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PSBEDM Review > 36 Type 1 Diabetes Mellitus > Flashcards

36 Type 1 Diabetes Mellitus Flashcards

1
Q

Randomized clinical trial that laid the foundation of intensive insulin therapy as the standard of care

A

DCCT

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2
Q

Interventions in DCCT

A

Intensive vs conventional insulin therapy

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3
Q

Number of participants in DCCT

A

1,441 persons

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4
Q

Age range of participants in DCCT

A

13-39 years old

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5
Q

Diabetes type of participants in DCCT

A

T1DM

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6
Q

Median HbA1c levels of the groups compared in DCCT (2)

A

Intensive: 7%
Conventional: 9%

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7
Q

DCCT: Decrease in microvascular complications in intensive therapy group

A

35-76%

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8
Q

DCCT: Microvascular complications (3) that were decreased in intensive therapy group

A

Retinopathy
Nephropathy
Neuropathy

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9
Q

EDIC: Years of follow-up from DCCT

A

20-25 years

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10
Q

Outcomes in intensive therapy group in EDIC (3)

A

Reduced microvascular complications
Reduced macrovascular complications
Reduced overall mortality

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11
Q

Standard composition of macronutrients in nutritional therapy for T1DM (3)

A

50% carbohydrates
30% fat
20% protein

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12
Q

Breakdown of fat intake targets in T1DM (3)

A

<10% saturated fat
<10% polyunsaturated fat
>10% monounsaturated fat

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13
Q

Recommended daily fruit and vegetable portions in T1DM

A

5 portions

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14
Q

Risk factors (3) for ketosis during intake of very low carbohydrate diet in T1DM

A

Insulin dose reductions
Disordered eating behaviors
Use of SGLT2Is

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15
Q

Recommended duration of physical activity in youth with T1DM

A

≥60 mins daily

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16
Q

How many days/week should muscle and bone strengthening exercises be done in youth with T1DM

A

≥3 days/week

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17
Q

Recommended duration of physical activity in adults with T1DM

A

≥150 mins/week of moderate intensity aerobic activity
≥75 mins/week of vigorous aerobic activity

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18
Q

How many days/week should muscle strengthening exercises be done in adults with T1DM

A

≥2 days/week

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19
Q

Definition of significant ketosis prior to exercise in T1DM

A

More than small urinary ketones
Blood betahydroxybutyrate ≥1.5 mmol/L

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20
Q

In individuals with T1DM, intense exercise should be postponed in the setting of significant hyperglycemia, defined as glucose levels:

A

≥350 mg/dL or 19.4 mmol/L

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21
Q

Frequency of blood glucose and ketone monitoring in T1DM during sick days

A

Every 1-3 hours

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22
Q

Correction doses or __% of TDD with rapid acting insulin every 2-3 hours while ketones persist is recommended in T1DM patients during sick days

A

5-20% of TDD

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23
Q

Preferred method of monitoring ketones in T1DM during sick days

A

Blood beta hydroxybutyrate

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24
Q

In the lag effect of exercise in T1DM, hypoglycemia occurs how many hours after exercise

A

7-11 hours

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25
Q

To prevent hypoglycemia during exercise in T1DM, one should begin exercise with a glucose of:

A

≥100 mg/dL or ≥5.6 mmol/L

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26
Q

When physical activity lasts ≥40 mins in T1DM, consider providing how much carbohydrates per min?

A

0.25-1 g per min

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27
Q

Consider providing 0.25-1 g of carbohydrates per minute of exercise when the activity lasts how long?

A

≥40 mins

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28
Q

For any meal or snack within 2 hours of planned activity in T1DM, one should decrease bolus insulin doses by how much?

A

50%

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29
Q

For T1DM patients on CSII, basal rates should be decreased by how much during exercise to prevent hypoglycemia?

A

50%

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30
Q

For T1DM patients on CSII, basal rates can be suspended for how long during exercise to prevent hypoglycemia?

A

1-2 hours

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31
Q

To manage lag effect of exercise in T1DM patients on CSII, basal rates should be decreased by how much for up to 6 hours at bedtime?

A

~20%

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32
Q

To manage lag effect of exercise in T1DM patients on CSII, basal rates should be decreased by 20% for up to __ at bedtime

A

6 hours

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33
Q

To manage lag effect of exercise in T1DM patients, long-acting insulin doses should be decreased by how much at bedtime?

A

~20%

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34
Q

Two peaks of T1DM presentation in terms of age

A

Small peak between 5 and 7 years
Larger peak at or near puberty

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35
Q

Drug that is directly toxic to beta cells used to induced diabetes in mice

A

Streptozotocin

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36
Q

Standardized definition of insulitis

A

At least 3 islets containing >15 CD45+ cells in a pancreas

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37
Q

Symptoms of diabetes were thought to appear when how much of pancreatic beta cells had met their demise

A

85-90%

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38
Q

10 year risk of T1DM in an individual with 2 or more anti-islet autoantibodies who seroconvert before 3 years old

A

75%

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39
Q

10 year risk of T1DM in an individual with 2 or more anti-islet autoantibodies who seroconvert after 3 years old

A

60%

40
Q

Proportion of T1DM patients without a first degree relative with the disease

A

> 85%

41
Q

Highest known incidence of T1DM (2)

A

Finland
Sardinia

42
Q

T1DM is uncommon in these countries (~0.1 per 100,000 per year) (3)

A

China
India
Venezuela

43
Q

Risk of type 1 diabetes:
General population

A

0.3% (15-25/100,000)

