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INTRODUCTION
Heterogeneous group of diseases, characterised by
hyperglycemia, resulting from a diversity of environmental
and genetic, acting jointly
Urine examination
Blood sugar testing
Urine examination
Urine test for glucose 2 hrs after meal
All with glycosuria are considered diabetic unless otherwise proved
by a standard oral glucose tolerance test
Studies confirm that glusoce is found in urine in only severe forms
of disease and not in milder forms and such cases are missed
Lack of sensitivity ( only 10-50%)
This means that many diabetic would have been missed if it is the
only test
ie it yields more false positives
Also glycosuria may be found in normal people too
This gives rise ti false positive
But specificity is 90% - so yeild of false positive nothigh
Finally- urine testing not an appropriate tool for case finding or
epidemiological surveys
BLOOD SUGAR TESTING
Because of inadequacies of urine examination standard oral glucose
test- remains cornerstone of diagnosis of diabetes
Mass screening programmes have used glucose measurements of
fasting, post-prandial or random blood sample
The measurement of glucose levels in random blood samples is
considered unsatisfactory for epidemiological use: at the most, it can
give only a crude estimate of the frequency of diabetes in a population
The fasting value alone is considered less reliable since true fasting
cannot be assured and spurious diagnosis of diabetes may more
readily occur
for epidemiological purposes, the 2-hour value after 75 g oral glucose
may be used either alone or with the fasting value
Automated biochemistry has now made it possible to screen
thousands of samples for glucose estimation.
TARGET POPULATION
Screening of the whole population for diabetes is not a rewarding
exercise
However, screening of "high-risk" groups is considered more
appropriate.
These groups are:
(i) those in the age group 40 and over
(ii) those with a family history of diabetes
(iii) the obese
(iv) women who have had a baby weighing more than 4.5 kg (or 3.5
kg in constitutionally small populations)
(v) women who show excess weight gain during pregnancy, and
(vi) patients with premature atherosclerosis.
PREVENTION AND CARE
Primary prevention
Population strategy
High risk strategy
Secondary prevention
Tertiary prevention
POPULATION STRATEGY
Glycosylated Hb
Self care
Home based blood glucose
SECONDARY PREVENTION
When diabetes is detected. it must be adequately treated.
Aims of treatment are :
to maintain blood glucose levels within the normal limits as is
practicable
To maintain ideal body weight.
Treatment is based on
(a) diet alone- small balanced meals more frequently,
(b) diet and anti diabetic drugs. or
(c) diet and insulin.
Good control of glucose protects against the development of
complications
SECONDARY PREVENTION