DELHI PHARMACEUTICAL SCIENCES AND RESEARCH UNIVERSITY

ACADEMIC YEAR: 2020-22

DEPARTMENT: MASTER IN PUBLIC HEALTH
ASSIGNMENT
ON

“DIABETES”
SUBMITTED BY SUBMITTED TO
NEERU CHAUDHARY Dr. J. SWAMINATHAN
MPH Bach 2020-22 (ASSOCIATE PROFESSOR)
Enrollment No: 230/MPH/2020-22 SCHOOL OF ALLIED HEALTH SCIENCES
 CONTENT
• INTRODUCTION

• TYPES OF DIABETES
• KEYFACTS

• HEALTH IMPACT
• PREVENTION
• DIAGNOSIS AND TREATMENT

• WHO RESPONSE
 Introduction
• Diabetes is a chronic disease that occurs either
when the pancreas does not produce enough
insulin or when the body cannot effectively use
the insulin it produces. Insulin is a hormone that
regulates blood sugar.
• Hyperglycaemia, or raised blood sugar, is a
common effect of uncontrolled diabetes and over
time leads to serious damage to many of the
body's systems, especially the nerves and blood
vessels.
– How does this happen?
• Glucose enters the bloodstream, from food we eat. This is
later used for fuel in the body. Our pancreas located near
the stomach makes insulin, which plays a role in moving
glucose to muscles, liver cells, and fat.
• The pancreas then fails to make enough insulin or the
muscle or…
• Fat or liver cells fail to respond to the insulin properly
• As a result, our body’s cells are starving for energy and
over time, high blood glucose levels change our overall
health damaging the kidney, heart, eyes, and nerves
 Parts of the body and hormones involved in diabetes

