Harmonizing to the World Health Organisation diabetes mellitus is a province of chronic hyperglycemia due to familial and environmental factors. In type 1 diabetes mellitus there is no production of insulin whereas In type 2 diabetes mellitus there is deficient insulin or cells do non react to insulin present in the organic structure ( insulin opposition ) ( 1 ) . The most frequent signifier is type 2 diabetes that accounts for more than 85 % of instances, with type 1 diabetes accounting for 10 % of instances, specific and gestational diabetes with 5 % of instances ( 2 ) .
Harmonizing to WHO estimations more than 180 million people in the universe have diabetes mellitus and this figure will likely more than double by 2030 if no pressing action is taken. In 2005 it is estimated that up to 1.1 million people died from diabetes and 80 % of these deceases occurred in low and in-between income states such as Zimbabwe, half of these people being under the age of 70 and 55 % being adult females ( 2 ) .
Diabetess mellitus was by and large considered to be a rare status in Africa before the 1990s. Evidence of increased incidence and prevalence of type 2 diabetes mellitus was provided by some epidermiological rapid in the history of the universe and is characterized by a rise in the load of researches carried out in that decennary. ( 3 ) . Africa is sing a demographic and epidemiological passage that is the most noncontagious diseases. ( 4 ) . Most studies published between 1959 and 1985 indicated a prevalence of diabetes below 1.4 per centum with the exclusion of those those from South Africa where higher prevalence was seen.
In 1994 the prevalence of diabetes mellitus in Africa was 3 million ( 5 ) . The highest prevalence being found in populations of Indian beginning, followed by black populations and Caucasians. In South Africa and Tanzania, the prevalence of those of Indian beginning was between 12 and 13 % ( 6 ) . The prevalence in inkinesss in rural countries of Africa was by and large below 1 per centum and that of urban countries of Africa was between 1 and 6 per centum. Prevalence of type 2 diabetes was low in both rural and urban communities of West Africa except in urban Ghana, where a high rate of 6.3 per centum was late reported ( 7 ) . Moderate prevalence rates have been reported from South Africa with 4.8 per centum in a semi-urban community in the Orange Free State, 6.0 per centum in an urban community of the Orange Free State, 5.5 per centum in Durban which is largely occupied by the Zulu folk, and 8 per centum in Cape Town which is largely occupied by the Xhosa folk.
In Zimbabwe from 1991-97 the prevalence of diabetes mellitus increased from 150 to 550 per 100 000 people. Harmonizing to the Zimbabwe National Health profiles ( 1996-98 ) the figure of new instances recorded in the ages 15years and supra rose from 2734 instances in1996 to 5114 in 1998 which is an addition of 87 % of recorded cases.Diabetes mellitus is among the top five chronic conditions seen in Clinics in Zimbabwe. A study carried out in 2005 recorded a prevalence of diabetes mellitus among the grownup population of 10 % .Many of these people were non cognizant of their increased glucose degrees.
INSULIN AND ITS FUNCTION IN GLUCOSE METABOLISM
Chief among the maps of insulin is to keep low blood glucose degrees and counter the conjunct action of some hyperglycemia-generating endocrines.Disorders that go without intervention associated with insulin lead to terrible hyperglycaemia and shortened life span and this can be the instance in untreated diabetes mellitus ( 1 ) . Insulin is produced in the ?-cells of the islets of Langerhans as a preprohormone. Removal of its signal peptide is done in the cisternae of the endoplasmic Reticulum and it is packaged into secretory cysts in the Golgi, after which it is folded to its native construction and so maintain in this conformation by formation of 2 disulfide bonds ( 1,8 ) . The halfway tierce of the molecule is cleaved by specific peptidase activity and it dissociates as C peptide.This leaves the amino terminus B peptide disulfide bonded to the carboxy terminus A peptide.Plasma glucose degrees regulate insulin secernment from the ?-cells of the islets of langerhans. ( 8 ) . Increased consumption of glucose by pancreatic ?-cells consequences in a attendant addition in metamorphosis which leads to an lift in the ATP/ADP ratio. As a consequence there is suppression of an ATP-sensitive K channel ( KATP channel ) . The net consequence of this procedure is a depolarisation of the cell taking to Ca2+ inflow and insulin secernment ( 8 ) .
