DIABETES MELLITUS

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Metabolic disorder characterized by hyperglycemia,

glycosuria, ketonemia and negative nitrogen balance

Responsible for morbidity, not only in the developed countries

but is gradually reaching epidemic proportions in the developing countries too population, especially in young adults, the prevalence of diabetes is also on the rise, hence diabetes has been redefined as diabesity or obesity dependent diabetes mellitus

With the increased prevalence of obesity in the general

As per International Diabetes Federation [IDF] Diabetes Atlas,

285 million people worldwide now suffer from diabetes

If the current rate of growth continues unchecked number is

expected to exceed 435 million in 2030

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Number of Cases with diabetes (20-79 years)

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S. No. 1 2 3 4 5 6 7 8 9 10

Country/Territory India China USA Russian Federation Brazil Germany Pakistan Japan Indonesia Mexico

2010 (Millions) 50.8 43.2 26.8 9.6 7.6 7.5 7.1 7.1 7.0 6.8
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2030 (Millions) 87 62.6 36.0 10.3 12.7 13.8 12.0 11.9

Universal symbol for diabetes

33

BLUE CIRCLE

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Diabetes Mellitus
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TYPE 1 DIABETES MELLITUS (T1DM)

55

T1DM which was previously encompassed by the terms

insulin-dependent diabetes, type 1 diabetes, or juvenileonset diabetes

Accounts for only 510% of the cases Cellular-mediated autoimmune destruction of the -

cells of the pancreas

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TYPE 2 DIABETES MELLITUS (T2DM)

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T2DM previously referred to as noninsulin dependent

diabetes, type 2 diabetes, or adult-onset diabetes

Accounts for approximately 9095% of diabetes cases The risk of developing T2DM increases with age,

obesity, and lack of physical activity

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GESTATIONAL DIABETES
77

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Complications of Diabetes Mellitus

88

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99

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10 10

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11 11

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12 12

NORMAL GLUCOSE UPTAKE

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13 13

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T1DM

14 14

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T2DM

Type-2 Diabetes Mellitus

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DIAGNOSIS OF DIABETES MELLITUS

Fasting

plasma

glucose

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test

(FPG;>126

mg/dl)
Oral glucose tolerance test (OGTT; >200

mg/dl 2 hr after glucose challenge) glycation of hemoglobin A (HbA1c levels).8

HbA1c has been considered as the gold
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Current drug therapies used for the management of T2DM

Class of drug
Sulfonylureas 1st generation

Drugs
Acetohexamide, Chlorpropamide, Tolbutamide, Tolazamide Glibenclamide, Glyburide, Glipizide

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Role
Insulin secretagogues Insulin secretagogues

2nd generation 3rd generation Meglitinides (Glinides) Biguanides Thiazolidinediones (PPAR agonists; Glitazones) Gliptins

Glimepiride

Insulin secretagogues

Repaglinide, Nateglinide Metformin, Phenformin Rosiglitazone, Pioglitazone, Sitagliptin, Saxagliptin

Insulin secretagogues

Insulin sensitizers Insulin sensitizers

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Insulin secretagogues

New Targets For The Management of T2DM

Target
Glycogen Synthase Kinase-3 (GSK-3) Inhibitors PPAR / dual agonist Na+ glucose co-transporter (SGLT) inhibitors

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Role
Activation of glycogen synthase Insulin sensitizers Inhibits renal glucose reabsorption from urine

HGO Inhibitors 3- Adrenoreceptor Agonist Retinoid X receptor Protein Tyrosine Phosphatase 1B (PTP 1B) inhibitors

Insulin sensitizers & decrease insulin resistance Decreases food consumption Controls lipid and carbohydrate metabolism Prevents dephosphorylation of activated insulin receptor

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Algorithm for the treatment of diabetes

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THANKS
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