• Hormones
• Pancreas
• Gut or digestive system
• Liver
• Muscles
• Insulin
• Glucagon
 Diagram showing how food is broken down into
Diagram showing the α and β cells in the smaller units within the gut and then absorbed into
islets of Langerhans in the pancreas  the blood through the wall of the small intestine
The relationship between glucose in the Diagram of insulin actions and the consequences of
blood and its storage and release from a lack of insulin
skeletal muscle, liver and fat tissue
TYPES OF DIABETES
1. Type 2 diabetes
• Type 2 diabetes (formerly called non-insulin-dependent, or adult-
onset) results from the body’s ineffective use of insulin. The
majority of people with diabetes have type 2 diabetes. This type of
diabetes is largely the result of excess body weight and physical
inactivity.
• Symptoms may be similar to those of type 1 diabetes, but are often
less marked. As a result, the disease may be diagnosed several
years after onset, after complications have already arisen.
• Until recently, this type of diabetes was seen only in adults but it is
now also occurring increasingly frequently in children.
2. Type 1 diabetes
• Type 1 diabetes (previously known as insulin-dependent, juvenile
or childhood-onset) is characterized by deficient insulin
production and requires daily administration of insulin. Neither the
cause of Type 1 diabetes nor the means to prevent it are known.
• Symptoms include excessive excretion of urine (polyuria), thirst
(polydipsia), constant hunger, weight loss, vision changes, and
Flow diagram showing the
fatigue. These symptoms may occur suddenly.
consequences of insulin resistance
3. Gestational diabetes
• Gestational diabetes is hyperglycaemia with blood
glucose values above normal but below those
diagnostic of diabetes. Gestational diabetes occurs
during pregnancy
• Women with gestational diabetes are at an increased
risk of complications during pregnancy and at delivery.
These women and possibly their children are also at
increased risk of type 2 diabetes in the future.
• Gestational diabetes is diagnosed through prenatal
screening, rather than through reported symptoms.
4. Impaired glucose tolerance and impaired
fasting glycaemia
• Impaired glucose tolerance (IGT) and impaired fasting
glycaemia (IFG) are intermediate conditions in the
transition between normality and diabetes. People with
IGT or IFG are at high risk of progressing to type 2
diabetes, although this is not inevitable.
Symptoms of diabetes
• high blood levels of glucose
• blurry vision
• fatigue
• thirst
• painful urination
• frequent urination
• sores that do not heal
• nausea
• vomiting
• weight loss
• Hunger
• **In some cases…there are no symptoms at
all!!
• **Diabetes type 1 and type 2 symptoms are
closely similar, although, type 1 is often
worse in severity
Key facts
• The number of people with diabetes rose from 108 million in 1980 to 422
million in 2014. Prevalence has been rising more rapidly in low- and middle-
income countries than in high-income countries.
• Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke
and lower limb amputation.
• Between 2000 and 2016, there was a 5% increase in premature mortality from
diabetes.
• In 2019, an estimated 1.5 million deaths were directly caused by diabetes.
Another 2.2 million deaths were attributable to high blood glucose in 2012.
• A healthy diet, regular physical activity, maintaining a normal body weight
and avoiding tobacco use are ways to prevent or delay the onset of type 2
diabetes.
• Diabetes can be treated and its consequences avoided or delayed with diet,
physical activity, medication and regular screening and treatment for
complications.
 How does diabetes transmit?
• Genetically (type 1 diabetes,
pre-diabetes, gestational)
• Can develop due to poor diet
& inadequate exercise (pre-
diabetes, type 2 diabetes,
gestational diabetes)
• Develops due to following
factors
– Overweight
– High blood pressure
– High cholesterol
– Family history of diabetes
– African-American, Asian-American, Latino,
Hispanic-American, Native American ethnicity
– Family history of gestational diabetes
When is a person at high risk for Diabetes?
1. If he/she is overweight (BMI is more than 23kg/m2)
2. If he/she is physically inactive, that is, he or she exercises less than 3
times a week
3. If he/she has high blood pressure
4. If he/she has impaired fasting glucose or impaired glucose tolerance
5. If his/her triglyceride and/or cholesterol levels are higher than
normal
6. If his/her parents/siblings or grandparents have or had diabetes
7. If she delivered a baby whose birth weight was 4 kgs or more
8. If she has had diabetes or even mild elevation of blood sugars during
pregnancy
When to suspect diabetes?
 Symptoms of uncontrolled hyperglycemia: excess thirst, excess
urination, excess hunger with loss of weight
 Frequent infections
 Non-healing wounds
 Unexplained lassitude
 Fatigue
 Impotence in men
Criteria for diagnosis of T2DM using venous blood samples*
Fasting Glucose(mg/dl) 2-hour Post-Glucose
Load(mg/dl)
Diabetes Mellitus >=126 or >=200

