
  • Viruses such as rubella, mumps and koxackie virus.

Chemical agents:

  • A number of chemical agents are known to be toxic to beta cells, rodenticide, high intake of cyanide producing food may also be toxic effect on beta cells.

Stress:

  • Stress situation-internal or external

Other factors:

  • social factors like marital status, religion, economic status, education, urbanization, changes in life style.