Diabetes Mellitus

Classification of Diabetes

1. Insulin dependent diabetes mellitus (IDDM)
2. Non-insulin dependent diabetes mellitus (NIDDM)
   1. Non-obese
   2. Obese
3. Other types of diabetes mellitus related to:
   1. Pancreatic disease/surgery
   2. Other endocrine disorders e.g. Cushing's Disease
   3. Iatrogenic disease (Drugs and chemically induced)
   4. Certain genetic syndromes e.g. Maturity Onset Diabetes in the Young (MODY) which is dominantly inherited
   5. Miscellaneous causes

Commonly the main types of diabetes are referred to as Type I and Type II

Type I - Juvenile diabetes mellitus

Type II - Late onset diabetes (Non-obese or Obese)

Prevalence in the UK

UK General population 1.01%
Over 65 years 3.5%

This would equate to 20-25 diabetic patients for a General Practitioner with 2500 patients and to 2,500 diabetic patients for a District General Hospital area with 250,000 patients.

Indian population
Living in India prevalence is not very different from the general UK population	Living in the UK, 3.8x higher than for European population. From 4-64 years 5 x.   Percentage of population 50-59 8% 60-69 12%

How important are the disabilities?

Overall disability rate in diabetes 2-3x higher than non-diabetics

USA 25% of all patients reaching end-stage renal failure requiring dialysis or transplantation are diabetics.

Diabetes is the single most common cause of blindness in UK

Gangrene of the lower limbs requiring amputation is 20-30 times more common in diabetics than in non-diabetics.

Ocular manifestations in diabetes mellitus

Early

1. Transitory refractory changes
2. Diabetic cataract

Late

1. Accelerated senile cataract
2. Diabetic retinopathy and its complication
3. Oculomotor palsies

Complications of diabetic retinopathy

1. Maculopathy
2. Vitreous haemorrhage/membrane formation
3. Traction retinal detachment
4. Rubeotic glaucoma

References

Hill RD. (1987) Diabetes Health care: A guide to the provision of health care services. London: Chapman & Hall.