Impaired Glucose Tolerance < 126 and >140 to

Impaired Fasting Glucose >=110 to <126
*WHO Definition 1999
Capillary blood glucose value is also sufficient. Where capillary blood glucose measured by glucometer is used in the fed
state (i.e., post food/post glucose/post meal), the >200 mg/dl cut off may be revised to >220 mg/dl.
 How does diabetes affect the body?
• Diabetes can affect:
o heart
o kidneys (direct result from large amounts of protein being deposited
into the urine)
o eyes
o nervous system
o skin
o your WHOLE body
o long-term complications include stroke, peripheral vascular disease,
hypertension, urinary infections, and coronary artery disease
o the most frequent health risk from diabetes is known as
cardiovascular disease (diabetes can cause high blood pressure that
then causes an even stronger resistance to insulin)
o Diabetes lowers our good cholesterol and raises our bad cholesterol
leading to an increase of heart disease and stroke. This can cause the
arteries to become clogged with fat.
o at least 65% of people with diabetes die from heart disease or stroke
Diagnosis and treatment
• Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.
• Treatment of diabetes involves diet and physical activity along with lowering of blood
glucose and the levels of other known risk factors that damage blood vessels. Tobacco use
cessation is also important to avoid complications.
• Interventions that are both cost-saving and feasible in low- and middle-income countries
include:
• blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require
insulin, people with type 2 diabetes can be treated with oral medication, but may also
require insulin;
• blood pressure control; and
• foot care (patient self-care by maintaining foot hygiene; wearing appropriate footwear;
seeking professional care for ulcer management; and regular examination of feet by health
professionals).
• Other cost saving interventions include:
• screening and treatment for retinopathy (which causes blindness);
• blood lipid control (to regulate cholesterol levels);
• screening for early signs of diabetes-related kidney disease and treatment.
 Testing for diabetes
1) FPG (Fasting Plasma Glucose
Test)
• patient must fast for eight hours
• doctor draws blood
• doctor will mix blood with other liquids
to determine the amount of sugar or
glucose in the blood
• this is measured in mg/dL
• blood glucose range for pre-diabetics will
be in the 100-125 mg/dL range.
• type 2 diabetes will have blood sugar
results in the range of 126 mg/dL and
above
• these levels can increase the risk of heart
disease and stroke
3. Blood test
4. Urine test
2) OGTT (Oral Glucose
Tolerance Test)
• doctor measures how well your body
reacts to average dose of sugar
• patient will be drawn blood two
hours before and after he/she drinks
pre-mixed beverage with the sugar
• blood glucose levels are measured to
see how the body reacted
• Blood glucose range for pre-diabetics
will be between 140-199 mg/dL.
• For those with type 2 diabetes, the
range will start at 200 mg/dL and
continue to peak
 How to prevent/control diabetes
• Prevention all starts with a better lifestyle
• eating healthier
• being active
• taking medicine as directed
• taking care of your body
• check feet to make sure there is no nerve damage or interruption of blood flow
• take care of teeth
• control blood pressure and high
• no smoking!
• check in with your doctor at least once a month
• have your blood sugar checked along with weight, blood pressure, and feelings
• Check blood sugar levels daily by using home monitoring device
 Can diabetes be cured?
• Unfortunately, there is not yet a cure for diabetes
• BUT DON’T GIVE UP HOPE! There are always new
facts and discoveries being made every day.
• Doctors are providing treatment that can lower
symptoms of diabetes of all types, which can reduce
pain.
• By following a good diet and exercise plan, body may
be able to use insulin minimally, or none at all in cases
besides type 1
• There is also research being done on “islet”
transplantation
• **This can be seen on the next slide
 Islet transplantation

• During this procedure, islets (clusters of cells from the pancreas that help make
insulin) are taken from the pancreas of a deceased organ donor. Then, the islets are
purified, processed, and transferred to someone else. These then begin to make and
release insulin individually. This could possibly be the biggest step in helping
patients with type 1 diabetes live without insulin injections.
 ORAL ANTIDIABETIC DRUGS
DRUGS ADVANTAGES DISADVANTAGES
WHO response
• WHO aims to stimulate and support the adoption of effective measures for the surveillance,
prevention and control of diabetes and its complications, particularly in low- and middle-income
countries. To this end, WHO:
• provides scientific guidelines for the prevention of major noncommunicable diseases including
diabetes;
• develops norms and standards for diabetes diagnosis and care;
• builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14
November).
• The WHO "Global report on diabetes" provides an overview of the diabetes burden, interventions
available to prevent and manage diabetes, and recommendations for governments, individuals, the
civil society and the private sector.
• The WHO "Global strategy on diet, physical activity and health" complements WHO's diabetes
work by focusing on population-wide approaches to promote healthy diet and regular physical
activity, thereby reducing the growing global problem of overweight and obesity.
• The WHO  module on diagnosis and management of type 2 diabetes brings together  guidance on
diagnosis, classification and management of type 2 diabetes in one document. The module will be
useful to policy makers who plan service delivery of  diabetes care, national programme managers
responsible for training, planning and monitoring service delivery, and facility managers and
primary care staff  involved in clinical care and monitoring processes and outcomes of diabetes
care.
 P rogrammes in india FOR DIABETES
CONTROL
 NATIONAL DIABETES CONTROL PROGRAMME
 NATIONAL PROGRAMME FOR PREVENTION & CONTROL
OF CANCER, DIABETES, CARDIOVASCULAR DISEASES &
STROKES( NPCDCS)
REMEMBER….TAKE
CONTROL OF YOUR
LIFE! DON’T LET
DIABETES
CONTROL YOU!