By Dr. Sk Sabir Rahaman, MBBS, MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD
⚖️ 1. What is Diabetes Mellitus?
Diabetes is a chronic metabolic disorder characterized by high blood glucose levels due to defects in insulin secretion, insulin action, or both.
Types of Diabetes:
Type 1 Diabetes: Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency
Type 2 Diabetes: Insulin resistance + relative insulin deficiency
Gestational Diabetes: Hyperglycemia first detected during pregnancy
Others: MODY, pancreatic diabetes, drug-induced diabetes
📊 2. Global and Indian Scenario
Over 537 million adults globally have diabetes (IDF 2021)
India has >77 million diabetics, projected to be 134 million by 2045
Known as the "Diabetes Capital of the World"
📊 3. Risk Factors
Non-modifiable: Age >45, genetics, ethnicity
Modifiable: Obesity, sedentary lifestyle, poor diet, stress, smoking, alcohol
🔎 4. Diagnosis of Diabetes
| Test | Diagnostic Criteria |
|---|---|
| Fasting Plasma Glucose (FPG) | ≥ 126 mg/dL |
| 2-hr OGTT (75g) | ≥ 200 mg/dL |
| HbA1c | ≥ 6.5% |
| Random Plasma Glucose | ≥ 200 mg/dL + symptoms |
Prediabetes:
FPG: 100-125 mg/dL
HbA1c: 5.7-6.4%
🚑 5. Clinical Features
Polyuria, polydipsia, polyphagia
Weight loss (Type 1)
Fatigue, blurred vision
Recurrent infections, delayed wound healing
In Type 2: Often asymptomatic for years
🔬 6. Investigations and Monitoring
HbA1c: Glycemic control (3-month average)
Lipid profile, renal function, urine microalbumin
Fundus exam, foot exam, ECG
🧳 7. Complications
Acute:
Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycemic state (HHS)
Hypoglycemia
Chronic:
Microvascular: Retinopathy, nephropathy, neuropathy
Macrovascular: CAD, stroke, PVD
🩺 8. Treatment Overview
Type 1 Diabetes:
Requires insulin therapy for life
Blood glucose monitoring
Diet + exercise + education
Type 2 Diabetes:
Lifestyle modification: Diet, weight loss, physical activity
Oral hypoglycemics:
Metformin: First-line
Sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 agonists
Insulin: In advanced disease or poor control
Gestational Diabetes:
Diet, insulin if needed, post-partum follow-up
📌 9. Targets in Diabetes
| Parameter | Target |
| FPG | 80-130 mg/dL |
| PPG | <180 mg/dL |
| HbA1c | <7% (individualized) |
| BP | <140/90 mmHg (or <130/80) |
| LDL | <100 mg/dL (or <70 in CVD) |
🏥 10. Role of Family Physicians
Early detection & screening
Lifestyle counseling
Rational drug prescribing
Preventing complications
Referral when necessary
🔄 11. Lifestyle and Preventive Strategies
30 mins/day brisk walking
Balanced low-calorie diet
Avoid sugar-rich & fried foods
Quit smoking & alcohol
Regular check-ups
🖊️ 12. Conclusion
Diabetes is not just a disease but a lifestyle challenge. It requires multidisciplinary, continuous care. With proper screening, early intervention, lifestyle change, and individualized treatment, we can delay complications and improve quality of life.
“Empowering patients through education is the cornerstone of diabetes care.”
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