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Epidemiology of Diabetes Mellitus

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... a UK cohort of 24,155 participants aged 40-79 years, the authors assessed the association between achievement of five diabetes healthy behavior prevention goals ... – PowerPoint PPT presentation

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Title: Epidemiology of Diabetes Mellitus


1
Epidemiology of Diabetes Mellitus
2
  • Definition
  • Diabetes mellitus is a group of diseases marked
    by high levels of blood glucose resulting from
    defects in insulin production, insulin action, or
    both.
  • - Diabetes mellitus is a group of disorders with
    common features, of which a raised blood glucose
    is the most evident.
  • Blood glucose levels
  • Normal blood glucose level
  • Fasting blood glucose lt7 mmols or lt126 mg/100 ml.
  • .

3
Essential features of the (ADA) recommendations
for diabetes (in non-pregnant adults) and the
previous WHO recommendations
Previous WHO recommendations Provisional ADA recommendations
Based on clinical stages General Based on clinical stages
Same   FPG gt7.8 mmol/l (gt140 mg) or 2 h PG gt 11.1 mmol/l (gt200 mg) an OGTT Diabetes Symptoms of diabetes plus casual PG   gt11.1 mmol/l or FPG  gt7.0 mmol/l (gt126 mg) or 2 h PG gt11.1 mmol/l (gt200 mg) an OGTT with 75 gm Any of the above need to be confirmed on a subsequent day for the diagnosis to be made.

4
Essential features of the (ADA) recommendations
for diabetes (in non-pregnant adults) and the
previous WHO recommendations (cont.)
Previous WHO recommendations Provisional ADA recommendations
Same Impaired glucose tolerance (IGT) 2 h PG gt7.8 mmol/l (140) but lt11.1 mmol/l (lt200 mg)
Not previously recognized Impaired fasting glucose (IFG) FPG gt6.1 mmol/l (gt110 mg) and lt7.0 mmol/l (lt126 mg)


5
  • Types of Diabetes Mellitus
  • Non-insulin dependent diabetes mellitus (NIDDM)
  • Insulin dependent diabetes mellitus (IDDM)
  • Gestational diabetes mellitus (GDM)
  • Induced diabetes mellitus

6
Prevalence of NIDDM in certain countries
  • Country Prevalence (ADA criteria, gt20 years old)
  • United States 9.6
  • Pima Indians 50-70
  • Native Indians, Canada 19
  • England 7.1
  • Turkey 7.2
  • China 9.8
  • Poland 15.7
  • India 8.6
  • Oman 14
  • Jordan 12.7
  • United Arab Emirates 18.3

7
  • National data on prevalence of NIDDM
  • 1995 2000 2004
  • Sareeh, Sikhra,
  • South Mazar,
  • Sabha 13.4
  • Gefgefa 6
  • - Housha Ramon 14.2
  • - Sareeh 12.7 16.1

8
  • Factors associated with NIDDM
  • Variable Odds Ratio (OR) p-value
  • Gender (M vs. F) 2.0 lt.001
  • Age(gt40 vs. lt40 Y) 12.7 lt.001
  • Family History DM (Y vs. N) 2.5 lt.001
  • High cholesterol (Y vs. N) 1.6 lt.001
  • High triglycerides (Y vs. N) 2.1 lt.001
  • Hypertension (Y vs. N) 1.6 lt.01
  • Body mass index
  • (obese vs. non-obese) NS
  • (obese overweight vs. non-obese) 1.9 lt.01
  • Smoking NS
  • --------------
  • Source Ajlouni et.al. Diabetes and impaired
    glucose tolerance in Jordan prevalence and
    associated factors. J Internal Medicine, 1998,
    244 317-323.
  • Further analysis of data.

9
  • Frequency distribution of certain CVD risk
    factors by diabetic status Among Jordanian
    adults.
  • Variable NIDDM General population
  • High cholesterol 44.8 30.2
  • High triglycerides 45 26.2
  • Hypertension (130/85) 74.9 39
  • Obese overweight 88.9 83.2
  • Smoking 13.9 15.5
  • --------------
  • Source Ajlouni et.al. Diabetes and impaired
    glucose tolerance in Jordan prevalence and
    associated factors. J Internal Medicine, 1998,
    244 317-323.

