According to WHO, diabetes is a
chronic disease that occurs either when the pancreas does not produce enough
insulin or when the body cannot effectively use the insulin it produces 1.
Diabetes is a group of metabolic diseases characterized by increase in blood
glucose level resulting from defects in insulin secretion, insulin action, or
both 2. Diabetes mellitus is a generally and clinically heterogeneous group
of disorders that share glucose intolerance in common 3.
Diabetes Mellitus is one of the four
most prevalent Non Communicable Diseases (NCDs)4. It is estimated to account
for approximately 1.5 million deaths in 2012, with more than 80% of diabetes-related
deaths occurring in low- and middle-income countries 1. Relative to
neighboring countries such as Pakistan, Sri Lanka, and Bangladesh, Nepal has a
higher prevalence of type II diabetes mellitus and impaired glucose tolerance5.
According to WHO , there is no exact data of patients with diabetes in Nepal
but 2016 Diabetes profile has shown that 9.1 % Nepali population are living
with diabetes. It includes 10.5% men and 7.9 % women.himalyan tyms.
Disease diabetes Mellitus ranges from
autoimmune destruction of ?-cells of pancreas with insulin deficiency to
abnormalities like resistance to insulin action2.
Diabetes Mellitus has been
classified by the American Diabetes Association (ADA into four categories. They
1. Type I or insulin-dependent diabetes
2. Type II or non-insulin-dependent
diabetes mellitus (NIDDM)
3. Type III diabetes
4. Gestational diabetes
I or insulin-dependent diabetes
mellitus (IDDM) is also known as
juvenile diabetes as it emerges in juveniles 3. This form of diabetes,
accounts for only 5–10% of those with diabetes, results from a cellular
mediated autoimmune destruction of the ?-cells of the pancreas2. It is
characterized clinically by abrupt onset of symptoms, dependence on injection insulin
to sustain life and proneness to ketosis3. Type I diabetes mellitus patients
are prone to complications such as nephropathy, retinopathy and neuropathy.
IDDM appears to be heterogeneous in terms of genetic and environmental factors;
genetic determinants are important for the association of increasing and
decreasing frequency of histocompatibility antigens (HCA) on chromosome 63.
These patients are also prone to other autoimmune disorders such as Graves’
disease, Hashimoto’s thyroiditis, Addison’s disease, vitiligo, celiac sprue,
autoimmune hepatitis, myasthenia gravis, and pernicious anemia7.
Idiopathic diabetes: Some forms of
type 1 diabetes have no known etiologies. These patients have permanent
insulinopenia and are prone to ketoacidosis, but have no evidence of
autoimmunity 8. Individuals with this form of diabetes suffer from episodic
ketoacidosis and exhibit varying degrees of insulin deficiency between episodes
9. This form of diabetes is strongly inherited, lacks immunological evidence
for ?-cell autoimmunity, and is not Human leukocyte antigen (HLA) associated
II or Non-insulin dependent diabetes
mellitus (NIDDM) . It accounts for approximately 90–95% of those with diabetes.
It results from relative insulin deficiency and/or insulin resistance. It has a
genetic basis; appears to be stronger than in IDDM, as evidenced by a more
frequent familial pattern of occurence 3. It frequently presents with minimal
or no symptoms referable to the metabolic aberrations of diabetes 11.
Environmental factors superimposed on genetic susceptibility are undoubtedly
involved in onset of NIDDM types 3. Intake of excessive calories leads to
weight gaining and obesity which is an important factor in the pathogenesis of
NIDDM types 3. Patients with this type of diabetes are obese (60% to 90% of
all NIDDM population 3), and the obesity itself causes some degree of insulin
resistance 11-12. Ketoacidosis occasionally occurs and it is usually seen in association with the stress of another illness
such as infection. 13-15 This type of diabetes often goes undiagnosed for
many years as hyperglycemia develops gradually and at its earlier stages it is
not severe enough for patients to notice any of the classic symptoms of
diabetes. 15-18 .With this type of diabetes insulin levels may appear normal
or elevated, the higher blood glucose levels in these diabetic patients would
be expected to result in even higher insulin values if their ?-cell function is
normal. 19 .Age, obesity, and lack of physical activity increases the risk of
developing this form of diabetes. 20, 21 It occurs more frequently in women
with prior gestational diabetes mellitus (GDM) and in individuals with hypertension
or dyslipidemia, 22 and frequency varies in different racial ethnic subgroups.
22-25.It is often associated with a strong genetic predisposition, more so
than is the autoimmune form of type 1 diabetes. 25, 26
III diabetes,Alzheimer’s disease and it
results from resistance to insulin in the brain. 27 Some researchers have
shown resistance to insulin and insulin-like growth factor as a key factor of
the progression of Alzheimer’s disease. 28 Alzheimer’s can show progress without
the presence of significant hyperglycemia in the brain. 29
Gestational diabetes mellitus (GDM),another
category of diabetes which is defined as any degree of glucose intolerance that
was first recognized during pregnancy, regardless of whether the condition may
have predated the pregnancy or persisted after the pregnancy. 2
Various symptoms of diabetes
mellitus include polyuria, polydipsia, glycosuria, weight loss, sometimes with
polyphagia, and blurred vision.30 Impairment of growth, susceptibility to
certain infections, numbness or tingling in the extremities, are also seen. 31
Hyperglycemia with ketoacidosis or the non-ketotic hyperosmolar syndrome are
acute, life-threatening consequences of diabetes. 30 Tiredness and slow wound
healing is also experienced by the patient. 32
There are various diagnostic tools
to monitor the glycemic level in type 2 diabetes mellitus (DM2). These tools
include FPG (fasting plasma glucose) ADA and glycosylated hemoglobin A1c
(HbA1c) 33. The reference range of FPG is