Idf course module 1 introduction to diabetes
- 1. Module One An Introduction to Diabetes IDF Basic Diabetes Course
- 2. 1. Define diabetes and differentiate types of diabetes 2. Identify the signs and symptoms of diabetes 3. Understand the risk factors associated with type 2 diabetes 4. Define healthy living (Physical activity, balanced diet) 5. Know how to diagnose diabetes 6. Demonstrate an understanding of the basic pathophysiology of diabetes
- 5. Diabetes that occurs when the body cannot produce enough insulin or cannot use insulin effectively. is a chronic disease Insulin is a hormone produced in the pancreas that allows glucose from food to enter the body’s cells where it is converted into energy needed by muscles and tissues to function. A person with diabetes does not absorb glucose properly, therefore glucose remains circulating in the blood (a condition known as hyperglycaemia) damaging body tissues over time. This damage can lead to disabling and life-threatening health complications. The aim of diabetes care and education is to help people with diabetes keep their blood glucose levels as near normal as possible, while living a normal life, in order to minimise the risk of complications
- 6. Type 2 diabetes is the most common type of diabetes representing approximately 85% of all cases of diabetes. In type 2 diabetes, the body is able to produce insulin but either the amount is insufficient or the body is unable to respond to its effects (also known as insulin resistance). Type 2 diabetes usually occurs in adults, but is increasingly seen in children and adolescents. Often both issues (insufficient insulin and/or insufficient response to insulin) are present together and lead to a build-up of glucose in the blood.
- 7. Gestational diabetes (GDM) is a transient type of diabetes that occurs during pregnancy. It is associated with insulin resistance and thought to result from the hormone changes that occur duping pregnancy As gestational diabetes normally develops later in pregnancy, the unborn baby is already well-formed but still growing. The immediate risk to the baby is therefore not as severe as for those whose mother had type 1 diabetes or type 2 diabetes before pregnancy (a condition known as diabetes in pregnancy). Nonetheless, uncontrolled gestational diabetes can have serious consequences for both a mother and her baby.
- 12. INCREASING IN PREVALENCE Current estimates suggest 415 m1111on adults in the world have diabetes. This is estimated to Increase by over 50% over the next twenty-five years – When it will affect 10% of the world's adult population. EXPENSIVE TO TREAT Treating complications can be very expensive and accounts for a large proportion of the costs of managing diabetes . As a result , diabetes imposes a large economic burden on individuals and families ,national health systems , and countries Health spending on diabetes accounted for 11.6% of total health expenditure worldwide in 2015. CAUSES EARLY DEATH The complications of diabetes account for many deaths of people with diabetes during work1ng age In 2015 it was estimated that nearly 5 million people died as a result of diabetes This estimated number of deaths is similar in magnitude to the combined deaths from several infectious diseases that are major public health priorities and is equivalent to one death every seven seconds
- 16. INCREASING IN PREVALENCE Current estimates suggest 415 m1111on adults in the world have diabetes. This is estimated to Increase by over 50% over the next twenty-five years – When it will affect 10% of the world's adult population. EXPENSIVE TO TREAT Treating complications can be very expensive and accounts for a large proportion of the costs of managing diabetes . As a result , diabetes imposes a large economic burden on individuals and families ,national health systems , and countries Health spending on diabetes accounted for 11.6% of total health expenditure worldwide in 2015. CAUSES EARLY DEATH The complications of diabetes account for many deaths of people with diabetes during work1ng age In 2015 it was estimated that nearly 5 million people died as a result of diabetes This estimated number of deaths is similar in magnitude to the combined deaths from several infectious diseases that are major public health priorities and is equivalent to one death every seven seconds
- 18. INCREASING IN PREVALENCE Current estimates suggest 415 m1111on adults in the world have diabetes. This is estimated to Increase by over 50% over the next twenty-five years – When it will affect 10% of the world's adult population. EXPENSIVE TO TREAT Treating complications can be very expensive and accounts for a large proportion of the costs of managing diabetes . As a result , diabetes imposes a large economic burden on individuals and families ,national health systems , and countries Health spending on diabetes accounted for 11.6% of total health expenditure worldwide in 2015. CAUSES EARLY DEATH The complications of diabetes account for many deaths of people with diabetes during work1ng age In 2015 it was estimated that nearly 5 million people died as a result of diabetes This estimated number of deaths is similar in magnitude to the combined deaths from several infectious diseases that are major public health priorities and is equivalent to one death every seven seconds
- 23. The only recognised risk factors for type 1 diabetes are related to genetic predisposition. Thus children of people with type 1 diabetes have an increased risk of developing type 1 diabetes. Type 1 diabetes is most common in Caucasians, and much less common in other ethnicity. These are so-called non- modifiable risk factors and so there is nothing that an individual can do to affect them and reduce their risk. There are many risk factors for type 2 diabetes. Some, as with type 1 diabetes, are non-modifiable. However many others are modifiable, which suggests that in some cases, type 2 diabetes could be prevented.
