DIABETES:- A SILENT KILLER DISEASE

Introduction:

According to WHO Diabetes causes about 5% of all deaths globally each year 80% of people with diabetes live in low and middle in come countries. Most people with diabetes in low and middle income countries are middle – aged (45-64), not elderly (+65), Diabetes deaths are likely to increase by more than 50% in the next 10 years without urgent action. Globally, the number of people with diabetes is expected to rise from the current estimate of 150 million to 220 million in 2010 and 300 million in 2025. type 2 diabetes has become one of the world's most important public health problems.

The world wise prevalence of DM has risen dramatically over the past two decades. Likewise Prevalence rates of IFG (Impaired Fasting Glucose) are also increasing. Although the Prevalence of both type 1 and type 2 DM is increasing world wise. The prevalence of type 2 Dm is expected to rise more rapidly in the future because of increasing obesity and reduced activity level. The mission al the WHO Diabetes programme is prevents diabetes whenever possible and where not possible to minimize complications and maximize quality of life.

Diabetes mellitus (DM) comprises a group of common metabolic disorders that share the phenotype of hyperglycemia several distinct types of DM exist and are caused by a complex interaction of genetics, environmental factors, and life-style choices

Depending on the etiology of life the DM factors contributing to hyperglycemia may include reduced insulin secretion, decreased glucose utilization, and increased glucose production.

The metabolic deregulations associated with DM causes secondary patho- physiological changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.

With an increasing incidence worldwide, DM will be a leading cause of morbidity and motility for the foreseeable future.

Classification:-

The classification of DM is based on the pathogenic process that leads to hyperglycemic, age of onset or therapy type Broadly DM had two categories type 1 and type 2.

Two features at the current classification of DM diverge from previous classifications. First the term insulin dependent diabetes mellitus (IDDM) and Second non -insulin Dependent diabetes mellitus (NIDDM).

I type1 diabetes;- b-cells destruction, usually leading to absolute insulin deficiency.

Type 1A= Immune – mediated

Type 1 A = Idiopathic

II type 2 diabetes;- A Heterogeneous group DM insulin variable variable degree of insulin resistance, characterized by insulin secretary defect, increased Glucose production.

III Other types of DM

1. Genetic defects of b-cells functions by mutation in Mody (Maturity onset diabetes of the young)
2. Genetic defects in insulin action
3. Disease of Pancreas exocrine gland – pancreatitis, post-pancreactomy etc.
4. Endocrinopatheies – Acromegaly, Cushing syndrome.
5. Drug induced
6. Infections

IV. Gestational Diabetes mellitus (GDM)

Glucose intolerance may developouring pregnancy. Related determinant (parity, gestational diabetes in offspring of woman with diabetes during pregnancy, intrauterine malnutrition or over nutrition.

Causes;-

Considerable factors that are responsible for the development of type 2 diabetes,

Ø Genetic factors: Genetic markers, family history.

Ø Demographic characteristics : Sex, Age, ethnicity

Ø Behavioral and life style – related risk factors

Ø Obesity (including distribution of obesity and duration)

Ø Physical inactivity

Ø Diet

Ø Stress

Ø Westernization, urbanization, modernization

Diagnosis

The diagnosis a diabetes rests on the measurement al plasma glucose levels. The national Diabetes data group and World Health Organization have issued diagnostic criteria for DM, are shown in table

Normal Glycemia	Impaired fasting glucose or Impaired Glucose Tolerance	Diabetes mellitus
FPG <110>	FPG ³ 110 and <126>	FPB ³ 126 mg/dl
2hr PG <140>	2hr PG ³ 140 and <>	2hr PG ³ 200 mg/dl symptoms al diabetes and causal plasma glucose concentration ³ 200 mg/dl

FPG = Fasting plasma glucose (Fasting means no caloric intake for at least 8 hours)

IFG = Impaired fasting glucose

IGT = Impaired Glucose Tolerance

PG = Plasma Glucose.

IFG or IGT are at substantial risk for developing type 2 DM (40% risk over the next 5 years) and cardiovascular disease (Ref. Herrison's Pg. 2154 16^th ed.)

Some investigators have advocated the hemoglobin A, C (HbA,C) as a diagnostic test for DM. Plasma glucose and A,C have a strong correlation between elevations, the relationship between the FPG and A, C in individuals with normal glucose tolerance or mild glucose intolerance is lets clear and thus the use of A, C is not currently recommended for the diagnosis of diabetes.

It is estimated that in up to 50% of affected people the disease is undiagnosed .

Subjects with IGT and undiagnosed type 2 diabetes are at significantly increased risk for coronary heart disease, stroke, and peripheral vascular disease. In addition, affected individual have a greater likelihood of having dis-lipidemia, hypertension and obesity. Therefore, it is important to screen for diabetes in subjects who at high risk for developing diabetes.

Major Risk factors for type 2 DM

Ø Family history of diabetes (i.e. parents or siblings with diabetes)

Ø Overweight (BMI ³ 25 kg./m²)

Ø Habitual physical inactivity

Ø Race / ethnicity

Ø Previously identified IFG or IGT

Ø Hypertension (³ 140/90 mm Hg in adults)

Ø HDL Cholesterol £ 35 mg/dl and/or a triglyceride level ³ 250 mg/dl

Ø History of GDM or delivery of a body weighting > 4 kg.

Ø Polycystic every syndrome

Globally, the number of people with diabetes is expected to rise from the current estimate of 150 million to 220 million in 2010 and 300 million in 2025. type 2 diabetes has become one of the world's most important public health problems.