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Geo Data Institute, University of Southampton Prevention of Diabetes and the Care of People with Diabetes M G Sayyad, KEM Hospital and Research Centre,

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Presentation on theme: "Geo Data Institute, University of Southampton Prevention of Diabetes and the Care of People with Diabetes M G Sayyad, KEM Hospital and Research Centre,"— Presentation transcript:

1 Geo Data Institute, University of Southampton Prevention of Diabetes and the Care of People with Diabetes M G Sayyad, KEM Hospital and Research Centre, Pune, India. A L Searle, School of Mathematics, University of Southampton, UK. A K Shahani, School of Mathematics and GeoData Institue, University of Southampton, UK. J A Shirodkar, KEM Hospital and Research Centre, Pune, India. C S Yajnik, KEM Hospital and Research Centre, Pune, India.

2 Prevention of Diabetes and the Care of People with Diabetes Outline of Presentation Diabetes History of diabetes Western and Indian Ayurvedic classifications Data Analysis and Modelling for control of diabetes Concluding remarks

3 Geo Data Institute, University of Southampton Diabetes Problems with body’s carbohydrates metabolism Excess glucose in blood Many serious consequences. e.g. Kidney failure, blindness Damage to body’s systems specially blood vessels and nerves

4 Geo Data Institute, University of Southampton A History of Diabetes 5000 BC Ancient Indian scriptures (Rig and Athrava vedas) mention health and diseases including 20 types of “obstinate urinary disorders” (Prameha). Pra = Abundance Meha = Urine Prameha= Passing of excessive urine About 1000 BCAyurvedic texts of Indian physicians Charak and Sushruta discuss classification, causes,prevention, and treatment of Prameha. 2 nd Century ADThe word Diabetes is used to describe passing of excessive urine

5 Geo Data Institute, University of Southampton A History of Diabetes Discovery that damaged pancreas, and in particular damage to a cluster of cells called Islets of Langerhans causes diabetes. Mellitus is added to the word diabetes to distinguish the condition of excess glucose in urine from other urinary disorders. 19 th Century 1922 Insulin is discovered. Injection of manufactured Insulin becomes a major advance for controlling diabetes.

6 Diabetes Geo Data Institute, University of Southampton Diabetes is a major, and a growing, health problem In year 2000, 3.2 million deaths due to diabetes. About 194 million people worldwide have diabetes. India had about 31.7 million people with diabetes in There could be about 80 million people with diabetes by World’s diabetic population is estimated to double from 110 million in 1994 to 220 million by 2010.

7 Geo Data Institute, University of Southampton Classification of Diabetes Type 1 Diabetes Mellitus (Insulin dependent, IDDM) Type 2 Diabetes Mellitus (Non insulin dependent, NIDDM) Gestational Diabetes Mellitus(GDM) Pancreatic Diabetes Mellitus (FCPD, PDDM) Malnutrition Related Diabetes Mellitus (MRDM) Other

8 Classification of Diabetes Type 1 Diabetes (IDDM) Usually in children and young adults Severe symptoms, Sudden onset Life long insulin treatment 5% to 10% of all diabetic cases Usually in adults Mild symptoms, chronic course Various complications Treated with diet, exercise, tablets and insulin 90% to 95% of all diabetic cases Type 2 Diabetes (NIDDM)

9 Ayurvedic Classification of Prameha Prameha Apathyanimittaja (Inherited) defect in genetic substance in mother or father Sahaja (Acquired) Over-eating Lack of exercise Note correspondence with the “modern” Classification of Type 1 and Type 2 diabetes krisha Lean body Sthula Obese body Vataja Uncurable Prameha Pittaja Maintainable Prameha Kaphaja Curable Prameha

10 Geo Data Institute, University of Southampton Causes of Type 2 Diabetes Wisdom of Sushruta: Oversleeping, lack of exercise, overeating, especially sweet and fatty things, are the primary causes of prameha. Modern knowledge: Obesity, smoking, and lack of exercise are risk factors for developing diabetes

11 Geo Data Institute, University of Southampton Diagnosis of Diabetes Commonest symptom is ‘no symptom’ Rapid weight change General weakness Recurrent infections Excess urine Excess thirst Excess hunger Delivering large weight babies Level of glucose in blood has to be measured for detecting Diabetes

