1. Diabetes

2. Diabetes is recognized as the world’s fastest growing chronic condition and is recognized as a global epidemic with the potential to cause a worldwide healthcare crisis…..

3. Prevalence 2017 425 million adults with diabetes
2045 estimate 629 million
Prevalence in SA 9%
1 in 2 adults with diabetes is undiagnosed
2/3 of people with diabetes are of working age
2/3 of people with diabetes life in urban areas
Around 8% of woman live with diabetes worldwide / 1 in 11 adults has diabetes

4. Epidemiology Type 2 diabetes 90 to 95% of diabetes population
Dramatic increase in Sub Saharan Africa with 156%
Ageing population
Disturbing trends parallel obesity pandemic
Younger people diagnosed with Type 2
Increase in Gestational diabetes

5. People who die < 60 years

6. Definition of diabetes
A condition characterized by hyperglycemia due to: *Defects in insulin production *Autoimmune or other destruction of beta cells *Insulin insensitivity *Impaired action of insulin on target tissues

7. Risk factors Type 2 Age > 35 years Genetically
Member of high risk group
History of IFG or IGT
Vascular disease
History of gestational diabetes
History of delivering macrosomic babies
Hypertension
Dyslipidaemia

8. Abdominal obesity
Overweight
Polycystic ovary disease
Acanthosis nigricans
Skin tags
Schizophrenia
Lifestyle

9. Clinical Features Type 2
Excessive thirst
Drinking excessive amounts of fluids
Passing large amounts of urine
Extreme tiredness
Weight changes
Blurred vision
Lack of concentration/poor memory/moodiness
Infections / itchiness / skin rashes
Numbness/ tingling/ pins and needles in hands and feet

10. Broad Classification of Diabetes

11. Diagnosis
Anyone with diabetes?

12. Diagnostic Criteria: Fasting BG

13. Random BG

14. HbA1c

15. BMI

16. Ethnic Specific BMI Cut Points
White European
Asian Population
Classification
< 18.5  kg/m2
   <18.5 kg/m2
Underweight
 kg/m2
 kg/m2
‘Normal’
 kg/m2
      kg/m2
Overweight
30  kg/m2
 ≥27.5  kg/m2
Obese

17. Waist Circumference

18. Cornerstones of Diabetes Rx
Physical Activity
Nutrition
Medication

19. Reduction in HbA1c of 1%

20. Monitoring

21. Blood glucose levels Target HbA1 c Target FPG Target PPG
Table I: Average Fasting and Post-prandial glucose levels in relation to HbA1C
Target HbA1 c
Target FPG
Target PPG
Target for people who can achieve it (without too much hypoglycaemia)
< 6.5 %
mmol/l
< 8 mmol/l
Target for most people with diabetes
<7%
4 - 7 mmol/L
< 10 mmol/l
< 8 %
< 12 mmol/l
The targets in mmol/L are from the Canadian Diabetes Association Clinical Practice Guidelines. The targets in mg/dl are from the American Diabetes Association Clinical Practice Guidelines.
However, it is important that targets be individualized for people with diabetes depending on their specific needs. For example, the targets for young children or the elderly may be different from the average person.
Amod et al. (SEMDSA), JEMDSA 2017 Volume 22(1) Chapter 8 Page S35

22. Interpretation of HbA1c
Mean blood glucose (mmol/l) 6
7.0 7
8.6 8
10.2 9
11.8 10
13.4 11
14.9 12
16.5

23. Nutrition

24. Exersice Improve insulin sensitivety Improve blood glucose control
Lowers insulin requirements
Improves circulation
Lowers blood pressure
Increase weight loss
Improves cholestrol levels
Lowers stress levels
Decrease risk of heart disease

25. Increase physical fitness
Enhances sense of well being
Reduces the risk of osteoporosis
Patient must discuss exercise with doctor before he/she start.
Different forms of exercise
Find one that you enjoy
Always carry fast acting glucose when exercising

26. Pharmacological Treatment
Decrease symptoms of hyperglycaemia without episodes of HYPOGLYCAEMIA
Limit adverse effect of treatment
Maintain quality of life and psychological well-being
Prevent or delay the onset of complications

27. Acute Complications Hypoglycaemia Hyperglycaemia Diabetes Ketoacidosis
Hyprosmolar non-ketotic coma

28. Chronic complications
The prevalence of retinopathy, nephropathy and neuropathy increased with the longer duration of the hyperglycaemia and was highest in those with poor control.
In macrovascular disease hyperglycaemia appears to have a lesser effect than boold pressure control, dyslipidaemia and smoking.

29. Micro vascular complications
Retinopathy
Nephropathy
Neuropathy

30. Macrovascular complications
Cardio Vascular disease
Cerebro Vascular Disease
Peripheral Vascular Disease

31. The End and Thank You !!