Study and Prevalence of Diabetes Mellitus in Human Population of District Gilgit, Gilgit-Baltistan, Pakistan

This study was conducted and carried out to determine the distributional significance valve and prevalence pattern of diabetes mellitus in human population of different areas of district Gilgit in respect of gender and location wised. Random samplings were done from different areas of district Gilgit. The areas were Main city Gilgit, Danyore, Sakwar, Oskandas and Jalalabad. During study period 1100 individuals were evaluated for Diabetes in different targeted areas of district Gilgit. A total of 1100 samples were studied and analyzed. Out of 1100 analyzed individuals 243 (22%) samples were found Diabetic and 857 (78%) were found Non-diabetic. In Gilgit city 792 suspected individuals were evaluated for diabetes found 158 (19.95%) diabetic and 643 (80.05%) Non.diabetic.In Danyore village 103 suspected individuals were evaluated for diabetes, the ratio of infestation was 21 (20.40%).In Sakwar 100 suspected individuals were evaluated for diabetes,32 (32%) were found diabetic while 68 (68%) were found Non-Diabetic. In Oskandas village 58 suspected individuals were evaluated for significant diabetes.15 (25.86%) were found diabetic and 43 (74.14%) were found Non-diabetic followed by in Jalalabad 47 suspected individuals were evaluated for significant diabetes 17 (36.17%) were found diabetic while 30 (63.83%) were found Non-diabetic.


INTRODUCTION
The diabetes mellitus (DM) or simply diabetes is the malfunctioning of pancreas, in which it cannot produce insulin or the body has problem in utilizing insulin. According to National Diabetes Data Group (NDDG), Pakistan, it has main types 1 and 2.It is evolved as an epidemic all over the world. It is one of the metabolic disorders; if not properly managed can lead to long term life threaten complications 5 .
According to World Health Organization (WHO) defines diabetes as a chronic metabolic disease that occurs either when the Pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
Diabetes is unfortunately one of the biggest public health challenges in human history and it is affecting even more people around the world each year. Even though the real aetiology of diabetes is not fully understood by experts, the associated risk factors are numerous ranging from genetic triggers to environmental ones.
Individuals with diabetes are 25 times more likely to become blind than individuals without this disease. In many developed countries, diabetic retinopathy is the leading cause of new cases of visual impairment and blindness among adults aged 20-74 years. Among people with type 1 diabetes; about 25% have diabetic retinopathy during the first 5 years and about 100% in two decades. Among people who have type 2 diabetes, around 21% have retinopathy at diagnosis, and more than 60% have diabetic retinopathy during the first two decades of the disease.2 Diabetes occurs at a much younger age in South Asian countries than it does in developed countries. Pakistan has a population of 154 million. More than 10% of its adult population has diabetes. Although the country ranks 6th among countries with the highest burden of diabetes, 6 population-based data on the prevalence of diabetic retinopathy in Pakistan and on the visual impairment due to diabetic retinopathy are lacking. Data that are available are hospital-based 3 .
It is a complex chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemric control.
The prevalence of diabetes is increasing in adult population of more than 20 years. It was 6.7% in 1995 while 7.1 in 2000. The highest percentages of increases in disease prevalence are likely to be in developing nations, with major increases in the Middle-East, Sub-Saharan Africa, South Asia, and Latin America. WHO listed 10 countries to have the highest numbers of people with diabetes in 2000 and 2030. According to this report, Bangladesh has 3.2 million of diabetic subjects in 2000 and the number is expected to increase to a staggering 11.1 million by 2030 placing her among the top 10 countries with diabetes 1 .
Diabetes mellitus is a common problem worldwide affecting 200 million people worldwide and causing 32 million deaths yearly. Its prevalence in Pakistan, whose population is about 154 million has 10% of adult population are diabetic and about same number having impaired glucose tolerance. Pakistan rank 6th in highest diabetic population.
It becomes imperative to detect and manage the disease as soon as possible because excessive fluctuations in blood glucose level can injure tissues throughout the whole body. About 382 million people, in 2013, have diabetes in the world and it is expected to rise up to 592 million by 2035 if serious attention is not drawn towards the problem 6 . Diabetes can be classified into four clinical categories: Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency). Type 2 diabetes (due to a progressive insulin secretary defect on the background of insulin resistance) Other specific types of diabetes due to other causes, e.g., genetic defects in b-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drug-or chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation) Gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy that is not clearly overt diabetes). In type 1 diabetes mellitus, it has been shown that the frequency of complications is reduced by the maintenance of good glycemric control. In addition, it has been reported that patients with type 1 diabetes have more frequent complications with feeding behavior abnormalities and eating disorders, as well as a significantly faster progression of complications. It has especially been noted that complications of anorexia nervosa significantly increase mortality 8 .
One of the most potential factors which cause to pressure on the diabetic patient is the hypertension.
Hypertension and diabetes are one of the most serious disease threats all over the world that decreases the quality of human life. The indication and prevalence of other associated complications are increasing the rate of morbidity and mortality in most part of the third world developing countries. Oxidative stress is known to be a component of molecular and cellular tissue damage mechanisms in a wide spectrum of human diseases including hypertension, diabetes and increasing age. These risk factors is a common feature that has plagued Nigeria which has a present population of 170 million people but according to the United Nations, the population of Nigeria will reach 440 million by 2050, this will make Nigeria the 3rd most populous country in the world . Unfortunately, in the Northern part of Nigeria a large number of patients affected by this disease and its associated complications have unsatisfactory awareness and knowledge. Yet, more and more people die for ignorance of these complications 7 .