44
Q

Risk of type 1 diabetes:
Offspring

A

1%

45
Q

Risk of type 1 diabetes:
Sibling

A

3.2% through adolescence
6% lifetime

46
Q

Risk of type 1 diabetes:
Dizygotic twin

A

6%

47
Q

Risk of type 1 diabetes:
Mother

A

2%

48
Q

Risk of type 1 diabetes:
Father

A

4.6%

49
Q

Risk of type 1 diabetes:
Both parents

A

~10%

50
Q

Risk of type 1 diabetes:
Monozygotic twin

A

50%
70% before age 5
<10% after age 25

51
Q

Most important loci determining risk of T1DM

A

HLA class II molecules (DR, DQ, DP)

52
Q

Major HLA determinants of T1DM susceptibility

A

DR and DQ molecules

53
Q

HLA molecule that provides dominant protection from T1DM

A

DQ6

54
Q

Highest risk HLA-DR-DQ genotype

A

DR3/4-DQ2/8 heterozygotes

55
Q

Best single marker for T1DM development in young children

A

IAA

56
Q

Mutation in this gene can result in permanent neonatal DM but does not cause IUGR

A

ABCC8

57
Q

Mutations in these genes (2) may result in either transient or permanent forms of neonatal DM

A

KCNJ11
ABCC8

58
Q

Most common form of neonatal DM

A

ZAC/HYMAI

59
Q

Gene mutated in Wolcott-Rallison syndrome

A

EIF2AK3

60
Q

Mutation in EIF2AK3 results in this syndrome with transient neonatal DM

A

Wolcott-Rallison syndrome

61
Q

Gene mutated in X-linked permanent neonatal DM

A

FOXP3

62
Q

X-linked syndrome that results in permanent neonatal DM

A

IPEX syndrome

63
Q

Most common form of MODY

A

MODY 3

64
Q

Second most common form of MODY

A

MODY 2

65
Q

Gene affected in MODY1

A

HNF4A

66
Q

Gene affected in MODY2

A

GCK

67
Q

Gene affected in MODY3

A

TCF1

68
Q

Gene affected in MODY4

A

IPF1

69
Q

Gene affected in MODY5

A

TCF2

70
Q

Gene affected in MODY6

A

NeuroD1 or BETA2

71
Q

Typical age of onset of MODY6

A

4th decade of life

72
Q

Treatment of IPEX/XPID syndrome

A

Bone marrow transplantation

73
Q

In this prospective study, a genetic risk score model was able to identify infants with high risk of developing anti-insulin autoantibodies by 6 years of age

A

TEDDY study

74
Q

US study that showed the most rapid rise of T1DM is in teenagers

A

SEARCH

75
Q

These hypotheses suggest that childhood obesity increases insulin demand, overloading the islet cells and accelerating beta-cell autoimmune damage

A

Accelerator and overload hypotheses

76
Q

This hypothesis implicates dietary exposure as a possible direct regulator of the immune system and of self-tolerance by altering gut microbiota and intestinal permeability

A

Old friends hypothesis

77
Q

This hypothesis proposes that microbial infection induces a temporary state in which other antigens can easily react to yield autoreactive T cells

A

Fertile field hypothesis

78
Q

Best evidence for a specific environmental agent to contribute to T1DM pathogenesis

A

Congenital rubella infection

79
Q

Anti-CD3 antibody that delayed progression to clinical T1DM in high risk patients

A

Teplizumab

80
Q

This protocol used meticulous islet isolation techniques, transplantation of islets from multiple pancreata, avoided the use of steroids, and utilized an immunosuppressive regimen involving rapamycin, that improved outcomes for patients with T1DM

A

Edmonton protocol

81
Q

Insulin autoimmune syndrome or Hirata syndrome is associated with treatment of the following medications (2)

A

Sulfhydryl-containing medications, particularly methimazole
Alpha-lipoic acid

82
Q

ADA target HbA1c for (1) adults (2) younger children

A

7% for adults
7.5% for children

83
Q

Most common form of permanent neonatal DM involves a mutation in what gene?

A

KCNJ11

84
Q

IFG or IGT is usually present within how many months before the onset of overt DM?

A

6 months

85
Q

Stage of pre-T1DM where dysglycemia develops

A

Stage 2

86
Q

Most common strategy of implementing feedback control of automated insulin delivery

A

Proportional integral derivative

87
Q

Two peaks of T1DM diagnosis

A

Small peak between 5 and 7 years of age
Larger peak at or near puberty

88
Q

Sex predilection of T1DM

A

Males > Females

89
Q

Standard definition of insulitis

A

Three islets containing >15 CD45* cells in a pancreas

90
Q

In this hypothesis, beta cell destruction is proposed to result from interactions between the environment, immune system, and the beta cells themselves in genetically susceptible individuals.

A

Copenhagen model

91
Q

This finding in gut microbiota has been associated with anti-islet autoimmunity

A

High Bacteroides to Firmicutes ratio

92
Q

These bacteria may protect against T1DM by promoting synthesis of mucin and reducing intestinal leakiness

A

Butyrate-producing bacteria

93
Q

Use of these medications are associated with insulin autoimmune syndrome or Hirata syndrome

A

Sulfhydryl-containing medications (methimazole, alpha-lipoic acid)

94
Q

Carbohydrate ratio is roughly computed as:

A

450 divided by TDD

95
Q

Correction factor (sensitivity factor/index) can be approximated as:

A

1650 divided by TDD

96
Q

Most common strategy of implementing feedback control of AID

A

PID controller

PSBEDM Review (20 decks)

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