EPIDEMIOLOGY OF NON COMMUNICABLE DISEASES

Definition of a non communicable disease

Non-communicable diseases include diseases which do not have infectious agents which
make them spread from one person to another.

It might result from hereditary factors, improper diet, smoking, or other factors.

WHO (World Health Organization) cluster of non communicable disease include

Cardiovascular diseases, Cancer, Diabetes, chronic respiratory diseases, mental illness and
injuries.

They are causes of enormous morbidity, premature mortality and a threat to the economic
resources of many countries

The major non communicable diseases in India are:

Cancer and cardio vascular diseases

Respiratory tract infections

Occupational hazards

Psychiatric disorders

Accidents

Addiction

Diabetes

Blindness

STANDARD METHODS OF STUDYING A NON COMMUNICABLE DISEASE

The standard format for description of non communicable diseases:

Introduction

Magnitude

Pre-pathogenesis

1. Agent factors:-physical, chemical or nutrient agents.

2. Host factors:-age, sex, heredity, habits, lifestyle.
3. Environmental factors:-social status, educational level, economic pattern, housing, sanitation.
Pathogenesis:- refers to the evolution of the disease in the following sequence.

1.
2.
3.
4.
5.

Latent period
Early manifestation
Late stage
Remote effects
Chronicity and death

Prevention and control

Health promotion
Early diagnosis and treatment
Disability limitation
Rehabilitation:-physical, social, psychological and vocational.

DIABETES
Diabetes is an iceberg disease.
It is a metabolic disorder where the blood sugar level is higher than normal.
Currently the number of diabetics world wide is estimated at 150 million.
The WHO reports found that the prevalence of the disease in Indian adults is 2.4% in rural
areas and 4.0-11.6% in the urban areas.
Classification of Diabetes: (As given by WHO)
1. Diabetes mellitus (DM)

Insulin dependent Diabetes Mellitus (IDDM, type 1)- most severe form of the disease.

Non-Insulin dependent Diabetes Mellitus (NIDDM, type 2)-more common than IDDM.

Malnutrition Related Diabetes Mellitus (MRDM)- in developing countries like India a special
type of diabetes was identified by WHO in 1995. This was called as malnutrition related
diabetes mellitus & affects nearly 1% of the county's diabetic population..

Other Types( genetic, hormonal, drug induced)

Impaired Glucose Tolerance (IGT)-an intermediate state between diabetes mellitus &
normality. It represents the risk groups.

Gestational Diabetes Mellitus-Gestational diabetes affects about 4% of all pregnant women

(temporarily). It is believed that the hormones produced during pregnancy reduce a woman's
receptivity to insulin, leading to high blood sugar levels.

Host factors

Age:- Diabetes can occur at any age, but the prevalence rises with age (NIDDM is more
common in the middle aged & elderly, IDDM is seen in individuals less than 30 years of age.
MRDM occurs largely in young malnourished individuals in developing countries).

Sex :-in some countries like U.K, male : female ratio is almost equal, while in South east Asia it
has been seen to occur more in males.

Obesity has been accepted as a risk factor for diabetes, particularly NIDDM.

Maternal Diabetes- research shows that offspring of diabetic mothers (including gestational
diabetes) tend to develop obesity in childhood & hence have a high risk of developing type 2
diabetes.

Environmental Factors

Sedentary life styles and lack of exercise appears to be a major risk factor for NIDDM.

Diet:-consumption of more saturated and fatty diet reduces the insulin sensitivity and results
in hyperglycemia. Hence it is a risk factor for IGT and also imposes greater risk for type 2
diabetes. Intake of more dietary fibres help to reduce the blood glucose levels in people with
type 2 diabetes and IGT.

Malnutrition in infancy and childhood results in the failure of B-cell function and hence
associated with IGT.

Stress factors & alcoholism also increases the risk factors of the disease.

Other factors like changes in life styles, education, urbanization have been linked to diabetes
causation.

Screening for Diabetes

Urine examination for the presence of glucose in urine (glycosuria) is conducted 2 hrs after a
meal.

Blood sugar testing:-the measurements of glucose levels in fasting, post prandial or random
blood samples. The criteria for the diagnosis of diabetes proposed by WHO is:-

Glucose (mg/dl)
Whole blood
Venous

capillary

a) Fasting

> 120

> 120

a) 2 hrs after glucose load

> 180

> 200

< 120

< 120

120-180

140-200

Diabetes Mellitus

Impaired glucose tolerance

a) Fasting value
a) 2hrs after glucose load

What are the symptoms of diabetes?

The early symptoms of untreated diabetes are elevated blood sugar levels, loss of glucose in
the urine & increased urine output. Extremely elevated glucose levels can lead to lethargy and
coma.

Increased urine output leads to dehydration. Dehydration causes increased thirst and water
consumption(polydipsia).

A relative or absolute insulin deficiency eventually leads to weight loss despite an increase in
appetite(polyphagia).

Some untreated diabetes patients also complain of fatigue, nausea and vomiting.

Fluctuations in blood glucose levels can lead to blurred vision and in acute cases cause
diabetic retinopathy.

Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels,
leading to coronary heart disease (heart attack, strokes )

Kidney damage from diabetes is called diabetic nephropathy. Initial malfunctioning of the
kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their ability to
cleanse and filter blood.

The accumulation of toxic waste products in the blood leads to the need for dialysis. (Dialysis
involves using a machine that serves the function of the kidney by filtering and cleaning the
blood)

Prevention and Control

Primary prevention is based on basically eliminating the environmental risk factors e.g.
maintaining of normal body weight, good nutritional habits, intake of dietary fibres in diet.
Arranging of community based programmes to make people aware are also helpful.

Secondary prevention:- As soon as diabetes is detected, it must be treated properly. This is

done by routine checking of blood sugar, urine, blood pressure, intake of oral anti diabetic
drugs, home blood sugar monitoring etc.

Tertiary prevention:-diabetes causes disability and severe complications like blindness,

kidney failure, gangrene etc. Diabetic clinics and rehabilitation centres can provide diagnostic
& management skills of high quality to the patients.