Diabetes mellitus prevalence

Diabetes mellitus is defined as hyperglycaemia (fasting > 7 mM and/or 2 h postprandial >11.1 mM) due to absolute or relative lack of insulin. The most common forms are type 1 diabetes (prevalence 0.25%), with absolute lack of insulin, and type 2 diabetes (prevalence 4-6%) which is due to the combination of insulin resistance and insufficient insulin secretion. 

The prevalence of Type 2 Diabetes (T2D) is increasing world-wide and considered one of the main threats to human health in the 21st century. In 2010, 221 million patients are expected to be diabetic (compared to 151 million in the year 2000). The increase in diabetes prevalence is considered to be secondary to changes in human lifestyle accompanied by physical inactivity and unlimited food supply. Skeletal muscle insulin resistance, defined as the reduced response of skeletal muscle to a given dose of insulin, is a common finding in patients with type 2 diabetes mellitus and can be found before the onset and predict the development of the disease. Several factors determine skeletal muscle insulin sensitivity and among others alterations in fatty acid metabolism have been proposed. ... 

In the adult population, the prevalence of overt hypothyroidism is 19 per 1000 women and 1 per 1000 men with annual incidence of overt hypothyroidism is 4 per 1000 women and 0.6 per 1000 men. Subclinical hypothyroidism is also more common in women, the incidence increases with age, with up to 10% of women older than 60 years having an increased thyroid-stimulating hormone concentration. Subclinical hypothyroidism is more common in people who have been treated for hyperthyroidism with radioactive iodine or surgery, and in those with organ-specific autoimmune diseases, such as pernicious anaemia, type 1 diabetes mellitus, or Addison s disease. 

Diabetes mellitus (DM) is a chronic disorder characterized by altered metabolism of carbohydrates, proteins and fats. Epidemiological survey conducted in several developing countries show that prevalence rates of diabetes mellitus vary from two to four percent in different population groups. Roughly two percent of the world population suffers from diabetes mellitus. 

Over 5% of the population of western nations is afflicted with diabetes. TTie most prevalent form of diabetes, non-insulin-dependent diabetes mellitus (NIDDM, or type 11), is commonly associated with obesity and hypertension, and is believed to be the consequence of altered insulin action or insulin secretion (for review see Defronzo, 1988 Defronzo and Ferrannini, 1991). Insulin-dependent diabetes mellitus (IDDM, or type 1 diabetes) accounts for approximately 10% of all cases of diabetes. IDDM is characterized by specific destruction of insulin secreting /3-cells found in islets of Langerhans. Destruction of 80-90% of islet /3-cells causes insulin deficiency and the inability to regulate blood glucose levels. 

Since its isolation in 1921, insulin has been the object of an enormous amount of experimentation aimed at clarifying its mode of action. It is produced by the P cells of the pancreatic islets of Langerhans and released into the bloodstream in response to elevated glucose levels. Tire absence of insulin or of a normal response to insulin results in the condition of diabetes mellitus, which is the most prevalent human metabolic disorder (see Box 17-G).343... 

Because of the great complexity ot a number of the natural hormunes. conventional approaches of organic synthesis which have been used so successfully over the years in connection w uh many drugs have not proved viable to date with some of the hormones. Insulin is an example. Presently, millions of diabetics still depend upon animal insulin as extracted from the pancreatic glands of slaughtered pigs, If diabetes mellitus continues to become more prevalent, us it has over the past several years, natural sources may not be sufficient. 

