Diabetes mellitus is a syndrome of multiple etiologies characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. This disorder is often associated with long term complications, involving organs like eyes, kidneys, nerves, heart and blood vessels. Types of diabetes According to the American Diabetes Association and the World Health Organisation, diabetes can be classified into four main types. Classification of Diabetes Type 1 diabetes Type 2 diabetes Gestational diabetes Other types of diabetes (Monogenic diabetes, pancreatic diabetes, drug-induced diabetes etc.) Goals for management Relief from symptoms of diabetes and improvement in quality of lifeGlycemic control and prevention of acute complicationsIdentification and management of comorbid conditions like obesity, hypertension and dyslipidaemiaPrevention of microvascular complications like retinopathy, neuropathy and nephropathyPrevention of macro-vascular complications like cardiovascular, cerebrovascular and peripheral vascular disease Prevention of infectionsThe complete treatment of people with diabetes requires advocating a healthy life style with focus on increased physical activity and a proper balanced diet in addition to prescribing medications. Diabetes Education Diabetes education means empowering people with diabetes with knowledge and providing tools crucial for making them active partners in the diabetes management team. These include: In-depth information about diabetes, its complications and treatment Appropriate self care skills Appropriate resources for self care A positive attitude Self monitoring skills The compliance of people with diabetes is essential for effective management of diabetes. Education programmes are intended to help people to understand why these actions are so important and thereby increase their motivation for self-management. Prevention of Diabetes There is an urgent need for strategies to prevent or at least slow down the emerging epidemic of diabetes apart from treating diabetes and associated complications. Several factors are thought to contribute towards the acceleration of the epidemic, the most important being the rapid epidemiological transition due to urbanization and life style changes. Identifying individuals at risk is essential in planning preventive measures. Prevention of diabetes has several windows of opportunities. Primordial prevention attempts to reduce the risk factors for diabetes, e.g., reducing or preventing obesity to reduce the future risk of diabetes. Primary prevention targets people who are in the stage of prediabetes to prevent the onset of diabetes. All people with prediabetes should be regularly screened and encouraged at each health care visit to pursue a healthy life-style, including a healthy diet, adequate exercise and weight control in order to prevent diabetes. Several studies including from India have shown that diabetes can be prevented in up to a third of people with prediabetes. When lifestyle alone is not sufficient and especially in those with combined IFG and IGT where progression to type 2 diabetes appear imminent, use of metformin in addition to lifestyle measures may be considered especially in Indians who progress rapidly to diabetes from the prediabetes stage. Secondary prevention is to prevent the onset of complications in those who are already diagnosed to have diabetes. This can be achieved by meticulous control of diabetes with the help of diet, physical activity, life style modification and antihyperglycaemic drugs as indicated. Control should include holistic care beyond glycemic control i.e. attention to blood pressure, lipids etc. Tertiary prevention of diabetes is aimed at limiting physical disability and rehabilitation measures in those who have already developed diabetic complications and preventing them from going into end stage complications of diabetes. Reference- According to ICMR 2018
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