DIABETES OVERVIEWDIABETES OVERVIEWInternal Medicine Internal Medicine

Lecture SeriesLecture Series

September 5, 2007September 5, 2007RON BARAC, DORON BARAC, DO

HISTORYHISTORY

First described First described by Aretaeus in by Aretaeus in early 1early 1stst century century ACAC

Greek word Greek word diabaínein diabaínein meaning “passing meaning “passing through”through”

HISTORYHISTORY

In 1675 Thomas In 1675 Thomas Willis added Willis added mellitusmellitus

Latin word for Latin word for “honey”“honey”

STATISTICSSTATISTICS Diabetes currently affects 246 million people worldwide and is Diabetes currently affects 246 million people worldwide and is

expected to affect 380 million by 2025.expected to affect 380 million by 2025. In 2007, the five countries with the largest numbers of people In 2007, the five countries with the largest numbers of people

with diabetes are India (40.9 million), China (39.8 million), the with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany United States (19.2 million), Russia (9.6 million) and Germany (7.4 million).(7.4 million).

Each year a further 7 million people develop diabetes.Each year a further 7 million people develop diabetes. Each year 3.8 million deaths are attributable to diabetes.Each year 3.8 million deaths are attributable to diabetes. Every 10 seconds a person dies from diabetes-related causes.Every 10 seconds a person dies from diabetes-related causes. Every 10 seconds two people develop diabetes.Every 10 seconds two people develop diabetes. Diabetes is the fourth leading cause of global death by Diabetes is the fourth leading cause of global death by

disease.disease. At least 50% of all people with diabetes are unaware of their At least 50% of all people with diabetes are unaware of their

condition. In some countries this figure may reach 80%.condition. In some countries this figure may reach 80%.

Diabetes Atlas, third editionDiabetes Atlas, third edition, International Diabetes Federation, 2007., International Diabetes Federation, 2007.Diabetes and Cardiovascular Disease: Time to ActDiabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001. , International Diabetes Federation, 2001. World Health Organisation Diabetes Unit - World Health Organisation Diabetes Unit - www.who.intwww.who.int/diabetes/diabetes. .

DIABETES MELLITUSDIABETES MELLITUS

Type 1Type 1 Type 2Type 2 Gestational DiabetesGestational Diabetes

Type 1Type 1

Autoimmune Autoimmune processprocess

Beta-cell Beta-cell destructiondestruction

Requires InsulinRequires Insulin Patients Patients

commonly leancommonly lean Most patients Most patients

diagnosed before diagnosed before age 20age 20

Presence of Presence of ketosisketosis

TYPE 1TYPE 1

Type 2Type 2 Most common formMost common form Strong genetic basisStrong genetic basis Inparied insulin Inparied insulin

secretion and insulin secretion and insulin resistanceresistance

Obesity is a strong Obesity is a strong factorfactor

Ketosis rareKetosis rare Oral and insulin Oral and insulin

therapytherapy

TYPE 2TYPE 2

OBESITY & DM TYPE 2OBESITY & DM TYPE 2

2006 OBESITY TRENDS2006 OBESITY TRENDS

DM PREVALENCEDM PREVALENCE

Gestational DiabetesGestational Diabetes Exact etiology unknownExact etiology unknown 2-4% incidence during 2-4% incidence during

22ndnd or 3 or 3rdrd trimester trimester More common in “older” More common in “older”

women with family women with family history of DM history of DM

Resolves with deliveryResolves with delivery Monitor for Monitor for

hypoglycemia of neonatehypoglycemia of neonate Diet control or InsulinDiet control or Insulin Higher chance of Higher chance of

developing DM in the developing DM in the futurefuture

TYPE 1 AND 2 RISK TYPE 1 AND 2 RISK FACTORSFACTORS

GESTATIONAL DIABETES GESTATIONAL DIABETES RISK FACTORSRISK FACTORS

SYMPTOMSSYMPTOMS

PolydypsiaPolydypsia PolyphagiaPolyphagia PolyuriaPolyuria FatigueFatigue Blurred visionBlurred vision Increased infection occurrenceIncreased infection occurrence Impaired healingImpaired healing

DIAGNOSISDIAGNOSIS

DIAGNOSISDIAGNOSIS

CLINICAL CLINICAL INTERPRETATIONINTERPRETATION

DIAGNOSISDIAGNOSIS

SYSTEMIC SYSTEMIC COMPLICATIONS OF DMCOMPLICATIONS OF DM

CardiovascularCardiovascular RenalRenal NeurologicalNeurological Skin and MusculoskeletalSkin and Musculoskeletal EyesEyes

CARDIOVASCULARCARDIOVASCULAR

CARDIOVASCULARCARDIOVASCULAR

RENALRENAL

RENALRENAL

NEUROLOGICALNEUROLOGICAL

SKIN & SKIN & MUSCULOSKELETALMUSCULOSKELETAL

EYESEYES

GLUCOSE CONTROLGLUCOSE CONTROL

GOALS OF THERAPYGOALS OF THERAPY

LIFESTYLE LIFESTYLE MODIFICATIONMODIFICATION

ORAL THERAPYORAL THERAPY

NEW THERAPYNEW THERAPY

EFFICACYEFFICACY

INSULININSULIN

CONTROL CONTROL COMORBIDITIESCOMORBIDITIES