CLASSIFICATION AND EPIDEMIOLOGY OF DIABETES Flashcards
TYPE I DIABETES USUALLY APPEARS BEFORE THE AGE OF?
40
WHEN DID DIABETES MORTALITY START DECREASING?
EARLY 20TH CENTURY
EXAMPLES OF DIABETES MANAGEMENT PRE INSULIN DISCOVERY?
OATMEAL, MILK DIET, POTATO THERAPY, THE RICE CURE, OPIUM, INJECTIBLE PANCREATIC EXTRACT, LOCK AND KEY STRATEGY (STARVING ONESELF)
OUTCOMES FOR DIABETEC PEOPLE BEFORE 1922?
CHILDREN RARELY LIVED A YEAR PAST DIAGNOSIS, UNTREATED DIABETICS FACED BLINDNESS, LOSS OF LIMBS, KIDNEY FAILURE, STROKE, HEART ATTACK AND DEATH
WHERE DOES THE NAME ‘INSULIN’ COME FROM?
FROM LATIN ‘INSULA’, MEANING ISLAND, REFERRING TO INSULIN PRODUCING ISLETS OF LANGERHANS IN THE PANCREAS
1910 ENGLISH PHYSIOLOGIST E.A. SHARPEY-SHAFER STUDIED THE PANCREAS AND DISCOVERED:
THAT THERE IS A SUBSTANCE THAT WOULD NORMALLY BE PRODUCED IN NON DIABETIC PEOPLE MISSING IN THOSE WITH DIABETES
WHO AND WHEN DISCOVERED INSULIN?
FREDERICK BANTING AND CHARLES BEST IN 1922, (CANADA)
BEFORE BEING CALLED T1D AND T2D WHAT WERE THESE DISEASES CALLED?
T1D: INSULIN-DEPENDANT DIABETES
T2D: NON-INSULIN DIABETES MELLITUS
OTHER TYPES OF DIABETES EXCEPT FOR I AND II (BY CAUSE)?
GESTATIONAL, DISEASES OF THE PANCREAS LEADING TO DIABETES, ENDOCRINOPATHIES THAT LEAD TO DIABETES (CUSHING’S, ACROMEGALY..), STEROIDS CAN BRING DIABETES, GEN DISORDERS (DOWN’S, TURNER’S, PW)
CAUSES OF T1D?
IMMUNE MEDIATED (ABSOLUTE INSULIN DEFFICINECY) OR IDIOPATHIC
T2D DIABETES METABOLIC CAUSES?
CAN RANGE FROM PREDOMINANTELY INSULIN RESISTANCE TO RELATIVE INSULIN DEFICIENCY
WHICH TYPE OF DIABETES HAS A HLA ASSOCIATION?
TYPE I
FAMILY HISTORY OF DIABETES IS MORE COMMON IN WHICH TYPE?
TYPE II
IN HOW MANY PERCENT OF CASES IS THERE FAMILY HISTORY IN T1D VS T2D?
<20% IN T1D
CCA 60% IN T2D
GENETIC LOCUS OF T2D IS ON CHROMOSOME?
6
2 TYPES OF ‘PRE-DIABETES’?
IMPAIRED GLUCOSE TOLERANCE AND IMPAIRED FASTING GLUCOSE
GLUCOSE REMAINS STUCK TO HEMOGLOBIN FOR UP TO HOW MANY DAYS?
120
CRITERIA FOR DIABETES DIAGNOSIS: FASTING GLUCOSE? 2 HRS POST OGTT? HbA1C? RANDOM PLASMA GLUCOSE + DIABETES SYMPTOMS?
> 7mmol/L
11.1 mmol/L
6.5% (48mmol)
11.1 mmol/L
HOW IS ‘FAST’ DEFINED?
NO CALORIC INTAKE FOR AT LEAST 8 HRS
WHAT AMOUNT OF GLUCOSE IS GIVEN IN OGTT?
