Epidemiology of Diabetes Mellitus by Santi Martini Departemen of Epidemiology Faculty of Public Health University of Airlangga

1.type 1, which results from autoimmune beta-cell destruction in the pancreas and is characterized by a complete lack of insulin production; 2.type 2, which develops when there is an abnormal increased resistance to the action of insulin and the body cannot produce enough insulin to overcome the resistance; 3.gestational diabetes, which is a form of glucose intolerance that affects some women during pregnancy; and 4.a group of other types of diabetes caused by specific genetic defects of beta-cell function or insulin action, diseases of the pancreas, or drugs or chemicals Pathophysiology of Diabetes

the new diagnostic criteria for type 2 diabetes are as follows: (ADA Revisions, Diabetes Care, Suppl, January 2010) 1.An A1c level of 6.5% or more. 2.Fasting plasma glucose level of 126 mg/dL or more. 3.A 2-hour plasma glucose level of 200 mg/dL or more after a 75-g oral glucose tolerance test. 4.A random plasma glucose level of 200 mg/dL or more in a patient with symptoms of hyperglycemia.  In the absence of symptoms of hyperglycemia, the first 3 options listed should be confirmed with repeated testing.  Patients with an A1c level between 5.7% and 6.4% should be considered to have prediabetes and should receive appropriate counseling on therapeutic lifestyle change.

NormoglycemiaIFG or IGTDiabetes FPG < 110 mg/dl 2-h PG < 140 mg/dl FPG ≥110 and < 126 mg/dl (IFG) 2-h PG ≥140 and < 200 mg/dl (IGT) FPG ≥126 mg/dl or 2-h PG ≥200 mg/dl or Symptoms of diabetes and casual plasma glucose concentration ≥200 mg/dl Tabel 1. Kriteria Diagnosis Diabetes Mellitus

Prevalensi DM di AS : 7% (20,8 juta penduduk) 14,6 juta DM dan 6,2 juta UDDM (30%) (sumber: Desphande, dkk. Phys Ther. 2008;88)

(Sumber: Laporan Riskesdas, 2008)

 Overall, the risk of death among people with diabetes is almost twice that of people of similar age who do not have diabetes.  Duration of diabetes also is an important determinant of mortality; younger age-of-onset groups (45 years of age) have an increased risk of premature death.  Two thirds of people with diabetes die of heart disease and stroke.  The risk for cardiovascular disease mortality is 2 to 4 times higher in people with diabetes than in people who do not have diabetes. Mortality

(Sumber: Riset Kesehatan Dasar, 2007)

 family history,  race (with whites at higher risk than other racial or ethnic groups),  certain viral infections during childhood. Risk factors for type 1 diabetes

Risk factors for type 2 diabetes  Non modifiable risk factors include :  age, incidence and prevalence increases with age.  race or ethnicity,  family history (genetic predisposition),  history of gestational diabetes,  and low birth weight. Diabetes  Modifiable or lifestyle risk factors include:  increased body mass index (BMI), W/H ratio  physical inactivity,  poor nutrition,  hypertension,  smoking,  and alcohol use,  Depression, increased stress, lower soscial support, poor mental health

Microvascular complications: - nervous system damage (neuropathy), - renal system damage (nephropathy) and - eye damage (retinopathy) Macrovascular complications: - cardiovascular disease, -stroke, -peripheral vascular disease. Peripheral vascular disease may lead to bruises or injuries that do not heal, gangrene, and, ultimately, amputation. Complications

 The 3 most significant risk factors are hyperglycemia, high blood pressure, and hypercholesterolemia.  It has been suggested that improvements in glycemic control, blood pressure, and cholesterol level can reduce a person’s risk for complications.  For example, in a person with diabetes, each percentage point reduction in glycosylated hemoglobin (Hb A1c) level can reduce that person’s risk for microvascular complications by 40%;  a 10 mm Hg decrease in blood pressure can reduce that person’s risk for any diabetic complication by up to 12%; and  control of serum lipids can reduce that person’s risk for cardiovascular complications by 20% to 50%.  Clearly, better control of these risk factors in people with diabetes can lead to more favorable outcomes. Control of Risk Factors to Reduce Complications

 the estimated costs associated with diabetes in the United States in 2002 totaled $132 billion, with direct medical costs of $92 billion and indirect costs (disability, loss in work productivity and premature mortality) of $40 billion.  these expenditures would be expected to reach approximately $192 billion by  Approximately 40% of the total cost of diabetes in the United States is due directly to inpatient care for treatment of diabetes complications Burden to the Health Care System