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    Chapter 1 Definition and Epidemiology of DM

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    Endegena Tadesse

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    Chapter 1 Definition and Epidemiology of DM

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    Endegena Tadesse
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    7 views28 pages

    Chapter 1 Definition and Epidemiology of DM

    Uploaded by

    Endegena Tadesse

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    Chapter 1

    Definitions & Epidemiology of


    Diabetes Mellitus
    National Training on Management of Diabetes Mellitus
    for Physicians

    1
    Objectives

    • Define key terms in diabetes


    • Describe the diagnostic criteria for DM
    • Describe the global, regional and national
    epidemiology of diabetes
    • Explain risk factors, screening criteria and
    preventive interventions of DM
    Outline

    • Definition of key terms


    • DM diagnostic criteria
    • Epidemiology of DM
    • Risk factors, screening & preventive
    interventions
    • Summary
    Activity 1.1: Individual
    Refection
    Instruction: Read and reflect individually the following
    questions.
    1. How do you explain the definition of diabetics for a
    patient?
    2. What does ‘’defective insulin secretion’’ and “insulin
    resistance” mean?
    Time: 5 minutes
    1.1 Definition of Key Terms
    Diabetes
    • A metabolic disorder-disturbances of
    carbohydrate, fat and protein metabolism

    • Characterized by chronic hyperglycemia

    • Resulting from defects in insulin secretion,


    insulin action, or both

    • Marked propensity to develop renal, ocular,


    neurologic, and premature cardiovascular
    diseases
    1.1 Definition of Key Terms
    (2)
    Defective insulin secretion
    • Inadequate compensatory increase of β-cell
    mass
    • Impaired glucose-dependent insulin release

    Insulin resistance
    • Inability insulin to increase glucose uptake
    and utilization
    1.2 DIAGNOSIS of DM
    • DM is diagnosed by laboratory measurement of
    glucose or glycosylated haemoglobin level in
    a blood sample.

    • Fasting blood glucose is likely to be the most


    feasible measurement in PHC facilities.
    1.2 Diagnosis of DM
    • Be certain about diagnosis.

    • Consequences: considerable & lifelong.

    • Hyperglycemia may be transitory.

    • In asymptomatic individuals: at least 2


    tests.

    • Do not make diagnosis based on single


    elevation of FBS.
    • Exception – DHA & HHS

    • Urine glucose: not recommended.


    Diagnostic Criteria for DM

    WWW.DIABETES.ORG/DIABETESCARE Volume 39, Supplement 1, January 2016


    Prediabetes
    • IGT: 140 < 2-hr PG < 200 mg/dl
    • IFG: 100 < FBS < 126 mg/dl

    • Why is Prediabetes important?


    • Risk for future diabetes
    • Risk for macrovascular diseases
    1.3 Epidemiology of DM
    • Diabetes is one of the largest global health
    emergencies of the 21st century.

    • It is in a state of global epidemic affecting


    every country, age group and economy.

    • DM and its complications are major cause for


    early death in most countries
    • Cardiovascular death is leading cause in diabetic
    population.
    Diabetes around the
    world: IDF 2021
    • 537 million adults (20-79 years) are living with
    diabetes: 1 in 10

    • This number is predicted to rise to

    • 643 million by 2030 and

    • 783 million by 2045

    • Over 3 in 4 adults with diabetes live in low- and


    middle-income countries
    Diabetes Around the World:
    IDF 2021
    • 6.7 million deaths in 2021
    • 1 every 5 seconds

    • Caused at least USD 966 billion dollars in


    health expenditure
    • 316% increase over the last 15 years

    • 541 million adults have IGT


    • Places them at high risk of type 2 diabetes
    Diabetes in Africa: IDF
    2021
    • 24 million adults are living with diabetes.

    • 1 in 22 adults

    • This number is predicted to increase by 129% to 55 million by 2045

    • Over 1 in 2 (54%) people living with diabetes are undiagnosed

    • Diabetes is responsible for 416,000 deaths in 2021.

