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World Health Organization : Technical Report Series, No. 646: World Health Organization Expert Commiltee on Diabeles Melliius

By K. Kosaka

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Book Id: WPLBN0000168294
Format Type: PDF eBook
File Size: 2.9 MB
Reproduction Date: 2005
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Title: World Health Organization : Technical Report Series, No. 646: World Health Organization Expert Commiltee on Diabeles Melliius  
Author: K. Kosaka
Volume:
Language: English
Subject: Health., Public health, Wellness programs
Collections: Medical Library Collection, World Health Collection
Historic
Publication Date:
Publisher: World Health Organization

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Kosaka, K. (n.d.). World Health Organization : Technical Report Series, No. 646. Retrieved from http://kindle.worldlibrary.net/


Description
Medical Reference Publication

Excerpt
1. INTRODUCTION Diabetes mellitus is a universal health problem affecting human societies at all stages of development. At least 30 million people are involved throughout the world, and the numbers of cases reported are increasing rapidly with the aging of populations, changes in lifestyle, and improvement in ascertainment. Although a more prominent health problem in developed countries, it is erroneous to consider diabetes a disease of affluent societies. Epidemiological studies indicate high rates universally, but little is known of the real extent of diabetes and its sequelae in developing countries. Mortality data grossly underestimate the real magnitude of the problem. In some societies obesity is a major association of diabetes; in others malnutrition is probably an important determinant; infection and toxic conditions are also believed to play a part, through mechanisms that are now being elucidated. Environmental determinants of diabetes interact with varying degrees and types of inherent susceptibility. Observation and research have shown that the state of diabetes mellitus may be arrived at by divers routes. Once established, environmental influences and genetic constitution again interact to determine the course and the complications of the disease. With increasing knowledge of the nature of susceptibility and better identification of pathogenic factors, the exciting possibility arises of preventing the disease. Fundamental to improved health for the diabetic is the coordination and integration of many social and medical skills for the provision of health care, research, and education. Diabetes is an example of a chronic disorder in which the affected person must take

Table of Contents
CONTENTS Page I . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2 . Definition. diagnosis and classification . . . . . . . . . . . . . . . . . . . . . 8 2.1 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.2 Diagnosis and diagnostic criteria . . . . . . . . . . . . . . . . . . . . . 8 2.3 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3 . Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.1 Natural history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.2 Prevalence. incidence and risk factors . . . . . . . . . . . . . . . . . . . 15 3.3 Mortality and cost of diabetes . . . . . . . . . . . . . . . . . . . . . . . 18 3.4 Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 4 . Causes and mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 4.1 Natural history of the B cell . . . . . . . . . . . . . . . . . . . . . . . . 21 4.2 Genetic mechanisms and specific markers . . . . . . . . . . . . . . . . 21 4.3 Acquired and environmental factors . . . . . . . . . . . . . . . . . . . 22 4.4 Relationship between geneticand environmental factors . . . . . . . . 25 4.5 Metabolic and endocrine disturbances . . . . . . . . . . . . . . . . . . 26 5 . Management of diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 5.1 Food . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 5.2 Insulin . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . 29 5.3 Oral hypoglycaemic agents . . . . . . . . . . . . . . . . . . . . . . . . 30 5.4 Other antidiabetic treatment . . . . . . . . . . . . . . . . . . . . . . . . 31 5.5 Resources required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 5.6 Acute metabolic problems . . . . . . . . . . . . . . . . . . . . . . . . . 32 5.7 Other metabolic problems . . . . . . . . . . . . . . . . . . . . . . . . . 33 5.8 Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . 34 5.9 Surgery and the diabetic . . . . . . . . . . . . . . . . . . . . . . . . . . 35 5.10 Diabetes in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 5.1 1 Diabetes in the elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 6 . Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 6.1 Pathogenic processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 6.2 Suggested causal mechanisms . . . . . . . . . . . . . . . . . . . . . . . 39

 

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