Epidemiology of Diabetes Epidemiology of Diabetes MellitusMellitus

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 levelFasting blood glucose <7 mmols or <126 mg/100 ml.

.

Essential features of the (ADA) recommendations for Essential features of the (ADA) recommendations for diabetes (in non-pregnant adults) and the diabetes (in non-pregnant adults) and the previous previous WHO recommendationsWHO recommendations

Provisional ADA recommendations

Previous WHO recommendations

General:

Based on clinical stages Based on clinical stages

Diabetes:-Symptoms of diabetes plus

‘casual’ PG   >11.1 mmol/l or- FPG  >7.0 mmol/l (>126 mg) or

-2 h PG >11.1 mmol/l (>200 mg) an OGTT with 75 gm

Any of the above need to be confirmed on a subsequent day for the diagnosis to be

made.

Same -FPG >7.8 mmol/l (>140 mg) or

-2 h PG > 11.1 mmol/l (>200 mg)

an OGTT

Essential features of the (ADA) recommendations for diabetes (in non-pregnant adults) and the previous WHO recommendations (cont.)

Provisional ADA recommendations

Previous WHO recommendations

Impaired glucose tolerance (IGT):2 h PG >7.8 mmol/l (140) but <11.1 mmol/l (<200 mg)

Same

Impaired fasting glucose (IFG):FPG >6.1 mmol/l (>110 mg) and <7.0 mmol/l (<126 mg)

Not previously recognized

Types of Diabetes MellitusA. Non-insulin dependent diabetes mellitus (NIDDM)B. Insulin dependent diabetes mellitus (IDDM)C. Gestational diabetes mellitus (GDM)D. Induced diabetes mellitus

Prevalence of NIDDM in certain countries

Country Prevalence (ADA criteria, >20 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%

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%

Factors associated with NIDDM

Variable Odds Ratio (OR) p-valueGender (M vs. F) 2.0 <.001

Age(>40 vs. <40 Y) 12.7 <.001Family History DM (Y vs. N) 2.5 <.001High cholesterol (Y vs. N) 1.6 <.001High triglycerides (Y vs. N) 2.1 <.001Hypertension (Y vs. N) 1.6 <.01Body mass index

(obese vs. non-obese) NS(obese& overweight vs. non-obese)* 1.9 <.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.

Frequency distribution of certain CVD risk factors by diabetic status Among Jordanian adults.

Variable NIDDM General populationHigh 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.

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

http://www.pitt.edu/~super1/lecture/lec0042/014.htm.IDDM= insulin dependent diabetes mellitusCA= CancerCF= Cystic fibrosisMS=Multiple sclerosisJRA= Juvenile rheumatoid arthritisMD= Muscle dystrophy

hhttttpp::////

wwwwww..ppiitttt..eedduu//

~~ssuuppeerr11//lleeccttuurree//lleecc00004422//001144..hhtt

mm

• http://www.pitt.edu/~super1/lecture/lec0042/014.htm

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 ofdiagnosis Population Cases Males Females

Incidence1996 1,845,958 66 34 32 3.61995 1,774,960 64 34 30 3.61994 1,703,962 55 28 27 3.21993 1,635,864 47 22 25 2.91992 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 427:11-3. 1999.

Gestational diabetes mellitusGestational diabetes mellitus (GDM) is defined as

“carbohydrate intolerance of variable severity with onset or first recognition during pregnancy

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

Epidemiology of gestational diabetes mellitus and associated risk factors among attendants of antenatal services at Al

Corniche maternity hospital, Abu Dhabi City, UAE.

Study designAt 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:

1. 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.

Patient is defined as having impaired GTT when FBS is <7.8 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 >7.8mmols/liter or 2-hours plasma glucose >11.1mmols/liter.

Pregnants with FBS >7.8 mmols/liter or 2-hours plasma glucose >11.1 mmols/liter are defined as having GDM.

Results:GDM prevalence was 15.9%

• 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)

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

• Ethnicity

1. 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 <25 kg/m2, fat intake <30% of energy intake, saturated fat intake <10% of energy intake, fibre intake ≥15 g/day, physical activity >4 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%.

• 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.