Slide deck

FORWARD Advisory
Board
Module I
Epidemiology, Pathogenesis,
Classification & Diagnosis of
Diabetes Mellitus (DM)

Objectives
Definition of type 2 diabetes mellitus (type 2 DM)
Epidemiology of diabetes mellitus
Classification and diagnosis of diabetes mellitus
Glucose homeostasis and pathogenesis
The term diabetes mellitus describes a metabolic
disorder of multiple etiology characterized by chronic
hyperglycemia with disturbances of carbohydrate, fat,
and protein metabolism resulting from defect in insulin
secretion, insulin action, or both.

The effects of diabetes mellitus include long-term
damage, dysfunction and failure of various organs
World Health Organization., http://www.who.int/ncd/dia/
Definition
Epidemiology of
Type 2 Diabetes Mellitus
Diabetes Atlas, 3rd edition
IDF 2006. www.eatlas.idf.org/index2983.html
Global projections for diabetes
2007 2025
Diabetes
Comparative prevalence (%) 6.0 7.3
No. people with diabetes (millions) 246 380
Predicted diabetes epidemic greatest
prevalence
in AP (Asia Pacific) countries vs. rest of world
Ranking
2000 2030
Country
People with diabetes
(millions) Country
People with diabetes
(millions)
1 India 31.7 India 79.4
2 China 20.8 China 42.3
3 U.S.A. 17.7 U.S.A. 30.3
4 Indonesia 8.4 Indonesia 21.3
5 Japan 6.8 Pakistan 13.9
6 Pakistan 5.2 Brazil 11.3
7 Russian Fed. 4.6 Bangladesh 11.1
8 Brazil 4.6 Japan 8.9
9 Italy 4.3 Philippines 7.8
10 Bangladesh 3.2 Egypt 6.7
Wild S, et al. Diabetes Care 2004;27:1047
53
Indonesia prevalence= 5.7%
Riskesdas ,2007
Indonesia prevalence = 5.7%
Prevalence of Known Diabetes, Newly
Diagnosed Diabetes and IGT
9
Data from capital city of 33 provinces in Indonesia ,Riskesdas ,2007
Number of adults with diabetes in developed and developing
countries in 2010 and prediction in 2030, according to age-
group
Diabetes Research and Clinical Practice 87 (2010) 4-14
Age group (yrs)
250

200

150

100

50

0
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Developing
Developed
2010 2030
20-39 40-59 60-79
2010 2030 2010 2030
Prevalence DM based on age
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%
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Age
RISKESDAS 2007
Risk factors
Age > 45 years old
Obesity
Physical inactivity
First -degree relative with diabetes
Women who delivered a baby weighing 4 kg or were
diagnosed with gestasional DM
Hypertension ( blood pressure 140/90mmHg)
Dyslipidemia ( TG> 250, HDL < 35mg/dL)
IFG (impaired fasting glucose) or IGT (impaired glucose
tolerance) on previous testing
History with coronary heart disease
History of polycystic ovarial syndrome (PCOS)
Diabetes care 32,suppl1,2009
How To Diagnose?

Criteria for the Diagnosis
1. Classic symptoms* of DM + random plasma glucose 200
mg/dL or

2. Classic symptoms of DM + Fasting plasma glucose 126
mg/dL or
(Fasting is defined as no caloric intake for at least 8 h)

2-h plasma glucose >200 mg/dL) during an OGTT. The test
should be performed as described by the World Health
Organization, using a glucose load containing the
equivalent of 75 g anhydrous glucose dissolved in 200 cc
water .

*Classic Symptoms of DM : polyuria, polydipsia,polyphagia, weight loss without any causes
Criteria for the Diagnosis
Normal Prediabetes DM
IFG IGT
FPG
(mg/dL)
< 100 100-125 <100 > 126

2-h PG
(mg/dL)

< 140

< 140

140-199*

> 200
FPG : Fasting Plasma Glucose
2-h PG : 2- hour Plasma Glucose
IFG : Impaired Fasting Glucose
IGT : Impaired Glucose Tolerance
OGTT : Oral Glucose Tolerance Test
* OGTT : post load 75 g
Classification of Diabetes

Type 1 Type 2
Other specific type
of diabetes due to
other causes
Gestational
Cells destruction
leading to absolute
insulin deficiency
Progressive insulin
secretory defect on
background of insulin
resistance
Genetic defect on
cell function
Genetic defects in
insulin action
Disease of the
exocrine pancreas
Drug or chemical
induced diabetes
Diabetes
diagnosed during
pregnancy

Glucose Homeostasis And
Pathogenesis
Glucose Homeostasis
Skeletal
Muscle
Fat
Brain
Insulin-independent
Glucose Uptake
Plasma Glucose
Insulin-dependent
Glucose Uptake
Insulin
Liver
Insulin Glucagon
Pancreas

Joslins Diabetes Mellitus,2005
The natural progression of type 2 diabetes
Adapted from Type 2 Diabetes BASICS. International Diabetes Center; 2000.
Years -10-5 0 5 10 15 20 25 30
350
300
250
200
150
100
50
Insulin
level
Insulin resistance
-cell failure
250
200
150
100
50
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Fasting BG
Post-meal BG
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m
g
/
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)

DIAGNOSIS
Clinical
features
MACROVASCULAR CHANGES
Obesity IGT Diabetes
Uncontrolled
hyperglycaemia
MICROVASCULAR CHANGES
Mechanisms of Hyperglycemia
FFA Mobilization
Inherited / acquired factors/ overweight / inactivity
Hyperglycemia
GLP-1
GIP
GLP-1,
GIP
DPP-4 enzyme
Lipolysis
Gluconeogenesis
Glucagon
Glucose Uptake
Lipotoxicity
Insulin
The ominous octet
H Y P E R G L Y C E M I A
Decreased
Incretin Effect
Decreased
Glucose Uptake
Islet -cells
Neurotransmitter
Dysfunction
Increased
Lipolysis
Decreased Insulin
Secretion
Increased
Glucagon Secretion
Increased HGP
Increased
Glucose
Reabsorption
DeFronzo Ralph A Diabetes 2009; 58:773
Hyperglycemia in Type 2 Diabetes
Adapted from Yki-Jarvinen H. Textbook of Diabetes 1, third edition; 2003
Gluco-
lipotoxicity
Glucose production
in the liver
Overweight, inactivity
(inherited/acquired)
FFA
Type 2 diabetes
Inherited/acquired factors
Glucose
uptake
Insulin deficiency Insulin resistance
Hyperglycaemia
FFA=free fatty acid
Summary
Diabetes mellitus is a metabolic disorder characterized by
chronic hyperglycemia with resulting from defect in insulin
secretion, insulin action, or both.
Prevalence of type 2 DM tend to increase from 6% (2007)
to 7.3% (2025)
National Data of the prevalence diabetes: 5.7% , whereas
74% of them are newly diagnosed.
Most of the cases are type 2 diabetes.
The main factors of type 2 diabetes are insulin resistance
and insulin deficiency