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Epidemiology of Diabetes Mellitus

Epidemiology of Diabetes Mellitus. b y Santi Martini Departemen of Epidemiology Faculty of Public Health University of Airlangga. Pathophysiology of Diabetes.

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Epidemiology of Diabetes Mellitus

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  1. Epidemiology of Diabetes Mellitus by Santi Martini Departemen of Epidemiology Faculty of Public Health University of Airlangga

  2. Pathophysiology of Diabetes type 1, which results from autoimmune beta-cell destruction in the pancreas and is characterizedby a complete lack of insulin production; type 2, which develops whenthere is an abnormal increased resistanceto the action of insulinand the body cannot produceenough insulin to overcome the resistance; gestational diabetes, which is aform of glucose intolerance thataffects some women during pregnancy; and a group of other types of diabetescaused by specific genetic defectsof beta-cell function or insulin action,diseases of the pancreas, or drugs or chemicals

  3. the new diagnostic criteria for type 2 diabetes are as follows: (ADA Revisions, Diabetes Care, Suppl, January 2010) • An A1c level of 6.5% or more. • Fasting plasma glucose level of 126 mg/dL or more. • A 2-hour plasma glucose level of 200 mg/dL or more after a 75-g oral glucose tolerance test. • 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.

  4. Tabel1. Kriteria Diagnosis Diabetes Mellitus

  5. 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)

  6. (Sumber: Laporan Riskesdas, 2008)

  7. Mortality Overall, the risk of death among peoplewith diabetes is almost twice thatof people of similar age who do nothave diabetes. Duration of diabetesalso 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 diseaseand stroke. The risk for cardiovasculardisease mortality is 2 to 4times higher in people with diabetesthan in people who do not have diabetes.

  8. (Sumber: Riset Kesehatan Dasar, 2007)

  9. Risk factors fortype 1 diabetes family history, race (with whites at higher riskthan other racial or ethnic groups), certain viral infections duringchildhood.

  10. Risk factors for type 2diabetes • Nonmodifiable 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 factorsinclude: • 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

  11. Complications Microvascular complications:- nervous system damage (neuropathy),- renal system damage (nephropathy) and - eye damage (retinopathy) Macrovascular complications: - cardiovascular disease, stroke, peripheral vascular disease. Peripheral vascular disease may lead to bruises or injuries that donot heal, gangrene, and, ultimately, amputation.

  12. Control of Risk Factors toReduce 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 bloodpressure can reduce that person’srisk for any diabetic complication byup to 12%; and control of serum lipidscan reduce that person’s risk for cardiovascular complications by 20% to 50%. Clearly, better control ofthese risk factors in people with diabetescan lead to more favorable outcomes.

  13. Burden to the Health Care System • the estimated costs associated with diabetes in the UnitedStates 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 costof diabetes in the United States is duedirectly to inpatient care for treatment of diabetes complications

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