ABSTRACT
DEFINITION Diabetes mellitus is a chronic, progressive disease characterised by a raised blood ➤ glucose level.
PATHOLOGY Type I: insulin insuffi ciency results from autoimmune destruction of insulin-➤ secreting pancreatic β-cells. Type II: results from defects in insulin secretion or insulin insensitivity. ➤
STATISTICS Aff ects more than 2 million of the UK population (Type I 15%, Type II 85%). ➤ One of the most common chronic diseases aff ecting older people. ➤ Incidence is increasing in all age groups (projected rise of more than 40% by ➤ 2023). Prevalence rises with age (over 65 years: 1 in 20; over 85 years: 1 in 5). ➤ High rates of hospitalisation with long lengths of stay. ➤ An independent risk factor for admission to a care home. ➤ Most older people have Type II diabetes. ➤ More common in certain ethnic groups (South Asian, African, Afro-Caribbean ➤ and Middle Eastern). Diabetes care is costly – £4.9 billion/year (9% of total NHS budget). ➤
DIAGNOSIS Diabetes: ➤
random plasma glucose >11.1 mmol/L — fasting plasma glucose >7 mmol/L — 2-hour post-prandial glucose >11.1 mmol/L. —
Impaired glucose tolerance: ➤ 2-hour post-glucose load 7.8-11.1 mmol/L. —
Impaired fasting glucose: ➤ fasting plasma glucose 6.1-6.9 mmol/L. —
Normal: ➤ fasting plasma glucose <6.1 mmol/L — 2-hour post-prandial glucose <7.8 mmol/L. —
COMPLICATIONS Life expectancy is reduced by more than 20 years in Type I and up to 10 years in ➤ Type II.