12 Geo Data Institute, University of Southampton Diagnosis of Prameha In the absence of measurement of blood glucose levels, signs and symptoms for diagnosing Prameha include: Colour, taste, smell, and other characteristics of urine Family history of Prameha Coating on teeth Secretion from eyes/nose, burning/cracked palms and soles thirst

13 Geo Data Institute, University of Southampton Obesity Obesity is a major risk factor for diabetes and Prameha Body Mass Index (BMI) = Weight / Height 2 is used to define obesity. Underweight: BMI <18.5 Normal weight: BMI in range 18.5–24.9 Overweight: BMI in range 25.0–29.9 Obese: BMI >30.0

14 Geo Data Institute, University of Southampton Obesity Indians have more body fat for a given BMI “Normal” BMI range for Indians = kg/m2 BMI of obese Indians >23 kg/m2 Dr Yajnik and his colleagues have demonstrated that central obesity, measured by Waist to Hip Ratio (WHR), is a good measure of risk of diabetes. WHR = Waist circumference / Hip circumference Obese Men: WHR > 0.95 Obese Women: WHR > 0.85

15 Obesity Obesity is a major and a growing health problem in many countries. Obesity in England has increased by about 400% in the past 25 years. At present about 2/3 of the population in England are overweight or obese. Diet and life style changes are major challenges for many obese people. Effectiveness of Ayurveda for controlling obesity?

16 Geo Data Institute, University of Southampton Control of Diabetes Diabetes Control Diet Exercise Medication Education Regular monitoring

17 A Model for Preventing and Treating Type 2 Diabetes Normal Glucose Tolerance Normal Glucose Tolerance Type 2 Diabetes Diabetic complications Death Risk factors

18 Geo Data Institute, University of Southampton Wellcome Diabetes Study

19 Geo Data Institute, University of Southampton Wellcome Diabetes Study

20 Geo Data Institute, University of Southampton Wellcome Diabetes Study

21 Geo Data Institute, University of Southampton Wellcome Diabetes Study

22 Model Results for Effects of Treatments

23 Modelling Nephropathy G

24 Transition Probabilities and Transition Times Geo Data Institute, University of Southampton Analysis of the Wellcome Diabetes Study provided estimates of the probabilities of transitions between the various states of the “Nephropathy” model Transition times were assumed to be Weibull variates. Analysis of the Wellcome Diabetes Study provided estimates the parameters of the various Weibull distributions.

25 Geo Data Institute, University of Southampton Selected Interventions Control of blood glucose Control of high blood pressure

26 Geo Data Institute, University of Southampton Risk Groups for Nephropathy

27 Geo Data Institute, University of Southampton Model Results for Effects of Treatments Intervention Option No InterventionHypertensionGlucose OvertProteinurian%n% 683 (644, 724) 13.6 (12.8, 14.48) 143 (109,179) 2.9 (2.1, 3.5) 165 (156,173) 3.3 (3.12, 3.46) Chronic Renal Failure Patientsn%n% 609 (558, 660) 12.8 (11.8, 13.2) 20 (8,31) 0.4 ( 0.2, 0.6) 26 (23,36) 0.5 (0.4,0.7) End Stage Renal Failure Patientsn%n% 451 (409,494) 9 (8.2, 9.9) 13 (11,24) 0.26 (0.2, 0.5) 17 (7,27) 0.34 ( 0.1, 0.5) Kidney Transplantsn%n% 21 (10, 31) 0.5 (0.2,0.6) 1 (0,3) 0.02 (0,0.06) 1 (0,3) 0.02 (0,0.06) Deathsn%n% 1428 (1371, 1486) 28.5 (27.4,29.7) 1185 (1131,1239) 22 (21.1, 22.9) 1141 (1103, 1246) 22.8 (22.3, 23.3) Costs (Millions of Rupees) 44.6 ( 34.7, 54.6)489.3 (486.7, 491.9)395.3 (392.7, 398.0)

28 Geo Data Institute, University of Southampton High Blood Pressure Treatment: Deaths over time

29 Geo Data Institute, University of Southampton Concluding Remarks Diabetes is a major threat to the health of many nations Control of blood glucose, blood pressure, and obesity will control diabetes. Side effects of the western drugs? Combination of the Eastern wisdom of Ayurveda and western Science is likely to be a powerful combination for controlling diabetes.


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