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Members Seminar “An Overview of Diabetes Mellitus”
Dr Abu Ahmed
Clinical EndocrinologistTuesday 15th June 2010
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To provide a corporate image Provide information in a clear and concise manner To provide patients with a clear understanding of
procedures undertaken by the Trust explaining risks, benefits and alternatives
To ensure that all patient information leaflets follow the Trust procedure for Creating a Patient Leaflet Corp/Proc/057
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Adapted from: 1. Diabetes UK. Diabetes in the UK 2004. Diabetes UK, London, 2004.2. Diabetes UK. State of the Nation 2005. Diabetes UK, London, 2005.
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1940 1960 1980 1996 2004 2005 2010
Mil
lio
ns
of
peo
ple
w
ith
dia
bet
es
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Amos AF et al. Diabet Med 1997; 14 (Suppl 5): S1–S85.
Dia
be
tes
pre
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en
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tho
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an
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)
0
500
1000
1500
2000
2500
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1995 2000 2010
Type 1 Type 2
3 million by 20103 million by 2010
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Adapted from Department of Health. Health Survey for England 2003. London: The Department of Health.
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18.5 or under 18.5 to 25 25 to 30 30 to 40 Over 40
BMI (kg/m2)
Pre
vale
nce
of
T2D
M (
%)
MaleFemale
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As body weight increases, insulin resistance increases4
IR is closely linked to abdominal obesity2,3
Reducing abdominal obesity improves insulin sensitivity5
1. National Obesity Forum. How to measure your waist. www.nationalobesityforum.org.uk/apps/content/html/ViewContent.aspx?id=6463 (accessed 18.01.06).2. Carey DG et al. Diabetes 1996; 45: 633–638.3. Matsuzawa Y et al. J Diabetes Complications 2002; 16: 17–18.4. Abate N. J Diabetes Complications 2000; 14: 154–174.5. Williams KV et al. Diabetes Obes Metab 2000; 2: 121–129.
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Normal Impaired glucosetolerance
Time
Insulin resistance
Insulinproduction
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Adapted from Bailey CJ et al. Int J Clin Pract 2004; 58: 867–876.
Normal IGT T2 diabetes Time
Insulin resistance
Insulin production
Glucose level
Beta-celldysfunction
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Insulin resistance• It is the best predictor of T2DM• Factors contributing to IR:
– Obesity– Polygenic familial trait– Physical inactivity– Pregnancy– Drugs– Chronic hyperglycaemia
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Causes of type T2 diabetes
Type 2 diabetesInsulin resistance
B-cell dysfunction
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Haffner SM et al. Diabetes Care 1999; 22: 562–568.Bloomgarden ZT. Clin Ther 1998; 20: 216–231.
> 90% of T2DM are
insulin resistant
Genetic factors Environmental factors
• Family history
• Ethnicity
• Obesity• Age• Diet• Lack of
exercise
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0
10
20
30
40
35 - 45 - 55 - 65 - >75
% of population
Age (years)
DiabetesIGT
cost
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1. Haffner SM et al. Am J Med 1997; 103: 152–162.2. Reaven GM. J Intern Med 1994; 236 (Suppl 736): 13–22.
High BP1
High glucose1
Other CV risk factors2
Insulin resistance CV risk
High cholesterol
Obesity
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Causes of symptoms and signs High blood glucose levels Complications Treatment Cause of diabetes
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Increased thirst polyuria Extreme tiredness Weight loss Blurred vision Genital itching or thrush Slow healing of wounds
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1. Haffner SM et al. Am J Med 1997; 103: 152–162.2. Reaven GM. J Intern Med 1994; 236 (Suppl 736): 13–22.
High BP1
High glucose1
Other CV risk factors2
Insulin resistance CV risk
High cholesterol
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Stamler J., et al Diabetes Care: 16: 434-444
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0
10
20
30
40
50
No history of MI History of MI7-ye
ar i
nci
den
ce o
f ca
rdio
vasc
ula
r ev
ents
(%
)
No history of MI History of MI
Haffner SM et al. N Engl J Med 1998; 339: 229–234.
Non-diabetic
Type 2 diabetes
Remember – look at a person with Type 2 Remember – look at a person with Type 2 diabetes as if they have already had an MIdiabetes as if they have already had an MI
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Macrovascular Microvascular
Stroke
Heart disease and hypertension
2-4 X increased risk
Foot problems
Diabetic eye disease(retinopathy and cataracts)
Renal disease
Peripheral Neuropathy
Peripheral vascular disease
Meltzer et al. CMAJ 1998;20(Suppl 8):S1-S29.
Complications
Erectile Dysfunction
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HbA1c
MV complications
Heart attack *
Deaths related to diabetes *21
Stratton IM et al. UKPDS 35. BMJ 2000; 321: 405–412
Amputation or fatal PVD
37
14
12
43
Stroke **
1%
Epidemiological extrapolation showing benefit of a 1% reduction in mean HbA1c
* p<0.0001
** p=0.035
UKPDS: Tight Glycaemic Control Reduces Complications
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Cardiovascular events3
Microvascular complications1
Macrovascular complications2
Tight blood glucose control
Tight blood pressure control
Control of lipids
1. UKPDS Group. Lancet 1998; 352: 837–53.2. UKPDS. BMJ 1998; 317: 703–13.3. Colhoun HM et al. Lancet 2004; 364: 685–96.4. BMA. Revisions to the GMS contract 2006/07. Delivering investment in general practice. London: BMA; 2006.
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Multi-factorial approach:Optimal control of risk factors:
• Structured education• Lifestyle management• Optimal weight control• Optimal blood glucose control• Optimal blood pressure control• Optimal control of cholesterol
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Life-style measures:
Weight management
Increased exercise
Dietary treatment
Smoking cessation
Treatment of depression
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Benefits:Benefits: Lowers glucose levels in blood Contributes to weight loss Improves physical and mental
wellbeing Improves insulin sensitivity
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Type 2 diabetesInsulin resistance
B-cell dysfunction
MetforminGlitazone
SulphonyluriaGliptinsexenatide
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Leonard Thompson, 1922• In Jan, 1922, Banting and Best injected a
14-year-old "charity” patient • His blood glucose had dropped• Leonard lived a relatively healthy life for
13 years
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Diabetes is common Diabetes is associated with increased
risk of CV complications and late organ damage
Good diabetes management reduces the risk of complications