75g
PROS AND CONS OF HbA1C MEASUREMENTS?
PROS: STABLE, REPRODUCTIBLE, NO FASTING REQUIRED, TIME AVERAGED
CONS: INFLUENCED BY MANY FACTORS, NOT RELIABLE IN CONDITIONS LIKE PREGNANCY, MALIGNANCY, ANEMIA, SICKLE CELL, DYSLIPIDEMIA..
PROS AND CONS OF GLUCOSE MEASUREMENTS?
PROS: CHEAP, QUICK, ALLOWS INTERNATIONAL COMPARISON, USED FOR LONGER SO THERE’S MANY DATA ON IT, DIABETES IS A PRIMARILY ‘GLUCOSE DISEASE’
CONS: NEED TO FAST, GLUCOSE LEVELS AREN’T OVERLY STABLE..
2 EXAMPLES OF TOOLS FOR DIABETES RISK ASSESSMENT IN THE UK?
1) LEICESTER RISK ASSESSMENT SCORE
2) DIABETES UK SCORE
WHICH LEICESTER RISK ASSESSMENT SCORE MEANS SOMEONE IS AT HIGH RISK OF DIABETES?
25-47
WHAT KIND OF INFO DO TOOLS FOR DIABETES RISK ASSESSMENT IN THE UK ASK FOR?
AGE, SEX, ETHNICITY, BMI, BP, WAIST SIZE..
DIABETES, HIB/AIDS, MALARIA AND TUBERCULOSIS, WHICH IS THE CAUSE OF MOST DEATHS PER YEAR?
DIABETES (MORE THAN ALL OTHER 3 COMBINED)
NUMBER OF PEOPLE UNDER 20 Y.O. LIVING WITH T1D?
1.1 MILLION
NUMBER AND PERCENTAGE OF ADULTS (20-79 Y.O.) LIVING WITH DIABETES?
463 MILLION, I.E. 9.3%
SCREENING FOR DIABETES; UK GUIDELINES:
- FOR INDIVIDUALS AGED 40-74 WITHOUT AN EXISTING DIAGNOSIS OF DIABETES OR CVD
- DIABETES RISK ASSESSMENT USING A VALIDATED TOOL
- IN CASE THE RISK TURNS OUT TO BE HIGH; FASTING PLASMA GLUCOSE OR HbA1C TEST
THE NUMBER OF ADULTS LIVING WITH DIABETES HAS TRIPLED SINCE?
1975
% OF PEOPLE LIVING WITH DIABETES UNAWARE OF IT?
50.1%
WHICH CONTINENT IS MOST CONCERNING IN TERMS OF PREDICTED INCREASE IN DIABETES RATES?
AFRICA
WHICH CONTINENT HAS THE HIGHEST NUMBER OF CHILDREN AND ADOLESCENTS WITH T1D?
EUROPE
1 IN HOW MANY PEOPLE IN UK HOSPITALS HAVE DIABETES?
1/6
% OF NHS BUDGET THAT GOES TOWARDS DIABETES MANAGEMENT?
10%
CURRENT PREDICTION IS THAT PERCENTAGE OF OBESE ADULTS BY 2034 WILL BE?
> 70%
NUMBER OF PEOPLE DIAGNOSED WITH DIABETES IN THE UK?
3.7 MILLION
NUMBER OF PEOPLE UNAWARE THEY HAVE DIABETES IN THE UK?
1 MILLION
HOW MANY HRS DO PEOPLE WITH DIABETES SPEND WITH A HCP PER YEAR?
3
ALPHABET STRATEGY (‘A SAFETY CHECKLIST’) FOR DIABETES MANAGEMENT:
Advice on lifestyle Blood pressure (aim for < 140/80) Cholesterol and chronic kidney disease prevention Diabetes control (HbA1C) Eyes (yearly check) Feet (yearly check) Guardian drugs (aspirin, ACE inhibitors)
