Home Health Diabetes: Unit 1: Definition & Epidemiology of Diabetes Mellitus

Diabetes: Unit 1: Definition & Epidemiology of Diabetes Mellitus

by Kedir Abdulatif


Objectives of Module
• Define key terms in diabetes and describe the
diagnostic criteria for DM
• Describe the global and regional
epidemiology of diabetes
• Describe the national epidemiology of
• Explain strategies for prevention of DM

Outline of presentation
• Introduction
• Definitions and Diagnosis of DM
• Epidemiology
• Screening and prevention of DM

Definition of Diabetes Mellitus
• Diabetes is defined by the World Health
Organization (WHO) as a metabolic disorder
characterized by chronic hyperglycemia
associated with disturbances of carbohydrate, fat
and protein metabolism resulting from defects in
insulin secretion, insulin action, or both.
• It is accompanied by a marked propensity to
develop relatively specific forms of renal, ocular,
neurologic, and premature cardiovascular

• Diabetes is diagnosed by laboratory
measurement of glucose or glycosylated
hemoglobin level in a blood sample.
Fasting blood glucose is likely to be the most
feasible measurement in primary health care

Diagnosis of Diabetes Mellitus
• Be Certain About Diagnosis
• Consequences – Considerable & Lifelong
• Hyperglycemia May Be Transitory
• In Asymptomatic individuals- At Least 2 Tests
• Do Not Make Diagnosis Based On Single
Elevation Of FBS.
– Exception – DKA & HHS
• Urine Glucose – not Recommended

• Impaired Glucose Tolerance (IGT): 140 < 2-hr PG < 200 mg/dl
• Impaired Fasting Glycemia (IFG): 100 < FBS < 126 mg/dl
Why is Prediabetes important?
√ Risk For Future Diabetes
√ Risk For Macrovascular Diseases

Hyperglycemia in Pregnancy

1. Gestational diabetes is defined as:
• Fasting plasma glucose ≥92 mg/dL, but <126 mg/dL in second and third trimesters
• 75 gram two hour oral glucose tolerance test (OGTT) with at least one abnormal result: fasting plasma glucose ≥92 mg/dL but <126 mg/dL or one hour ≥180 mg/dL or two hour ≥153 mg/dL .
– OGTT should be done at 24-28 weeks for pregnant women with or without risk factors.
2. Overt Diabetes (diabetes mellitus in pregnancy):
is made if standard non-pregnant criteria for DM
diagnosis are met at any gestational age.


• Diabetes is one of the largest global health
emergencies of the 21st century.
• Diabetes mellitus is in a state of global epidemic
affecting every country, every age group and
every economy across the world.
• According to the International Diabetes
Federation (IDF) year 2019 estimate, 9.3% of
the world population is having diabetes (it was
4.7% in 1980).

IDF Diabetes Atlas 9th Edition

• Currently, 463 million people aged between 20 and 79 years are estimated to have diabetes, majority of which (79%) is living in low and middle income countries. This is set to reach 700 million
people with diabetes by 2045
• In the year 2019, an additional 374 million people have impaired glucose tolerance (prediabetes) which are at high risk to develop the disease in the future.
Type 2 diabetes is the most prevalent form of diabetes accounting for more than 91 to 95% of adult with the disease.

IDF Diabetes Atlas 7th edition

• The incidence of type 1 diabetes among children is also increasing in many countries (3% annually), with total 1.1 million children and adolescents having type 1 diabetes in 2019 across the world.
• The proportion of undiagnosed diabetes is 50.1% globally, but varies among countries ,with highest estimate of 59.7% in Africa.
• Diabetes and its complications are major cause for early death in most countries, cardiovascular death being the leading cause in diabetic population.

IDF Diabetes Atlas 9th edition

PREVALENCE of DM in Sub-Saharan Africa…
• South Africa : 4.6 million,
• Ethiopia :1.7 million
• Democratic Republic of Congo :1.8 million,
• Nigeria :2.7 million and
• Nearly half of all adults with diabetes in the region live in these four countries.
• The African Region is estimated to have the highest future increase in the number of people with diabetes compared to other parts of the world

IDF Diabetes Atlas 9th edition

• There are few local data on the prevalence of diabetes in Ethiopia.
1. Ayder Hospial, Mekele 1.3%
2. Gondar and Dabat: 5.1% for urban and 2.1% for rural
3. Bank employees and teachers 6.5 %
4. National NCD STEPS Survey 2015 showed 3.2% of adults have diabetes.
5. The prevalence of IFG based on STEPS survey was 9.1%.

• IDF estimate 2015
– Diabetes is rising in Ethiopia.
• There were over 1.9 million cases of diabetes in Ethiopia in 2015 based on STEPS survey.
• WHO 2016 Report:
–Annually 11,000 men and 10,000 women die from diabetes or raised blood
sugar and its complications in Ethiopia

Reasons for Increase in Prevalence of DM
• Urban-rural migration
• Increasing Population
• Increasing Age
• Unhealthy Diet (high salt, fat & sugar; low vegetables
and fruits)
• Sedentary Life Style
• Obesity
• Smoking
• Stress
• Increased Alcohol Intake

1. Testing should be considered in all adults who are overweight (BMI>25 kg/m2 ) and have additional risk factors:
– physical inactivity
– first-degree relative with diabetes
– members of a high-risk ethnic population (Asians, native
– women who delivered a baby > 4kg or diagnosed as GDM
– Hypertension (BP ≥140/90mmHg or on therapy)
– HDL <35 mg/dl and or TG >250 mg/dl
– A1c >5.7 %, IGT, or IFG on previous testing
– history of CVD
– women with poly cystic ovarian syndrome

2. For all patients, testing should begin at age 45 years.
3. For children age 10yrs and above or at onset of
puberty whichever comes first: who are overweight
with any two (2) of the following
– DM in first or second degree relative
– Signs of insulin resistance (Acanthosis nigricans, severe obesity)
– Gestational Diabetes Mellitus in mother during child’s gestation
4. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.

Prevention or Delay of Type 2 Diabetes
• For those clients with initial results showing prediabetes, interventions to prevent or delay the onset of type 2 DM should be instituted because prediabetes will progress to Type 2 DM in about 25- 50% of individuals and it predisposes to
macrovascular complications like coronary heart disease, stroke and peripheral vascular disease.
• Intervention:
√ Delays the onset of diabetes,
√ Preserves beta cell function,
√ Prevents or delays microvascular and
cardiovascular complications.

Pharmacotherapy for
prevention of Type 2 DM
• Metformin therapy for prevention of type 2
diabetes should be considered in those with
prediabetes, especially in those with BMI >35
kg/m2, those aged <60 years, and women with
prior gestational diabetes mellitus.
• At least annual monitoring for the development of diabetes in those with prediabetes is suggested.
• Screening for and treatment of modifiable risk
factors for cardiovascular disease is suggested.



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