- 24. NON-MODIFIABLE RISK FACTORS Age Genetic predisposition Ethnicity MODIFIABLE RISK FACTORS Abdominal or central obesity Overweight Physical inactivity Dietary factors (especially high consumption of sugar-sweetened food and beverages)
- 26. This study in China followed 577 people for six years. There were three groups: Those with a diet intervention Those with an exercise intervention Those with both diet and exercise The reductions in risk were as follows: 31% in the diet only group 46% in the exercise only group 41% in the diet and exercise group.
- 27. In this program, all the 3234 people involved had IGT (impaired glucose tolerance). There were three groups: Control Metformin Diet and exercise The groups were followed for 2.8 years. The risk reductions were as follows: 31% in the metformin group 58% in the diet and exercise group
- 28. This study used an alpha glucosidase inhibitor, acarbose, in an attempt to reduce the incidence of type 2 diabetes. 1368 people were followed for 3.3 years; a significant reduction (20%) in the incidence of type 2 diabetes was demonstrated. We now know that type 2 diabetes can be delayed in people who have IGT. Work needs to be done at community levels to reduce obesity by increasing opportunities for (and perceived value in) increased physical activity, while at the same time reducing people’s caloric and fat intake. A number of countries have national initiatives in place to help people eat less and walk more.
- 29. In this study 5269 people with either IGT or IFG were randomised to groups using Ramipril or placebo or Rosiglitazone (a TZD) or placebo and followed for 3 years. Diabetes or death was reduced by 60% in those randomised to the TZD compared with placebo. The reduction in the group using ramipril was not significant.
- 30. In this study 3305 patients (79% normal glucose tolerance, 21% with IGT) were randomised to lifestyle plus either orlistat three times daily or a placebo. Patients had a BMI > 30 kg/m2. After 4 years the cumulative incidence of diabetes was 9% in the placebo group and 6.2% in the orlistat group; corresponding to a risk reduction of 37.3%. Reduction in diabetes was evident only in those with IGT.
- 32. TYPE 1 DIABETES: Currently, there is no cure for type 1 diabetes, but it can be effectively managed with insulin treatment, blood glucose monitoring and by following a healthy, balanced diet and taking regular exercise. Effective management greatly reduces the risk of complications TYPE 2 DIABETES: In the early 2000s, a number of studies demonstrated that it is possible to prevent type 2 diabetes by adopting a healthy lifestyle. Moreover, recent research has demonstrated that with weight loss it is possible to reverse the underlying disease process.
- 35. Type 1 diabetes is generally of quick onset, with the usual symptoms, plus raised blood glucose level (above 11.1 mmol/1 or 199mg/dl). Absolute lack of insulin leads to a breakdown of fats for energy, which leads to accumulated ketones in the blood (and excreted in the urine). If untreated, this can lead to ketoacidosis - a medical emergency that requires urgent insulin treatment and rehydration in a hospital setup. Diagnostic strips are available to detect ketones in the urine or blood and the presence of ketones in urine or blood suggests a diagnosis of type 1 rather than type 2 diabetes.