( 1,3 ) pecial transporter proteins found in cell membranes allow glucose that is in the blood to come in into a cell. These transporters are controlled indirectly by blood insulin in certain organic structure cell types like musculus cells. Low degrees of go arounding insulin, or its complete absence, will forestall glucose from come ining those cells as in typical type 1 diabetes. More normally there is a lessening in the sensitiveness of cells to insulin like the decreased insulin sensitiveness that occurs in type 2 diabetes mellitus and resuls in a decrease of glucose soaking up. In both cases there is cell famishment and weight loss that can be utmost. In other instances though non common, there is a defect in the release of insulin from the pancreas. The consequence of this is the same and that is hyperglycaemia degrees ( 1,8 ) .
Activation of insulin receptors consequences in internal cellular mechanisms that affect glucose consumption by contolling the figure and map of protein molecules found in the cell membrane that are responsible for glucose consumption into the cell. Myocytes and Adipocytes are the chief organic structure tissues that are largely influenced by insulin in footings of being stimulated for glucose consumption. Myocytes are peculiarly of import because of their critical function in motion, external respiration and circulation and adipocytes are of import because they store extra nutrient energy against future demands. These two cell types form about 60 % of all cells in the human organic structure ( 1,8 ) .
Insulin binds to the extracellular part of the alpha fractional monetary units of the insulin receptor. This causes a conformational alteration in the insulin receptor and there is activativation of the kinase sphere situated on the intracellular part of the beta fractional monetary units. This activated kinase sphere autophosphorylates tyrosine residues on the C-terminus of the receptor every bit good as tyrosine residues in the IRS-1 protein. Consequently the undermentioned stairss occur:
1. Phosphorylated IRS-1, in bend, binds to and activates phosphoinositol 3 kinase ( PI3K ) .
2. PI3K catalyzes the reaction PIP2 + ATP > PIP3 + ADP.
3. PIP3 activates protein kinase B ( PKB ) .
4. PKB phosphorylates glycogen synthase kinase ( GSK ) and thereby inactivates GSK.
5. GSK can no longer phosphorylate animal starch synthase ( GS ) .
6. Unphosphorylated GS makes more animal starch.
PKB besides facilitates cyst merger, ensuing in an addition in GLUT4 transporters in the plasma membrane.After the signal has been produced, expiration of signaling is needed and this can be by debasement and endocytosis of the receptor edge to insulin. In add-on, signaling can be terminated by dephosphorylation of the tyrosine residues by tyrosine phosphatases. Serine/Threonine kinases are besides known to cut down the activity of insulin. Finally, with insulin action being associated with the figure of receptors on the plasma membrane, a lessening in the sum of receptors besides leads to expiration of insulin signaling ( 1,8,9 ) .
Other maps of insulin outside glucose metamorphosis includes stimulation of lipogenesis, decrease of lipolysis and addition of aminic acerb conveyance into cells. Insulin is besides involved in written text, changing the cell content of legion messenger RNA. It besides stimulates growing, DNA synthesis an consequence it portions with insulin like growing factors and relaxin. ( 1,9 ) .
DIAGNOSIS AND MONITORING OF DIABETES MELLITUS
Different trials can be used to name and supervise blood glucose degrees in diabetes mellitus patients and these include random and fasting blood glucose, unwritten glucose tolerance trial, blood carbamide, blood H, urinary protein, blood insulin, blood fructosamine and glycosylated hemoglobin ( HbA1c ) ( 1 ) .
