Clinical Features of DM

8/6/2019 Clinical Features of DM

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DM: A clinical Syndrome

� Hyperglycemia� Insulin deficiency ± absolute or relative

� Abnormal metabolism of CHO, Fat, Protein

� Disturbance of water & electrolytes

� Acute metabolic decompensation

� Chronic morbidity ± Eye, Kidney, Nervous

System.



Ep idemiology & Disease Burden

� 2000 - 150 million world wide� 2010 - 300 million worldwide

� Type 2 : Type I = 7:3

Prevalence:

� 0.19 % below 20 years

� 8.6% above 20 years

� 20.1% above 65 years

� Equal in both sexes, slightly greater in men

above 60 yrs.



Classification of DM

� Based on Aetiology� Independent of Age of the individual

Typ e 1:

� 1A ± Immune destruction of B-Cells

� 1B ± Idiopathic destruction of B-Cells

Typ e 2



Other s p ecific Ty p es:- Ty p e 3M ODY

Pancreatic Disease- Fibrocalculous Pancreatopathy

- Pancreatitis, Cystic disease

- Pancreatectomy

Endocrinopathy - Insulin antagonist

- Cushing¶s Syndrome

- Acromegally

- Hyperthyroidism



Iatrogenic

- Corticosteroids, Thiazide, Phenytoin

Viral Infections

- Congenital rubella

- M umps

- Coxsackie ± B

Genetic Syndromes

- Down¶s Syndrome

- Turner¶s

- Klinefelter¶s

Gestational Diabetes



Presenting features of DMW ide Spectrum:

Asymptomatic ------------- Acute ComplnHigh Index of SuspicionClassical Symptoms of Hyperglycemia

Thirst, Dry mouthPolyuriaW eight loss/ W eight gainTiredness, fatigue, irritability, apathyBlurring of visionHyperphasiaPruritus Vulvae, balanitis, boils,



Clinical Ex amination

� No physical Signs except weight loss inType 1 D M

� Central obesity in 70% of type 2 D M

� HTN ± 50% of type 2 D M

� X anthelasma, Xanthemata

� Cataract

Target Organ Involvement.



Criteria for the Diagnosis of DM

� Symptoms of D M & Random plasma glucose

more than or equal to 200 mg per dl.

� Fasting Plasma glucose more than or equal to

126 per dl.Two hour plasma glucose equal or more than

200 mg per dl during an oral glucose Tolerance

Test



Im p aired Fasting Glucose ( IFG)

Fasting Plasma glucose: 100 ± 125 mg per dl.

Im p aired Glucose Tolerance (75 gm Glucose )

2 hr Post ± glucose plasma glucose: 140 ± 199

mg per dl.



Screening of DM

Why Screening?� Large number of asymptomatic D M

� Type 2 D M may be present for upto a decade

before diagnosis.

� 50% of type 2 D M have one or more diabetic

complication at the time of diagnosis

� Treatment of Type 2 D M may favourably alter the

natural history



Screen all above 45 yrs every 3 years

Screen high risk individuals at an earlier age

FM of type 2 D M

ObesityIFG or IGD or GD M

Hypertension, IHD, PVD, Dyslipidaemia



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Clinical Features of DM