Control Diabetes

Diabetes Mellitus Risk Factors and Prevention

Let's Discuss Diabetes Mellitus risk factors and its prevention. Diabetes mellitus is a syndrome characterized by disordered metabolism and chronic hyperglycemia due to either an absolute deficiency of insulin secretion or reduction of insulin bio-effectiveness or both.

WHO Classification of Diabetes Mellitus 

1. Insulin-dependent Diabetes Mellitus (IDDM)
2. Non-Insulin dependent Diabetes mellitus (NIDDM)
3. Malnutrition dependent Diabetes Mellitus (MRDM)
4. Other types secondary to pancreatic, hormonal,drug-induced and other abnormalities
5. Impaired Glucose Tolerance (IGT)
6. Gestational Diabetes Mellitus

THE PROBLEM

Diabetes Mellitus is the 4th leading cause of death in the USA. Prevalence in adults worldwide is 4%. Over 143 million people are affected.

EPIDEMIOLOGICAL FACTORS:

1.Agent Factors

• Pancreatic disorders
• Defects in the formation of Insulin
• Destruction of Beta cells by viral infection and chemicals.
• Decreased insulin sensitivity
• Genetic defects
• Auto-immunity

2.Host Factors

• Age: Increased incidence of age
• Sex: Affects both sexes equally
• Genetic Factors: In NIDDM, concordance is about 90% in identical twins, In IDDM concordance is almost 50%
• Genetic Markers: IDDM is associated with HLA-DR3 and DR4 and also with HLA-B8 and B15.NIDDM is not HLA associated.
• Immune Mechanism: Both cell-mediated and humoral activity against islet cells.
• Obesity: a Risk factor for NIDDM
• Pregnancy: Risk Factor for NIDDM.

3.Social and Environmental Factors

• Sedentary lifestyle
• Diet: There is no evidence that diabetes mellitus is associated with any particular nutrient of diet.
• Malnutrition in early infancy and childhood may result in failure of beta cell function.
• Viral Infection: Rubella, Mumps
• Chemical Agents: rodenticide, VALCOR
• Alcohol: Causes DM by damaging the pancreas and liver
• Stress: Surgery, Trauma, and stress of situations may bring out the disease.

PREVENTION

A.Screening for Diabetes

• Urine test for glucose
• Blood sugar testing (fasting, random,2 hrs after 75g oral glucose.

B.Primary prevention

primary prevention has no role in IDDM

1.Population Strategy

• Emphases must be given on primordial prevention
• Maintenance of normal body weight
• Elimination of risk factors

2.High-Risk strategy

The person at risk for NIDDM are

• Living a sedentary lifestyle
• obese
• high alcohol consumers
• oral contraceptive users

C.Secondary Prevention

• diet alone
• diet and oral antidiabetic drugs
• diet and insulin

Taking Care Of

• percentage of Glycosylated Hb 6% monthly
• self-care by adhering to diet and drugs regimens
• home blood glucose monitoring
• routine checkup of blood pressure and visual acuity and weight

D.Tertiary Prevention

• Establishment of diabetic clinics
• Epidemiological research
• Establish national registries for Diabetes

Complications.

• Blindness
• Kidney Failure
• Coronary thrombosis
• Gangrene of lower extremitiesMortality

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