EPIDEMOLGY ASSIGNMENT ON DM

BY
1. Abdusatar Hussien
2. Bidika Mitiku
3. Gifty B/meskel
4. Israel Mengistu
5. Selam Muluneh
6. Yodit Aklilu
Submitted to Dr. Habtamu Kebede

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 Table of content

❖ Introduction
❖ Literature
❖ Risk factor
❖ Activities being undertaken to control the disease
❖ Levels of prevention
❖ Conclusion
❖ Recommendation
❖ Reference

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Introduction
Diabetes comprises many disorders characterized by hyperglycemia. According to
the current classification there are two major types: type 1 diabetes (T1DM) and
type 2 diabetes (T2DM).
The distinction between the two types has historically been based on age at onset,
degree of loss of β cell function, degree of insulin resistance, presence of
diabetes-associated auto antibodies, and requirement for insulin treatment for
survival. However, none of these characteristics unequivocally distinguishes one
type of diabetes from the other, nor accounts for the entire spectrum of diabetes
phenotypes.
There are several reasons for revisiting the diabetes classification. Firstly, the
phenotypes of T1DMand T2DM are becoming less distinctive with an increasing
prevalence of obesity at a young age, recognition of the relatively high proportion
of incident cases of T1DM in adulthood and the occurrence of T2DM in young
people. Secondly, developments in molecular genetics have allowed clinicians to
identify growing numbers of subtypes of diabetes, with important implications for
choice of treatment in some cases. In addition, increasing knowledge of patho
physiology has resulted in a trend towards developing personalized therapies and
precision medicine. Unlike the previous classification, this classification does not
recognize subtypes of T1DM and T2DM, includes new types of diabetes (“hybrid
types of diabetes” and unclassified diabetes”), and provides practical guidance
to clinicians for assigning a type of diabetes to individuals at the time of diagnosis.

Diabetes: Definition and diagnosis

The term diabetes describes a group of metabolic disorders characterized and

identified by the presence of hyperglycemia in the absence of treatment. The
heterogeneous aetio-pathology includes defects in insulin secretion, insulin action,
or both, and disturbances of carbohydrate, fat and protein metabolism.

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The long-term specific effects of diabetes include retinopathy, nephropathy and
neuropathy, among other complications. People with diabetes are also at increased
risk of other diseases including heart, peripheral arterial and cerebrovascular
disease, obesity, cataracts, erectile dysfunction, and nonalcoholic fatty liver
disease. They are also at increased risk of some infectious diseases, such as
tuberculosis. Diabetes may present with characteristic symptoms such as thirst,
polyuria, blurring of vision, and weight loss. Genital yeast infections frequently
occur. The most severe clinical manifestations are ketoacidosis or a non-ketosis
hyperosmolar state that may lead to dehydration, coma and, in the absence of
effective treatment, death. However, in T2DM symptoms are often not severe, or
may be absent, owing to the slow pace at which the hyperglycemia is worsening.
As a result, in the absence of biochemical testing, hyperglycemia sufficient to
cause pathological and functional changes may be present for a longtime before a
diagnosis is made, resulting in the presence of complications at diagnosis. It is
estimated that a significant percentage of cases of diabetes (30–80%, depending on
the country) are undiagnosed. Four diagnostic tests for diabetes are currently
recommended, including measurement of fasting plasma glucose; 2-hour (2-h)
post-load plasma glucose after a 75 g oral glucose tolerance test (OGTT); HbA1c;
and random blood glucose in the presence of signs and symptoms of diabetes.
People with fasting plasma glucose values of ≥ 7.0 mmol/L (126 mg/dl),2-h post-
load plasma glucose ≥ 11.1 mmol/L(200 mg/dl) (5), HbA1c ≥ 6.5% (48
mmol/mol); or a random blood glucose ≥ 11.1 mmol/L (200 mg/dl) in the presence
of signs and symptoms are considered to have diabetes . If elevated values are
detected in asymptomatic people, repeat testing, preferably with the same test, is
recommended as soon as practicable on a subsequent day to confirm the diagnosis.
A diagnosis of diabetes has important implications for individuals, not only for
their health, but also because of the potential stigma that a diabetes diagnosis can
bring may affect their employment, health and life insurance, driving status, social
opportunities, and carry other cultural, ethical and human rights consequences.