- 36. Type 2 diabetes can also present with the same symptoms as type 1 diabetes. However, in many cases, people may have no or only very mild symptoms, and can have the disease for many years before diagnosis. Type 2 diabetes is diagnosed by blood tests. If a person has the usual symptoms, but the blood tests are normal, then they do not have diabetes. If the blood tests indicate diabetes, then they have diabetes, even if they have no symptoms.
- 38. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 39. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 40. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 41. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 42. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 43. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 44. MAKING A DIAGNOSIS OF DIABETES: SYMPTOMS
- 46. Fasting blood glucose level Interpretation Up to 6.0 mmol/l or 109mgl/dl Normal 6.1 to 6.9 mmol/l or 110 to 125 mg/dl Impaired fasting hyperglycaemia 7.0 mmol/l or 126mg/dl or above Diabetes FASTING BLOOD GLUCOSE This is a blood test taken after a fast of 8-10 hours, during which time only water can be taken by mouth. The test is generally performed first thing in the morning. The results are expressed as the amount of glucose molecules per litre of blood. You can interpret the results as follows: If both the fasting and random glucose levels are normal, then the person does not have diabetes.
- 47. Random blood glucose level Interpretation Up to 7.7 mmol/l or 139mg/dl Normal 7.8 to 11 mmol/l or 140-199mg/dl Impaired glucose tolerance (IGT) 11.1 mmol/l or 200mg/dl or above Diabetes RANDOM BLOOD GLUCOSE This is often the first test that will be done and can be performed at any time of the day after breakfast. The result is expressed as the mmol of glucose per litre (or mg/dl) of blood. You can interpret the results as follows: If the random glucose is normal it is unlikely that the person has diabetes; however, if it is in the impaired glucose tolerance range, then a fasting glucose or a glucose tolerance test will usually be performed.
- 48. This is a standardised test where a fasting glucose level is measured and then the person is asked to drink a liquid that contains 75 grams of glucose. A further blood test is taken two hours after the drink to see how high the glucose level has risen. The results are interpreted in the same way as the fasting and random tests above. If either the fasting OR the two-hour values are diagnostic, then the person has diabetes. Both have to be normal to exclude the diagnosis.
- 49. When the level of blood glucose is higher than normal, the excess glucose attaches to a number of different molecules in the body. This process of attachment is termed glycation. A small amount of haemoglobin in each blood cell is glycated and just how much will depend on the amount of glucose present in the bloodstream. Glycated haemoglobin (abbreviated as HbA1c), is used to assess glucose levels over a 3 month period (the lifespan of a red blood cell).
- 50. HbA1c
- 51. Glycation describes the binding of glucose molecules to haemoglobin molecules in a red blood cell. Measurement of HbA1c reflects the level of glycaemic control of an individual over the past 8-12 weeks.
- 52. HbA1c is normally expressed as the percentage of the total haemoglobin that has been glycated (ie has glucose molecules attached to it) during the past 2-3 months. It is generally accepted that a target HbA1c of 7.0% or 53mmols/mol would significantly reduce the risk of microvascular complications. However, consideration must be given to the social and medical circumstances of each individual (for example a higher target would be more appropriate in the elderly or those prone to unrecognized hypoglycemia).
- 53. For many years this has been the standard means of assessing diabetic control. Historically it is expressed in a % of total Hb but in 2007, it was proposed that HbA1c reporting should be standardised reported as mmol/mol of haemoglobin. However most countries continue to use %.An HbA1c of 6.5 % (48mmol/mol) or above is diagnostic for type 2 diabetes. However it is important to note that a value below this does not exclude diabetes. HbA1c cannot be used to diagnose type 1 diabetes and is unreliable in people with certain blood disorders.
- 54. You will notice that for the blood glucose tests, there is a middle category, which is higher than normal, but not yet diagnostic of diabetes. This is sometimes termed 'pre- diabetes'. There is good evidence that lifestyle changes can help prevent pre-diabetes progressing to diabetes - and in many cases can lead to reversal to normal glucose tolerance. It is essential that anyone diagnosed with impaired fasting hyperglycaemia or impaired glucose tolerance is offered appropriate lifestyle advice.