Epidemiology of Diabetes Mellitus

bySanti Martini

Departemen of EpidemiologyFaculty of Public HealthUniversity 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.

Normoglycemia IFG or IGT Diabetes

FPG < 110 mg/dl2-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 or2-h PG ≥200 mg/dl orSymptoms 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 diseasemay 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 toReduce 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 2020.

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