Lecture. By Dr Ale A.O Lecturer. Consultant Physician/Endocrinologist.

Transcription

1 Lecture By Dr Ale A.O Lecturer. Consultant Physician/Endocrinologist.

2 DIABETES MELLITUS A GLOBAL EMERGENCY 2015

3 DIABETES MELLITUS Diabetes is one of the largest global health emergencies of the 21 st century.

4 Headings Introduction Epidemiology Classification of DM Risk factors for developing DM Presentation of DM Diagnosing /Screening DM Complications of DM Management of DM

5 Diabetes Mellitus DIABETES MELLITUS is a group of chronic metabolic disorders characterized chronic elevation in blood sugar/glucose resulting from disordered carbohydrate,fat and protein metabolism due to abnormalities in insulin secretion or its action(or both) which can lead to long-term organ dysfunction.

6 Insulin The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. In diabetes, the body does not make enough insulin or can't use its own insulin the way it should. This causes sugar to build up in your blood.

7 INSULIN IS THE KEY TO GLUCOSE UTILISATION

8 Insulin

9 EPIDEMIOLOGY IDF 2015 DATA (Projected) Global prevalence (20-79yrs) 8.8% 10.4% Number of people with DM 415 million 642 million Impaired Glucose Tolerance ( 6.7%) 318 M (7.8% ) 481 M Which puts them at high risk of developing the disease in future No of death due to diabetes 5.0 million -

10 EPIDEMOLOGY CONTD AFRICA No of Adult DM 3.8% Nigeria 2.6 % of Nigeria population % 2014 Varies from 0.65% in rural Mangu to 11% in Urban Lagos WHO suggests Nigeria has the highest number of

11 DM IN NIGERIA No of people living with DM in Africa. Diabetes is the leading cause of death in adult Nigerians DM is one of the commonest reasons for hospital admissions in Nigeria. 2 out of every 5 Nigerians with DM have hypertension as well. DM results in reduced quality of life and life expectancy if not properly managed.

12 Types of Diabetes Mellitus Type 1 or Insulin dependent Diabetes Mellitus Type 2 or Non-insulin dependent Diabetes Mellitus Gestational DM Secondary causes Diseases of the pancreas- malnutrition, cancer, pancreatectomy, hemochromatosis, pancreatitis Endocrine diseases- Cushing s syndrome, acromegaly, thyrotoxicosis Drugs- thiazides, corticosteroids, antipsychotic & antiretrovirals

13 Type 1 Diabetes Mellitus Due to lack of insulin production by the pancreas Accounts for less than 10% of all DM Seen more in childhood, reaching a peak at about puberty. Can occur at any age, though! Highest rates seen in northern European countries such as Finland Has seasonal incidence Due to autoimmunity. Viral infection suspected Always require insulin for treatment

14 Type 2 Diabetes Mellitus Commonest form, accounts for >90% of cases Occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body's tissues become resistant to normal or even high levels of insulin. This causes high blood glucose (sugar) levels, which can lead to a number of complications if untreated. Usually affects older people >30 years of age

15 Gestational DM Gestational DM- About 3 to 5% of pregnant women develop gestational diabetes, usually from 24 to 28 weeks of pregnancy & this is similar to type 2 DM, but usually resolves after a woman delivers her baby. These women are at high risk for developing type 2 diabetes later in life

16 Children Increasing incidence/prevalence of Type 2 DM in Children Why???????? Ensuring the health of future generations is key to sustainable development

17 Risk factors for developing DM Advancing age??? Family history of DM Habitual physical inactivity/sedentary life style Race/ethnicity Alcohol smoking Delivery of a baby weighing >4kg Previous gestational diabetes or fetal death Previously identified impaired glucose tolerance Overweight (BMI >25kg/m 2 ) Hypertension Cholesterol abnormalities

18 Symptoms of Diabetes Mellitus Frequent passage large of urination, excessive thirst, excessive hunger,weight loss and blurred vision. Sometimes, diabetes is discovered when a person seeks medical help for another problem (such as hypertension, erectile dysfunction, pain and numbness in the feet or repeated boils, unhealing wound). Heart attack, stroke or leg ulcer Infections TB etc Big babies or early fetal loss; infertility However, most people with type 2 diabetes have no symptoms at all, and the diagnosis is often delayed for five or more years.

19 Symptoms of DM

20 Diagnosis of Diabetes Mellitus Laboratory tests Random blood glucose test A random blood glucose level of 200 mg/dl (11.1 mmol/l) or higher in persons who have symptoms of high blood glucose suggests a diagnosis of diabetes Fasting blood glucose test A FBG of 126 mg/dl (7.0 mmol/l) indicates diabetes. Hemoglobin A1C test (A1C) The A1C blood test measures the average blood glucose level during the past 2 to 3 months. Normal values for A1C are 4 to 5.6 percent Oral glucose tolerance test It is routinely performed at 24 to 28 weeks of pregnancy to screen for gestational diabetes

21 Complications of DM Acute complications of DM Hypoglycaemia Hyperglycaemic crisis Chronic complications DM Associations : cancers,dementia,

22 Chronic Complications of DM

23 IMPLICATIONS The costs associated with DM include increased use of health services Loss of productivity and disability Economic Burden Individuals families National Health System Country

24 SCREENING Pre-diabetes(impaired glucose Tolerance) Fasting blood sugar = mg/dl 2 hour Post- prandial = mg/dl Glycated hemoglobin = %

25 DIABETES PREVENTION

26 DIABETES PREVENTION LIFE-STYLE MODIFICATION DIET EXERCISE : AEROBIC WEIGHT LOSS AVOID SMOKING ALCOHOL MODERATION

27 Management of Diabetes Mellitus Diabetic Education Life-style changes Healthy eating habits- low refined sugar High fiber diet- fruits, vegetables, beans Low-salt diet Quit smoking Take alcohol in moderation Exercise- walking, cycling, swimming, or rowing Drugs Cure?

28 DIABETES MANAGEMENT Individualised treatment =Set targets Fasting blood sugar 2hours Post Pradial Glycated hemoglobin Fasting lipid profile Blood pressure Aim is to stop or slow progression of DM

29 Management of DM Foot -care Eye check Screening for kidney diseae Others : check x-ray,ecg,hb/pcv Multi-disciplinary Approah. Diabetologist,Nutritionist,Opthalomologist,Sur geon, Nephrologist,Social workers,podiastritis

30 Take Home Notes Type 2 DM is growing rapidly worldwide Ageing population,economic development, increasing urbanisation, less healthy diets and reduced physical activity. Poorly managed DM leads to serious complications and early death Good self-management and health professional support,people with DM can live a long,healthy life

31 WAY OUT EARLY DETECTION IS CRITICAL TO PREVENT COSTLY COMPLICATIONS Routine Screening Life-style Changes Medical Intervention Good DRUG Adherent Regular follow up

32 POLICY Policies limiting the intake of Sugar,Fat and Salt as well as taxation on sugar-rich foods are key in the fight against rising rates of type 2 Diabetes

33 References IDF DIABETES ATLAS Seventh Edition 2015 State of Diabetes Care in Nigeria: A Review (Sonny et al) 2011.

34 THANK YOU FOR LISTENING. MERCI BIEN POUR AVOIR ECOUTÉ!