For diagnosing the OGTT, fasting and random blood glucose trials are ideal and harmonizing to the WHO guidelines, if the plasma glucose is less than 5.5 mmol/L so diabetes is extremely improbable. A fasting plasma glucose of 7.0 mmol/L or more, or a random glucose of 11.1 mmol/L or more makes diabetes likely possibility and the diagnosing is confirmed by a repeated unnatural trial. If the fasting plasma glucose is between 5.5 and 6.9 mmol/L or between 5.5 and 11.0 mmol/L non-fasting an OGTT with 75 g anhydrous glucose should be done. ( 1 )
Blood H, blood carbamide and urinary protein, can besides be used in diagnosing of diabetes but merely as non specific confirmatory trials for fasting, random blood glucose and OGTT.Blood Insulin is seldom measured in diagnosing of diabetes mellitus ( 1,8 ) .
In the direction and control of diabetes, blood glucose determined at the clip of the clinic attending can merely give limited information and may non stand for the overall intimacy of control at other times therefore it has restrictions in supervising glucose control. The HbA1c trial provides a better index of diabetic control than plasma glucose since it is non greatly affected by short-run fluctuations in plasma glucose ( 8 ) .
GLYCOSYLATED HAEMOGLOBIN AND ITS IMPORTANCE
HbA1c is a signifier of hemoglobin used chiefly to place the mean plasma glucose concentration over drawn-out periods of clip ( three to four months ) . In the normal 120 twenty-four hours lifetime of the ruddy blood cell glucose molecules fall in to haemoglobin in a non enzymatic reaction organizing HbA1c.In persons with ill controlled diabetes, additions in the measures of the glycosylated hemoglobin have been noted ( 10,11 ) . Once a hemoglobin molecule is glycosylated, it remains that manner. A build up of HbA1c within the ruddy blood cell reflects the mean degree of glucose to which the cell has been exposed during its life rhythm ( 1,8 ) .
Measuring HbA1c assesses the effectivity of therapy by supervising long term plasma glucose ordinance. Monitoring of glycogenic position is considered a basis of diabetes attention and affects how doctors and patients adjust medical therapy every bit good as behavioral therapy ( diet and exercising ) ( 11,12 ) . It has been shown in a randomized survey that when wellness attention suppliers and patients are informed about the HbA1c consequences blood glucose control is improved. Simply cognizing the consequences improves glycemic control, either through improved attempts by the patient or by the supplier ( 10 ) .
GLUCOSE CONTROL IN DIABETICS
In a diet control survey done among diabetics with HbA1c consequences available in the United States it was shown that, 39 % had good control ( HbA1c & A ; lt ; 7 % ) 36 % had suboptimal control ( HbA1c 7-9 % ) and 25 % had hapless control ( HbA1c & A ; gt ; 9 % ) ( 13 ) .
Public wellness research labs in Zimbabwe do non offer the HbA1c check for diabetic patients. Many patients are from hapless socio-economic background and rely entirely on public wellness installations as they can non afford private health care installations. Therefore, most Zimbabwean diabetics do non hold any signifier of long term monitoring of their blood glucose degrees and are at a hazard of holding high degrees of HbA1c degrees without them or their wellness attention suppliers cognizing it.
INCREASED HbA1c AND COMPLICATIONS OF DIABETES MELLITUS
A certain survey showed that an mean HbA1c degree of 7.2 % resulted in a 76 % decrease in retinopathy, a 60 % decrease in neuropathy, a 50 % decrease in kidney disease and a 35 % decrease in cardiovascular disease. ( 9,14 ) . Another survey in The united provinces Of America demonstrated unambiguously that maintainingclose to normal blood glucose degrees significantly lowers a individual ‘s hazard of developing complications of diabetes mellitus ( 9 ) .
In a survey done to find the relationship of HbA1c degrees to hospital admittance of patients, it was found that the likeliness of admittance increased with higher HbA1c degrees. The figure of admittances of diabetic patients with HbA1c degrees in the scope ( 10.8 % – 18.4 % ) was higher with 5 481 admittances in a 3 twelvemonth period compared with 2 566 admittances of patients with HbA1c degrees in the mention part of 7.7 % – 8.1 % ( 11 ) .