Overview of two important health

burdens

Dr. Abhishek RoyEmail: mail@abhishek.ro

Junior Resident, Dept. of Biochemistry,

Grant Govt. Medical College & Sir J.J. Group of Hospitals, Mumbai.

• Diabetes

• Hypertension

Diabetes MellitusBurden in India(Epidemiology):

• 63 million Indians are affected with Diabetes as of 2012.

• In 2007, the figure was 40 million.

• In just 5yrs, more than 50% increase in prevalence of the disease.

• The total number is said to rise to about 101 million by 2030 and India, USA and China will be the DIABETIC CAPITALS of the world.

Source: International Diabetes Federation

Source: International Diabetic Federation

Who is at Risk?•Obesity•Hypertension•Family History of Diabetes•Lack of Exercise and Lifestyle•Age 45 years or more•Pre-Diabetes

Plasma Glucose levels..

After overnight fasting:

Normal: <100 mg/dLPre-Diabetic: 100-125 mg/dLDiabetic: >=126 mg/dL

2hrs After Meals/Post Prandial:

Normal: <140 mg/dLPre-Diabetic: 140-199 mg/dLDiabetic: >=200 mg/dL

Insulin• Hormone from Pancreas that regulates glucose

metabolism• Secreted throughout the day• More quantity is released after the meals• Insulin deficiency or improper functioning causes

Diabetes

Physiologic Serum Insulin secretion profile

Organs affected

• Eyes• Kidneys• Nerves• Skin

What should be done?

• Self-monitoring of blood glucose (individualized frequency)

• HbA1c testing (2-4 times/year)• Patient education in Diabetes management (annual)• Eye Examination (annual)• Foot-examination (1-2 times/year by physician; daily by

patient)• Screening for Diabetic Nephropathy• Blood Pressure Measurement (quarterly)

Drugs..

Hypertension Hypertension has been seen as a global burden.

India alone has more than 140 million affected as of 2012

The number is predicted to increase to 214 million by 2030

Has caused more than 2.4 million deaths Estimated to cause 4 million deaths by 2030

Blood pressure Classification

• Normal <120 mm of Hg and <80 mm of Hg• Pre-Hypertension 120-139 mm of Hg or 80-89 mm of Hg• Stage I Hypertension 140-159 mm of Hg or 90-99 mm of Hg• Stage II hypertension >= 160 mm of Hg or>= 100 mm of Hg

Blood of Classification Systolic, mm of Hg Diastolic, mm of Hg

WHEN & WHY?

•When the normal regulatory mechanisms fail, it is only then that hypertension develops

•Hypertension is so dangerous because it is silent and does not give any warnings.

Factors influencing development of Hypertension

High Normal Blood pressure

Family History of Hypertension

Factors influencing development of Hypertension

Excess consumption of common salt (NaCl) Some segments of the populations are “Salt

Sensitive” because their blood pressure is affected by consumption of salt.

Factors influencing development of Hypertension

Alcohol Consumption

Factors influencing development of Hypertension

• Smoking

Factors influencing development of Hypertension

Obesity and Lack of Exercise

Less active individuals are 30-50% more likely to develop hypertension.

Factors influencing development of Hypertension

Other Factors:

PotassiumCalciumMagnesium

Complications of Hypertension

Hypertension

Stroke

Retinopathy

Renal Disease

Congestive HEART failure

•Hypertensive Retinopathy (Eyes)•Congestive Cardiac Failure and Myocardial Infarctions (Heart)•Hypertensive Nephropathy (Kidney)•Arteriosclerosis (Peripheral Arteries)•Cerebral Stroke (Brain)

Prevention is better than cure

•Maintain a healthy weight.•REDUCE WEIGHT if you are obese.•DO EXERCISE.•ABSTAIN from SMOKING & HEAVY DRINKING.•SAY NO to FAST FOODS.•Reduce the intake of Salt and Sodium in our diet. (< 2000 mg/day)

The DASH Diet

• The Dietary Approaches to Stop Hypertension Clinical trials

(DASH)

• Diets rich in fruits, vegetable and low fat dairy products can help reduce blood pressure in Hypertensive individuals

The DASH Diet includes• The DASH Diet includes:• 7-8 servings of grains and grain products• 4-5 servings of vegetables• 4-5 servings of fruits• 2-3 servings of low fat dairy products• 2 or less servings of meat, poultry and fish• 2-3 servings of fats and oils• Nuts, seeds and dry beans 4-5 times /week• Limited ‘sweets’ low in fat.

Reducing Sodium in diet

•Use fresh foods rather than canned food.•Even if you canned food, read if the label says “no salt added”.•Decrease the use of Table Salt.•Avoid too much sea food

Take Home Messages

SAY NO to?

• 1. SAY NO to SMOKING

•SMOKING KILLS..

3. SAY NO to ALCOHOL

2. SAY NO to FAST FOODS

4. SAY NO to EXCESS SALT

SAY YES to?

• 1. SAY YES to EXERCISE

2. SAY YES to HEALTHY FOOD

3. SAY YES to ROUTINE HEALTH CHECK-UPS

4. SAY YES to PRESCRIBED MEDICINES