In patients with chronic hepatic B or C the respective prevalences of pancreatic autoantibodies increased from 2% and 3% at baseline to 5% and 7% after interferon (544). In all, 31 published cases of type 1 diabetes mellitus attributed to interferon alfa treatment were detailed, mostly in patients with hepatitis C. Irreversible diabetes required permanent insulin treatment in all but eight cases. At least one marker of pancreatic autoimmunity was positive in nine of 18 patients before treatment, and in 23 of 30 patients at the onset of diabetes. In accordance with these results and the likelihood of a genetic predisposition, the authors recommended screening for islet cell and glutamic acid decarboxylase autoantibodies before and during interferon alfa treatment. However, owing to the low number of reported cases and the paucity of studies that have examined the relation between pancreatic autoimmunity and the occurrence of diabetes, further research on the predictive potential of such a systematic investigation is warranted. 

Glucose concentrations have been studied in 47 patients with non-responsive schizophrenia taking olanzapine (872). Three of them, who had taken olanzapine for 3-6 months, had persistently high blood glucose concentrations. However, this is similar to what would be expected on the basis of the prevalence of diabetes mellitus in US adults. 

In a pooled analysis of four randomized trials of tacrolimus versus ciclosporin after renal transplantation, the prevalence of post-transplant diabetes mellitus at 1 year (two studies, 532 patients) was five times higher with tacrolimus than with ciclosporin (OR = 5.0 95% Cl = 2.0, 12.4) (1094). In the opinion of the US FDA, diabetes mellitus after transplantation was a significant hazard in tacrolimus-treated patients, even though about half of the patients were no longer taking insulin at 2 years after transplantation (1095). 

The determination of blood glucose levels is an indispensable test for the exact diagnosis and therapy of many disorders, the most common of which is diabetes mellitus a condition that is estimated to affect over 170 milhon people worldwide, with prevalence rising rapidly [9]. 

Sridhar GR, Madhu K. Prevalence of sleep disturbances in diabetes mellitus. Diabetes Res Clin Pract 1994 23 183-186. 

Depression and Diabetes Mellitus. Patients with chronic medical illness have a high prevalence of major depressive disorder [59], Depression may be three times more prevalent in the diabetic population when compared with its occurrence in nondiabetic individuals [60], In addition, microalbuminuria, hypertension, and hyperinsulinemia are another three independent risk factors for cardiac disease in non-insulin-dependent diabetes mellitus (NIDDM) [61], Nosadini et al. showed that peripheral insulin resistance, hypertension, microalbuminuria, and lipid abnormalities are associated with NIDDM [61], Further, Helkala et al. determined that cognitive and memory dysfunction are associated with NIDDM and explored the disease s relationship with depression, metabolic control, and serum lipids. The results showed that the NIDDM patients had impaired control of their learning processes [62], Obviously, future research examining the causal relationship of depression to the onset on diabetes and the effect of depression on the natural course of diabetes is needed [60]. 

As mentioned earlier, there are a number of physiological disorders related to glandular hypofunction that require pharmacological intervention. However, the underlying principles of therapeutics are essentially the same. That is, determine the correct replacement dose and deliver the hormone in a manner that most accurately reproduces its normal physiological pattern of release. Among the endocrine replacement disorders, the most prevalent in the world is diabetes mellitus, which serves as our prototype. 

Meloni GF, Colombo C, La Vecchia C, et al. High prevalence of lactose absorbers in Northern Sardinian patients with type 1 and type 2 diabetes mellitus. Am J Clin Nutr. 73 582-585, 2001. 

Noninsulin-dependent (type 2) diabetes is the prevalent form of diabetes mellitus found in populations chronically exposed to inorganic arsenic from the environment (Rahman et al, 1998 Tseng, 2002). Type 2 diabetes is characterized by insulin resistance of internal organs and peripheral tissues that results in impaired glucose utilization, and, consequently, in abnormally high blood glucose levels between and especially after meals. Insulin resistance and P-cell dysfunction can be induced by chronic arsenic exposure and these defects may be responsible for arsenic-induced diabetes mellitus (Tseng, 2004). 

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39% in those of 40 years. Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14%). While the evidence is not conclusive, drug therapy is thought to underlie 25% of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H -receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly adrenoceptor blockers and thiazide diuretics. 

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