PREVELANCE:

In USA more than 17 million people have Diabetes Mellitus and approximately 16 million people have Pre-Diabetes (which is impaired glucose tolerance). Epidemiological studies have noted a dramatic increase in prevalence of type 2 Diabetes Mellitus in younger individuals (20s and 30s). The prevalence is already high in older individuals in 50- 80 yrs and above age group.

In USA there are certain high risk ethnic groups like African-Americans, Hispanic Americans, Native Americans, Asian Americans and Pacific islanders have increasing prevalence and predilection of Types 2 Diabetes Mellitus. There is an increased incidence of ‘metabolic syndrome’ (‘Syndrome-X’ Insulin Resistance Syndrome’ or ‘Cardiovascular Dysmetabolic Syndrome’) in these ethnic groups.  It may be present many years before development of full-blown Diabetes Mellitus. In this syndrome, there is abdominal obesity (perivisceral fat collection-increased free fatty acids, due to eating more and lack of exercise) hyperinsulinemia, Insulin resistance with dyslipidemia, increased prothrombolitic activity, hypertension and accelerated atherosclerosis. Such population groups should be tested for Diabetes Mellitus at regular intervals & have medical checkup for co-morbidities in heart, kidney, CNS (peripheral nerves, TIA and stroke), Eyes, Skin and Peripheral arteries.

FAMILY HISTORY:

There is genetic predisposition in type 2 Diabetes Mellitus. If both parents are Diabetic 90% chances are that the children will be Diabetic, and if one parent is Diabetic, only 60% offspring will become Diabetic.

SYMPTOMS AND SIGNS:

While Type1 Diabetics do not present with complications at the very outset, 10-20% of Type 2, may present with complications. Common initial symptoms include Polyuria, Polydipsia, Polyphagia, weight loss, fatigue, proneness to infection and delay in healing. Often people are asymptomatic for years and are diagnosed only when incidental blood testing is done for another reason. By that time patients actually have evidence of Diabetic complications in eyes, kidneys, nerves and arteries. Silent and fatal heart attacks stroke are common in Diabetics specially neglected and uncontrolled. Certain high-risk population should be screened for Diabetes at frequent intervals.

HIGH-RISK FOR DIABETES:

1.  Age over 45 years

2.  ‘Metabolic Syndrome’: overweight individuals with abdominal paunch, HDL Cholesterol less than 35 mg/dl and triglyceride level more than 250 mg/dl

3.  Impaired glucose tolerance and impaired fasting glucose

4.  High-risk ethnic population viz., African-American, African-Asians, Hispanic Americans, Native Americans and Pacific Islanders.

 5.   Females delivering overweight babies and diagnosed as Gestational Diabetes Mellitus

6.  Hypertensive more than 140/90(BP)

7. History of Diabetes in first-degree relative.

TREATING DIABETES:

· In order to survive, people with Type 1 Diabetes must have insulin delivered by injections or a pump.

· Many people with Type 2 Diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication.

· Many people with Diabetes also need to take medications to control their cholesterol and blood pressure.

· Among adults with diagnosed Diabetes, about 11% take both insulin and oral medications, 22% take insulin only, 49% take oral medications only, and 17% do not take either insulin or oral medications.

PREVENTING DIABETES:

Research studies in the United States and abroad have found that Lifestyle changes can prevent or delay the onset of Type 2 Diabetes among high-risk adults. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week). For both sexes and all age and racial and ethnic groups, the development of Diabetes was reduced 40% to 60% during these studies that lasted 3 to 6 years.

Studies have also shown that medications have been successful in preventing Diabetes in some population groups. In a Diabetes Prevention Study, a large prevention study of people at high risk for diabetes, people treated with the drug Metformin reduced their risk of developing Diabetes by 31%. Treatment with Metformin was most effective among younger, heavier people (those 25-40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight.

There are no known methods to prevent Type 1 Diabetes. Several clinical trials are currently in progress.

PREVENTING DIABETES COMPLICATIONS:

Glucose Control

· Research studies in the United States and abroad have found that improved Glycemic control benefits people with either Type 1 or Type 2 Diabetes. In general, for every 1% reduction in results of A1C blood tests, the risk of developing Microvascular Diabetic Complications (eye, kidney, and nerve disease) is reduced by 40%.

Blood Pressure Control

· Blood Pressure control can reduce cardiovascular disease (Heart Disease and Stroke) by approximately 33% to 50% and can reduce Microvascular Disease (eye, kidney, and nerve disease) by approximately 33%.

· In general, for every 10 millimeters of mercury (mm Hg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.

Control of Blood Lipids

· Improved control of cholesterol and lipids (for example, HDL, LDL, and Triglycerides) can reduce cardiovascular complications by 20% to 50%.

Preventive Care practices for Eyes, Kidneys, and Feet

· Detecting and treating Diabetic Eye Disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.

· Comprehensive foot care programs can reduce amputation rates by 45% to 85%.

· Detecting and treating early Diabetic Kidney Disease can reduce the development of kidney failure by 30% to 70%.

BLOOD SUGAR DIAGNOSTIC CRITERIA:

a) Fasting Plasma Glucose

Normal	< 110mg/dl
Impaired Fasting Glucose	110-125mg/dl
Diabetes	>126mg/dl

b) Plasma Glucose (2 hrs after Lunch or Meal)

Normal	< 140 mg/dl
Impaired Fasting Glucose	140-199 mg/dl
Diabetes	> 200 mg/dl

Random Plasma Glucose:

> 200 mg/dl

NB: In elderly and young, the criteria are same as above.