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Literature review
Globally, an estimated 422 million adults were living with diabetes in 2014,
compared to 108 million in 1980.
The Prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995
and to rise to 5.4% by the year 2025. It is higher in developed than in developing
countries. The number of adults with diabetes in the world will rise from 135
million in 1995 to 300 million in the year 2025. The major part of this numerical
increase will occur in developing countries. There will be a 42% increase, from 51
to 72 million, in the developed countries and a 170% increase, from 84 to 228
million, in the developing countries. Thus, by the year 2025, >75% of people with
diabetes will reside in developing countries, as compared with 62% in 1995. The
countries with the largest number of people with diabetes are, and will be in the
year 2025, India, China, and the U.S. In developing countries, the majority of
people with diabetes are in the age range of 45–64 years. In the developed
countries, the majority of people with diabetes are aged ≥65 years. This pattern
will be accentuated by the year 2025. There are more women than men with
diabetes, especially in developed countries. In the future, diabetes will be
increasingly concentrated in urban areas.
The global estimate of the number of diabetics in Africa was approximately 12
million people (adults of age group 20-79 years) in 2010 and the expectation is that
by 2030, about 23 million Africans will be diabetes.
No population-based prevalence study exists in Ethiopia but from hospital-based
studies it can be seen that the prevalence of diabetes admission has increased from
1.9% in 1970 to 9.5% in 1999 of all medical admissions. WHO estimated the
number of diabetics in Ethiopia to be about 800,000 cases by the year 2000, and
the number is expected to increase to 1.8 million by 2030.
All the Regional hospitals and one of the health centers were running established
diabetic referral clinics. Similarly, a lack of professionals was observed in all the
health institutions in general and the health centers in particular. Only 21% of
patients had access for blood glucose monitoring at the same health institutions.

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The emphasis given for diabetic education (24%) was less than expected. Only 11
(5%) of diabetic patients were able to do self-blood glucose monitoring at home.
Fifty one percent of patients didn't have urine analysis, BUN, creatinine and lipid
profile in the previous 1-2 years. None of diabetic patients had hemoglobin Alc
(HbA1c) determination. Nearly75% of the patients required admissions directly or
indirectly due to uncontrolled diabetes. About 87% of the diabetics had regular
follow ups at their respective health centers and hospitals. Hypertension (34%),
diabetes related eye disease (33%) and renal disease (21%) were the major
associated illnesses observed among the diabetics. Sixty-six patients (23%) had a
total of about 131 admissions. Although there is a well-established health
infrastructure for diabetic care in Addis Ababa, the diabetic care is below the
acceptable standard. (yeweynhareg and fekrie, 2005)

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Risk factors for Diabetes
Risk factors for type 1 diabetes include:
• Family history: having a parent or sibling with type 1 diabetes increase
the risk of a person having the same type. If both parents have type 1
diabetes, the risk is even higher.
• Age: type 1diabetes usually develops in younger adults and children. It is
one of the most common chronic conditions that develop in childhood.
Children are typically younger than 14 yrs old when they receive a
diagnosis. Type 1 diabetes might occur at any age, although developing
type 1 diabetes later in life is rare.
• Genetics: having specific genes may increase the risk of type 1 diabetes.

Type 2 diabetes is the most common form of diabetes. In type 2, the body can
still make some insulin but is not able to use the hormone as effectively as it
should. Insulin usually allows cell can become less sensitive to insulin, leaving
more sugar in the blood, if blood sugar is permanently high; a person may have
developed type2 diabetes.

An increase in blood sugar can lead to damage in the body. Type 2 diabetes often
moves through a stage called pre diabetes during which a person can reverse the
progress of the condition with healthful lifestyle choices.

Unlike type 1 diabetes, people often treat type 2 with oral, non-insulin medications.
However, insulin injections may still be necessary if type 2 diabetes does not
respond to these alternatives.

There are various risk factors for type 2 diabetes, some of which people cannot
avoid, including:

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 • Are overweight or obese
• Are age 45 or older
• Have a family history of diabetes
• Have high blood pressure
• Have a low level of cholesterol or high level of triglycerides
• Have a history of gestational diabetes
• Are not physically active
• Have a history of heart disease or stroke
• Have depression
• Impaired glucose tolerance (IGT)

Risk factors of gestational diabetes include:

• A family or personal history of diabetes
• Pre diabetes
• Previous, unexplained stillbirths
• Being overweight or obese
• Unhealthful diet

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 Activities being undertaken
To control the disease

Ethiopia has been challenged by the growing magnitude of non-communicable

disease; it causes 42% of deaths, of which 27% are premature deaths before the age
of 70. Ethiopia is among the top four countries with the highest adult diabetic
population in sub-Saharan Africa. To control diabetes mellitus both ministry of
health and Ethiopian diabetic association are working on multi task programs.
Ethiopian diabetic association was established on January23, 1984G.C (1976 E.C)
with a total of 100-180 members for the purpose of providing a forum to diabetes
patients so that they can discuss ways of prevention, the provision of the
information and treatment for all affected by diabetes.
It is created by members of Ethiopian medical association, some physicians and
individuals who have diabetes mellitus. It has 28 branches all over the country with
total member of over 8000 and mainly work on type 1 DM patient. Its objective is
to empower diabetic patients, their families and the wider public through up to date
information on diabetes prevention care and the right kind of treatment. It strives to
see the positive change in the lives of all people affected by the condition.

It is working to control the current burden of the disease by

➢ Provision of medicine to its very poor members based on donations secured.