10
  • Insulin-dependent diabetes mellitus (IDDM)
  • an autoimmune disease resulting in the
    destruction of insulin producing cells.
  • autoimmune diabetes, growth-onset diabetes,
    insulin-dependent diabetes mellitus, juvenile
    diabetes, juvenile-onset diabetes,
    ketoacidosis-prone diabetes, ketosis-prone
    diabetes, type I diabetes

11
  • http//www.pitt.edu/super1/lecture/lec0042/014.ht
    m.
  • IDDM insulin dependent diabetes mellitus
  • CA Cancer
  • CF Cystic fibrosis
  • MSMultiple sclerosis
  • JRA Juvenile rheumatoid arthritis
  • MD Muscle dystrophy

12
http//www.pitt.edu/super1/lecture/lec0042/014.ht
m
  • http//www.pitt.edu/super1/lecture/lec0042/014.ht
    m

13
  • Incidence of Type 1 diabetes in Jordan 1992-1996
    (cases per 100,000 per year) among children age
    0-4 years by year of diagnosis and gender.
  • Year of
  • diagnosis Population Cases Males Females Incidence
  • 1996 1,845,958 66 34 32 3.6
  • 1995 1,774,960 64 34 30 3.6
  • 1994 1,703,962 55 28 27 3.2
  • 1993 1,635,864 47 22 25 2.9
  • 1992 1,570,372 43 22 21 2.8
  • --------------
  • Source Ajlouni et.al. Incidence of
    insulin-dependent diabetes mellitus in Jordanian
    children aged 0-4 during 1992-1996. Acta paediar
    suppl 42711-3. 1999.

14
  • Gestational diabetes mellitus
  • Gestational diabetes mellitus (GDM) is defined as
    carbohydrate intolerance of variable severity
    with onset or first recognition during pregnancy

15
  • Approximately, 135,000 cases of GDM ,
    representing on average 3-8 of all pregnancies,
    are diagnosed annually in the US.
  • Higher incidence of GDM has been reported in
    ethnic groups that have a high prevalence of type
    2 diabetes figures approaching 20 have been
    reported in certain ethnic populations.
  • GDM complicates 2-5 of pregnancies in North
    America health settings which is more than 10
    times as common as pre-gestational diabetes.
  • Complications include
  • - maternal hypertension, - preeclampsia,
  • - postpartum DM, - infant macrosomia,
  • - hyperbilirubinemia, - congenital
    abnormalities,
  • - stillbirth, - traumatic delivery,
  • - infant perinatal death

16
  • Epidemiology of gestational diabetes mellitus and
    associated risk factors among attendants of
    antenatal services at Al Corniche maternity
    hospital, Abu Dhabi City, UAE.
  • Study design
  • At her first visit each singleton, non-diabetic
    pregnant, and at gestational age between 24-32
    weeks is included in the study if she satisfies
    one of the following criteria
  • has a positive family history of diabetes
    mellitus
  • 2. has a personal history of GDM.
  • 3. has a body mass index more than 27.
  • Women with abnormal FBS were treated as diabetic
    patients without being subjected to oral glucose
    tolerance test (OGTT).
  • Only women with normal FBS were subjected to
    OGTT.
  • OGTT was performed by measuring plasma glucose
    level at fasting and 2-hours post 75 gm of oral
    glucose loading.

17
  • Patient is defined as having impaired GTT when
  • FBS is lt7.8 mmols/liter and a 2-hours plasma
    glucose level between 7.8mmols/liter and 11
    mmols/liter.
  • The patient was defined as diabetic when FBS
    gt7.8mmols/liter or 2-hours plasma glucose
    gt11.1mmols/liter.
  • Pregnants with FBS gt7.8 mmols/liter or 2-hours
    plasma glucose gt11.1 mmols/liter are defined as
    having GDM.
  • Results
  • GDM prevalence was 15.9

18
  • Primary prevention and early detection of type 2
    diabetes
  • When looking for the opportunity to prevent type
    2 diabetes, risk determinants can be viewed in
    terms of being either modifiable or
    non-modifiable.
  • Modifiable risk factors
  • Overweight obesity
  • Sedentary lifestyle
  • Dietary factors
  • Tobacco smoking
  • Previously identified glucose
  • intolerance (IFG IGT)

19
  • Non-modifiable risk factors
  • Age
  • Sex
  • Family history type 2 diabetes
  • Genes/genetic markers
  • Previous gestational diabetes
  • Ethnicity

20
  • Primary Prevention
  • Life-style modifications in nutrition, physical
    activity and weight reduction help delay the
    development of Type II Diabetes in individuals at
    risk may be recommended for the general
    population.
  • The incidence of diabetes is more likely
    increased in smokers.
  • PIC-Norfolk, a UK cohort of 24,155 participants
    aged 40-79 years, the authors assessed the
    association between achievement of five diabetes
    healthy behavior prevention goals (BMI lt25 kg/m2,
    fat intake lt30 of energy intake, saturated fat
    intake lt10 of energy intake, fibre intake
    15 g/day, physical activity gt4 h/week) and risk
    of developing diabetes at follow-up (mean
    4.6 years).
  • None of the participants who met all five goals
    developed diabetes, whereas diabetes incidence
    was highest in those who did not meet any goals.
  • Conclusion If the entire population were able to
    meet one more goal, the total incidence of
    diabetes would be predicted to fall by 20.

21
  • Primary prevention components of the program
    include
  • extensive use of the mass media,
  • fiscal and legislative measures, and
  • widespread community, school, and workplace
    health education activities.
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