    • 1 in 8 live births are affected by hyperglycemia in pregnancy


    Diabetes in Ethiopia
    • Few local data on the prevalence of diabetes in Ethiopia
    • Ayder Hospial, Mekele: 1.3%
    • Gondar and Dabat: 5.1% for urban and 2.1% for
    rural
    • Bank employees and teachers: 6.5 %
    • National NCD STEPS Survey 2015
    • Prevalence of DM (FBS 126 mg /dl) including those
    on medication was 3.2%
    • The prevalence of IFG: 9.1% with ADA criteria
    Diabetes in Ethiopia: IDF 2021
    Diabetes estimates (20-79 y) 2000 2011 2021 2030 2045
    People with diabetes, in 268.1 1377.3 1920.00 2740.80 4755.50
    1,000s
    Age-adjusted comparative 3.4 5 5.3 5.4
    prevalence of diabetes, %
    People with undiagnosed 1105.9
    diabetes, in 1,000s
    Proportion of people with 57.6
    undiagnosed diabetes, %
    People with IGT, in 1,000s 3266.5 7140.7 10018.1 17391.5
    Age-adjusted comparative 8.9 19.2 21.2 22.5
    prevalence of IGT, %
    People with IFG, in 1,000s 3077.5 4805.4 7625.5
    Age-adjusted comparative 6.7 7.4 7.4
    prevalence of IFG, %
    Diabetes in Ethiopia: IDF
    2021
    Type 1 diabetes estimates 2000 2011 2021 2030 2045
    in children and
    adolescents
    Type 1 diabetes (0-14 y), in 0.5 0.6
    1,000s
    Live births affected by HIP 2986848
    Prevalence of gestational 15.1
    diabetes mellitus (GDM), %
    Total diabetes-related 200.2 281.2 452.4
    health expenditure, USD
    million
    Diabetes-related health 25 104.3 146.4 235.6
    expenditure per person,
    USD
    Activity 1.2: Group Discussion

    Instruction: Read and discuss the following


    questions in groups and present to the plenary.

    1. What are the risk factors for diabetes?


    2. What screening criteria is used for diabetes in
    resource limited settings?
    3. What preventive measures are recommended to
    prevent/delay diabetes?

    Time: 10 minutes
    18
    Risk Factors for DM
    • DM shares common Risk factors with Major
    NCDs.

    Others:
    • Urban-rural migration
    • Increasing population
    • Increasing Age
    • Stress
    DM Screening: Imperatives
    • The high prevalence of undiagnosed Type 2
    diabetes
    • High proportion of patients with complications
    at diagnosis
    • Presence of preventive interventions
    DM Screening: Criteria
    1.Adults: overweight (BMI>25 kg/m2 ) plus
    additional risk factors:
    • Physical inactivity
    • First-degree relative with diabetes
    • Members of a high-risk ethnic population:
    African Americans, Asians, native Americans
    • women who delivered a baby > 4kg or
    diagnosed as GDM
    • Hypertension (BP 140/90mmHg or on
    therapy)
    DM Screening: Criteria (2)
    • HDL <35 mg/dl and or TG >250 mg/dl
    • A1C >5.7 %, IGT, or IFG on previous testing
    • History of CVD
    • Women with polycystic ovarian syndrome

    All patients at age of 45 years


    DM Screening: Criteria (3)
    2. Children ≥ 10 years or at onset of puberty
    who are overweight with any two of the
    following:
    • DM in first or second degree relative
    • Signs of insulin resistance: Acanthosis
    nigricans, severe obesity
    • Maternal DM or GDM during child’s gestation

    • ‘Normal’ results: repeat at a 3-year intervals


    • ‘Prediabetes’: repeat yearly
    Preventive Inventions

    • Delays the onset of diabetes

    • Preserves beta cell function

    • Prevents or delays microvascular and


    cardiovascular complications
    Preventive Interventions (2)

    I. Lifestyle Modifications
    Preventive Interventions (3)

    II: Metformin therapy


    • For prediabetes, especially in those with BMI >35
    kg/m2
    • Aged <60 years
    • Women with prior GDM

    III. Annual monitoring for the development of


    diabetes in those with prediabetes

    IV. Screening for and treatment of modifiable


    risk factors for CVD
    Summary
     DM is a metabolic disorder resulting from defects in
    insulin secretion, insulin action, or both
     DM is diagnosed by measurement of FBG for A1C
    levels
     Diabetes is in a state of global epidemic affecting
    every country, every age group and every economy
     The major risk factors for diabetes are modifiable
     Screening and prevention delays Type 2 DM and
    prevents complications
     There are evidence-based lifestyle
    recommendations for prevention of Type 2 DM
    27
    Thank You

    28

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