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INTRODUCTION
Diabetes Mellitus is a common metabolic disorder that is characterized by hyperglycemia. It is a chronic disease caused by multiple etiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
EPIDEMIOLOGY
ncreasing trend of diabetes prevalence throughout the world The recent World Health Organization (WHO) report on diabetes prevalence alarmed that diabetes has posed a serious threat to entire population of the world irrespective of stages of industrialization and development. The prevalence of diabetes for all age groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The number of diabetic population was estimated to rise from 171 million in 2000 to 366 million in 2030.
200 |
2003 |
| Ranking |
Country |
People with
diabetis (milion)
|
Country |
People with
diabetis (milion)
|
1 |
|
31.7 |
India |
79.4 |
2 |
|
20.8 |
China |
42.3 |
3 |
|
17.7 |
U.S |
30.3 |
4 |
|
8.4 |
Indonesia |
21.3 |
5 |
|
6.8 |
Pakistan |
13.9 |
6 |
|
5.2 |
Brazil |
11.3 |
7 |
|
4.6 |
Bangladesh |
11.1 |
8 |
|
4.6 |
Japan |
8.9 |
9 |
|
4.3 |
Philipian |
7.8 |
10 |
|
3.2 |
Egypt |
3.7 |
Table 1: List of countries with the estimated cases of diabetes for 2000-2030
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Increasing trade of diabetes prevalence in Bangladesh
In 2000, Bangladesh had 3.2 million people with diabetes and was listed at 10, which will occupy the 7th position with 11.1 million in 2030 (table-I). Diabetes registry in the referral centers and diabetes survey at the community level reflects the rapid increase of diabetes prevalence in the country. For example, only 389 diabetic subjects were registered at BIRDEM, a referral center, throughout the year 1960. This figure increased to 1181, 2363, 9641 & 15188 in the year 1970, '80, '90 and 2000, respectively. This increasing frequency of diabetes registry appears to be either increasing awareness of diabetes among people or real increase in diabetes prevalence in the community. |
AETIOPATHOGENESIS
Diabetes mellitus results from defects in insulin secretion, insulin action, or both. Several pathogenic processes are involved in the development of diabetes. The basis of the abnormalities in carbohydrate, fat and protein metabolism in diabetes is deficient action of insulin on target tissues.
categories. In one category, Type 1 diabetes, there is an absolute deficiency of insulin secretion. Individuals at risk for Type I DM can often be identified by the serological evidence of an autoimmune pathologic processes occurring in the pancreatic islets of Langerhans and by genetic markers. In the other, much more prevalent category, Type 2 DM, the cause, as previously mentioned, is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response. In this type of diabetes, a degree of hyperglycaemia sufficient to cause pathologic and functional changes in various target tissues, but without clinical symptoms may be present for a long time before diabetes is detected. During this asymptomatic period, it is possible to demonstrate an abnormality in the carbohydrate metabolism, by measuring the plasma glucose in the fasting state or after oral glucose load.
CLASSIFICATION
The current classification proposed in report of a WHO Consultation (1999) includes both clinical stages and etiological types of diabetes mellitus (Table 2). The clinical stages describe that diabetes regardless of its etiology, progresses through several clinical stages during its natural
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