1. DIABETES OVERVIEW Internal Medicine Lecture Series September 5, 2007 RON BARAC, DO

2. HISTORY First described by Aretaeus in early 1 st century AC First described by Aretaeus in early 1 st century AC Greek word diabaínein meaning “passing through” Greek word diabaínein meaning “passing through”

3. HISTORY In 1675 Thomas Willis added mellitus In 1675 Thomas Willis added mellitus Latin word for “honey” Latin word for “honey”

4. STATISTICS Diabetes currently affects 246 million people worldwide and is expected to affect 380 million by 2025. Diabetes currently affects 246 million people worldwide and is expected to affect 380 million by 2025. In 2007, the five countries with the largest numbers of people with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million). In 2007, the five countries with the largest numbers of people with diabetes are India (40.9 million), China (39.8 million), the United States (19.2 million), Russia (9.6 million) and Germany (7.4 million). Each year a further 7 million people develop diabetes. Each year a further 7 million people develop diabetes. Each year 3.8 million deaths are attributable to diabetes. Each year 3.8 million deaths are attributable to diabetes. Every 10 seconds a person dies from diabetes-related causes. Every 10 seconds a person dies from diabetes-related causes. Every 10 seconds two people develop diabetes. Every 10 seconds two people develop diabetes. Diabetes is the fourth leading cause of global death by disease. Diabetes is the fourth leading cause of global death by disease. At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%. At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%. Diabetes Atlas, third edition, International Diabetes Federation, 2007. Diabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001. World Health Organisation Diabetes Unit - www.who.int/diabetes. Diabetes Atlas, third edition, International Diabetes Federation, 2007. Diabetes and Cardiovascular Disease: Time to Act, International Diabetes Federation, 2001. World Health Organisation Diabetes Unit - www.who.int/diabetes. Diabetes Atlas, third edition Diabetes and Cardiovascular Disease: Time to Actwww.who.int/diabetes Diabetes Atlas, third edition Diabetes and Cardiovascular Disease: Time to Actwww.who.int/diabetes

5. DIABETES MELLITUS Type 1 Type 1 Type 2 Type 2 Gestational Diabetes Gestational Diabetes

6. Type 1 Autoimmune process Autoimmune process Beta-cell destruction Beta-cell destruction Requires Insulin Requires Insulin Patients commonly lean Patients commonly lean Most patients diagnosed before age 20 Most patients diagnosed before age 20 Presence of ketosis Presence of ketosis

7. TYPE 1

8. Type 2 Most common form Most common form Strong genetic basis Strong genetic basis Inparied insulin secretion and insulin resistance Inparied insulin secretion and insulin resistance Obesity is a strong factor Obesity is a strong factor Ketosis rare Ketosis rare Oral and insulin therapy Oral and insulin therapy

9. TYPE 2

10. OBESITY & DM TYPE 2

11. 2006 OBESITY TRENDS

12. DM PREVALENCE

13. Gestational Diabetes Exact etiology unknown Exact etiology unknown 2-4% incidence during 2 nd or 3 rd trimester 2-4% incidence during 2 nd or 3 rd trimester More common in “older” women with family history of DM More common in “older” women with family history of DM Resolves with delivery Resolves with delivery Monitor for hypoglycemia of neonate Monitor for hypoglycemia of neonate Diet control or Insulin Diet control or Insulin Higher chance of developing DM in the future Higher chance of developing DM in the future

14. TYPE 1 AND 2 RISK FACTORS

15. GESTATIONAL DIABETES RISK FACTORS

16. SYMPTOMS Polydypsia Polydypsia Polyphagia Polyphagia Polyuria Polyuria Fatigue Fatigue Blurred vision Blurred vision Increased infection occurrence Increased infection occurrence Impaired healing Impaired healing

17. DIAGNOSIS

18. DIAGNOSIS

19. CLINICAL INTERPRETATION

20. DIAGNOSIS

21. SYSTEMIC COMPLICATIONS OF DM Cardiovascular Cardiovascular Renal Renal Neurological Neurological Skin and Musculoskeletal Skin and Musculoskeletal Eyes Eyes

22. CARDIOVASCULAR

23. CARDIOVASCULAR

24. RENAL

25. RENAL

26. NEUROLOGICAL

27. SKIN & MUSCULOSKELETAL

29. EYES

31. GLUCOSE CONTROL

32. GOALS OF THERAPY

33. LIFESTYLE MODIFICATION

34. ORAL THERAPY

35. NEW THERAPY

36. EFFICACY

37. INSULIN

38. CONTROL COMORBIDITIES