MATERIAL AND METHODS
Blood samples were collected randomly from the population and after collecting the blood all the samples were analyzed through glumetric method 10 .
The glumetric device is consisting of the Blood glucose meter, Test strips, Code cap, lancing device, sterile lancet, control solution and carrying case. Very small samples of blood which may be obtained from the fingertip washed the hands or clean the finger with alcohol, if we will use alcohol then let it dry before pricking the finger. Pricked the site with a lacing device and put a little drop of blood on the test strip. Within 5 seconds the blood glucose meter reads the blood sugar level. The expecting blood glucose levels for the person without diabetes are, in fasting or before fasting the plasma glucose should be less than 7.0mmoI/I (126mg/dl) and 2hours after meal the plasma glucose should be less then 11.1mmoI/I (200mg/dl) 10 .

Table 1: Overall Diabetic patients and Non Diabetic individuals in Human Population of Gilgit
In the present study Diabetes Mellitus was studied in 1100 of total Human Population of Gilgit and found 243diabetic patients from various location of Gilgit and 857 were found normal.

Fig. 3: Overall Diabetic and Non Diabetic from the Human Population of Gilgit
The results showed that the total samples were 1100 and out of this 243 were found diabetic Patients and 857 were found Non diabetic. The seclusion of male and female population was made in order to identify the potential diabetic patients and their sex and the subsequent trend in having diabetes. The dominating figures in male are seen with a ratio of 211 and 32 of females and males respectively.  The results showed that the Diabetic patients and Non diabetic individuals in human population of Gilgit that males has highest ration as compare to females. In the present study total samples from Gilgit were 792, among these 158 were diabetic and 634 were Non-diabetic.Simlilary 103 samples were studied from Danyore, counting of 21 diabetic and 82 were Non-diabetic, while 100 samples were studied from Sakwar and among these 15 were diabetic and 43 were Nondietetic and the total samples studied from Jalalabad were 47, 17 were diabetic and 30 were Non-dietetic individuals were observed.    The results showed that the Gilgit city has high percentage of Diabetic patients, second high diabetic percentage was found in Sakwar and Oshikhandass has the least Diabetic patients

DISCUSSION
This limited research study was conducted to out to find the genetic diversity in the human population of district Gilgit. This study was also aimed to find out the ration of diabetes in the district Gilgit. The finding of this study was that in Gilgit there were total of 792 samples and among these 158(19.95%) samples were diabetic and 634(80.05%) were Non-diabetic.
Similarly there were 103 from Danyore, 21(20.40%) samples were diabetic and 82(79.61%) samples were Non-diabetic, while 100 samples from Sakwar and among these 15(25.86) samples were diabetic and 43(74.14%) samples were Non-dietetic and the total samples studied from Jalalabad were 47, among these 17 (36.17%)samples were diabetic and only 30(63.83%) samples were Non-dietetic. According to this present study which was conducted in different locations of district Gilgit shows the increasing rate of diabetes among the population of Gilgit. Males have high ratio in diabetes as compared to females.
The number of people suffering from DM is increasing due to population growth, aging, urbanization, low physical activity and the high prevalence of obesity. Diabetes is one of the health problems that patients do not have an effective knowledge about their diet and blood glucose controlling methods 9 . In Pakistan, 10% of adult population as diabetic and about same number is having impaired glucose tolerance. Pakistan ranked 6 th in highest diabetic population country.
Mumtaz et al. 11 , found the prevalence of diabetes is increasing in an adult population of more than 20 years. It was 6.7% in 1995 while 7.1% in 2006, while in urban population, diabetes mellitus was prevalent in 6.9% of urban males while 6.0% of rural males were affected; and 3.5% of urban women and 2.5% of rural women were having DM. Incidence of type 1 DM is less in Pakistan.

CONCLUSIONS
This present study is the first documented report which provide the comprehensive and baseline information of the genetic diversity of district Gilgit. The study presents the importance of Diabetes and its prevalence among the human population of district Gilgit. On the bases of this study the adult human population of district Gilgit is suffering of both types of diabetes type 1 and type 2 but unfortunately due to lack of awareness and people negalence, this diabetes spread with high ration in adult human population of district Gilgit. Diabetes is the silent killer like cancer which shows its effects at its last stage so diabetes is also called silent killer for humans.