Diabetes Mellitus: Etiology and Epidemiology!

DIABETES MELLITIS

Definition:

Diabetes Mellitus (DM) describes a group pf chronic metabolic disorders characterized by hyperglycemia that may result in long-term microvascular, macrovascular and neuropathic complications. these complications contribute to diabetes being the leading cause of:
a) new cases of blindness among adults
b) end stage renal diseases
c)non-traumatic lower limb amputations

Etiology:

The increasing prevalence is caused by three influences:

1. ethnicity 2. Lifestyle 3. Age

Types:

a) Type 1 DM

b) Type 2 DM

c) Type 1.5DM

d) Gestational Diabetes Mellitus (GDM)

** In type 1 DM; the body fails to make insulin. In type 2 DM; body either develops resistance to insulin or not enough insulin is produced to lower the Blood glucose levels**

Epidemiology

The worldwide prevalence of DM has risen over past two decades with an estimation of 30 million cases in 1985 to 177 million cases in 2000.
Based on current trends, >30million individuals will have diabetes by 2030.
Pakistan is among the top countries to report the most cases of diabetes.

Comments

Diabetes Mellitus: Types!

TYPES OF DIABETES MELLITUS 1. TYPE1 DM Type 1 DM is usually diagnosed before age 30 years, but it can develop at any age. T1DM is an autoimmune disease in which insulin producing B-cells are destroyed. The presence of Human Leucocyte Antigens (HLAs ) is associated with the development of T1DM. In addition, these individuals often develop Islet cell antibodies , Insulin Autoantibodies or Glutamic Acid decarboxylase autoantibodies . At the time of development of diagnosis of T1DM, it is usually believed that most of the patients have 80-90%loss of beta cells. The remaining beta cells function at the diagnosis creates a " HONEYMOON PERIOD" during which the blood glucose levels are easier to control, and smaller amounts of insulin are required. after this, the remaining beta cells function is completely lost, and the patients become completely deficient of insulin and hence require exogenous insulin. 2. TYPE1.5 DM: Also referred as Latent autoimmune diabetes in Adults (LAD)

Diabetes Mellitus: Pharmacotherapy- Gliptins and a-Glycoside Inhibitors!

PHARMACOTHERAPY: Medications classifications include: Sulfonyl Urea's Nonsylfonylurea Secretagogues (a-Glinides) Biguanides Thiazolidinediones a-Glucosidase Inhibitors Dipeptidyl Peptidase-4 Inhibitors (Gliptins) Sodium-glucose co-transporter (SGLT) Inhibitors Central-Acting Dopamine Agonists Bile Acid Sequestrants Insulin therapy 5. a-GLUCOSIDASE INHIBITORS Acarbose and Miglitol are a-glucosidase inhibitors currently approved in the United States. Mechanism of Action: An enzyme that is along the brush border of the intestine cells called a-glucosidase; breaks down the complex carbohydrates into simple sugars, resulting in absorption. The a-glucosidase inhibitors work by delaying the absorption of carbohydrates from the intestinal tract, which reduces the rise in postprandial glucose levels. Therapy: As a monotherapy , a-glucosidase inhibitors primarily reduce post-prandial glucose excursions. Clinical Use: FPG concentrations have been decreased by 40-50mg/dL and A1c level

GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)!

MANAGEMENT OF GASTRO-ESOPHAGEAL REFLUX DISEASE "GERD refers to the endoscopically determined esophagitis or endoscopy-negative reflux disease" . "GERD is the term used to describe any symptomatic clinical condition or histopathological alteration resulting from episodes of reflux of acid, pepsin and occasionally, bile into the esophagus from the stomach". Patients with uninvestigated "reflux-like" symptoms should be managed as patients with uninvestigated dyspepsia. There is currently no evidence that H.pylori should be investigated in patients with GERD. Symptoms: Heartburn is the characteristic symptom of GERD. Acid regurgitation Dysphagia Belching Upper abdominal discomfort Bloating and postprandial fullness Chest pain Hoarseness Cough Complications include: Esophageal ulceration Formation of specialized columnar-lined esophagus at the gastro-esophageal junction known as Barretts Esophagus . Mechanism of Acid Reflux: The mechanism of acid reflux is mu

Medical Concepts

Search This Blog