Medicines such as insulin or tablets are given for free for those who are
found in the lower income group of society.
➢ It gives screening service for diabetic retinopathy
➢ It supplies glucometer, lanset and strips for free
➢ Prepares an educational gathering very month given by professionals and
volunteers to create awareness.

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 ➢ Prepares educational magazines and leaflets twice a year.
➢ November 14 is celebrated each year as the United Nations diabetes day and
EDA celebrate it colorfully with its supporters and sponsors.
➢ It has 3306 <18 year old members and planned to include type 2 DM
patients.
➢ Collaborate with cuamm organization that work on both Dm and
hypertension.
➢ Do screening by organizing campaigns.
➢ Work with 6 regional hospitals to treat diabetic retinopathy.

The ministry of health of Ethiopia works on DM through its disease control and
prevention center by
➢ Providing testing equipment to the level of health centers
➢ By making treatments available in every health sector to the level of health
centers with low cost
➢ Providing diabetic educational books and giving education on waiting area
for patients who come for follow up
➢ Do screening by organizing campaigns
➢ Create awareness through social media, events and programs
➢ Celebrate worlds national DM day
➢ Doing researches to know the burden and to construct effective control
mechanism
➢ Work with international diabetic federation and other sectors to get updates
on treatments and control strategies
➢ Screening of complications with low cost

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Levels of prevention
Type 1 diabetes cannot be prevented with current knowledge. Effective approaches
are available to prevent type 2 diabetes and to prevent the complications and
premature death that can result from all types of diabetes.

Primordial prevention
Organizing events for Awareness creation, celebration of world DM day and Mass
sport.

Primary prevention

For primary prevention of NIDDM to be successful, we need to address the

causative factor or factors in its etiology. The primary prevention of NIDDM could
theoretically be achieved by genetic or environmental manipulation. Realistically,
gene therapy is unlikely to be successful in such a polygenic disorder. A much
more likely approach to the primary prevention of NIDDM is through lifestyle
changes that favorably influence insulin sensitivity and insulin secretary capacity.
These changes would include the avoidance of obesity, increased physical activity,
dietary modification and optimization of the intrauterine environment the
avoidance of obesity is an important primary Preventive measure for reducing the
prevalence and Delaying the onset of NIDDM within the general Population.

Secondary prevention

In addition to the lifestyle changes essential for primary prevention, secondary

prevention is the prevention of diabetic complications through the optimization of
glycemic control, and the avoidance and treatment of coexisting risk factors.
For optimal impact secondary prevention needs to begin at the biochemical
presentation as opposed to the clinical presentation. The treatment and avoidance
of hypertension, microalbuminuria, dyslipidemia and cigarette smoking are
theoretically important secondary preventative strategies for lessening diabetic
complications. Achieving optimal glycemic control has proven benefits in reducing
the development and progression of microvascular complications.

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Tertiary prevention

Tertiary prevention is the early detection and treatment of diabetic complication.

This includes the screening for diabetic retinopathy, nephropathy, cardiovascular
and peripheral vascular diseases.

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Conclusion

Diabetes and associated complications in Ethiopia are major causes of

morbidity and mortality with consequential economic impact.

There are no simple solutions for addressing diabetes but coordinated,

multicomponent intervention can make a significant difference. Everyone
can play a role in reducing the impact of all forms of diabetes.
Governments, health-care providers, people with diabetes, civil society,
food producers and manufacturers and suppliers of medicines and
technology are all stakeholders. Collectively, they can make a significant
contribution to halt the rise in diabetes and improve the lives of those
living with the disease.

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Recommendation
The recommendations include screening, diagnostic, and therapeutic action
that are known or believed to favorable affect health out comes of patient
with diabetes. Many of these interventions has also been shown to be cost
effective.

American diabetic association also sets standards of medical care in diabetes.

• Frequent blood sugar determination
• Improving the availability of essential drugs
• Strengthening diabetic education for primary secondary and tertiary
prevention of DM
• Improving the number of health professionals and provide trainings on
diabetic care.

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Reference

Hilary King, MD, DSC, Ronald E Aubert, PHD and William H Herman, MD
MPH. (1998)G lobal burden of diabetes, 1995-2025: prevalence numerical
estimates, and projections: American Diabetes Association.
Sarpong C, Nsiah K, Mensah F. O, Agyeman-Duah E, Ahmed F.D. Prevalence of
the complications of diabetes in developing countries. Ghana: Arch clin biomed
Res 2017; 1(5).
Yeweyn hareg Feleke and fekre Enquselasie. (2005). an assessment of the health
care system for diabetes in AA. Ethiop.J.Health Dev.19 (3).
N Abebe, T Kebede, and D Addise. Diabetes in Ethiopia 2000-2016: prevalence
and related acute and chronic complications; a systematic review.
WHO guideline on DM 2019
Up-to date 21.6
International diabetes federation. Diabetes Atlas. IDF.7th edn.2015

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