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Global Health diseases > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is diabetes mellitus?

A

A metabolic disorder of multiple aetiology characterised by chronic hyperglycaemis with disturbances of carbohydrate, fay and protein metabolism resulting from defects in insulin secretion, insulin action or both

Effects of diabetes mellutus include long term damage, dysfunction and failure of different organs

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2
Q

What is the action of insulin

A
  1. Regulates glucose homeostasis in the body
  2. 2 signaling cascades: insulin-mediated glucose uptake (IMGU) and glucose-stimulated insulin secretion (GSIS)
  3. The IMGU cascade allows insulin to increase the uptake of glucose from skeletal muscle and adipose tissue and suppresses glucose generation by hepatic cells
  4. Insulin interacts with insulin receptor alpha subunit extracellularly
  5. Conformational changes
  6. Tyrosine kinase phosphorylation
  7. Downstream signalling pathway
  8. Translocation of GLUT-4 transporter from intracellular to extracellular onto skeletal muscle cell plasma membrane
  9. Uptake of glucose into the cell to be metabolised
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3
Q

What risks can diabetes cause?

A
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4
Q

What are some diagnostic cut-points of diabetes?

A
  • Possible approaches to defining cut off points
    • Statistical
    • Physiological
    • Clinical
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5
Q

What are the WHO criteria for the diagnosis of diabetes and intermediate hyperglycaemia (pre-diabetes)?

A

SYMPTOMATIC DIABETES

  • A single fasting plasma glucose of greater than or equal to 7mmol/L
  • Single random plasma glucose of greater than or equal to 11mmol/l

ASYMPTOMATIC

  • Fasting glucose greater than or equal to 7mmol/l on two separate occasions
  • HbA1c greater than or equal to 6.5% (48mmol/l) on 2 seperate occasions

PRE-DIABETES

  • HbA1c 6-6.4% (NICE)

IMPAIRED GLUCOSE TOLERANCE

  • Fasting plasma glucose of less than 7.0mmol/l + 2h plasma glucose (after 75g oral glucose load)
  • Oral glucose tests are expensive and not applicable for some countries to afford
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6
Q

What are some of the overlaps between diagnostic testing?

A

Limited overlap between 3 different tests (2hr glucose, HbA1c, and fasting plasma glucose)

2hr glucose identifies more people (2.5%) with glucose (it is also called oral glucose). However, it is more expensive.

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7
Q

What is the relationship between aetiological types of diabetes and clinical stagesof hyperglycaemia?

A

Diabetes is a continuum, therefore some tests may not pick of hyperglycaemia, whilest others can

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8
Q

GLOBAL BURDEN OF DIABETES

A
  • In adults greater than or equal to 20 years, TIIDM accounts for 95% of diabetes globally
  • There are 415 Million people living with diabetes today. Approx. 80% of adult cases live in LMICs
  • 1.5 million deaths annually
  • 48% of deaths occurred before the age of 70
  • Prevalence predicted to rise to 784 million in 2045 (a 46% increase)
    • Rises due to population demographic changes and modifyable risk factors
  • In 2019, the number of DALYs due to type 2 diabetes worldwide was 66.3 million
  • Global burden is in the WHO EMRO region (55 million of the adult population aged 20–79 years. in 2021)
  • Affects people mostly in the 39-49 year old demographic
  • •Up to half undiagnosed with DM
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9
Q

What is the role of the IDF?

A
  • Prevalence estimates and projections
  • Mortality impacts
  • Economic impacts
  • Guidance on the management, prevention and policy implications
  • Resources for action
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10
Q

What are the limitations of the IDF diabetes projections?

A
  • Only use data on urbanisation and age/sex
  • Do not take into account trends in diabetes risk factors (therefore it may be conservative)
  • Every time the IDF update the diabetes atlas, the projections rise
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11
Q

What features would you include to develop a simple model for use in data poor settings?

A

Simple to implement and use

Few data requirements

Transparent, easy to understand and challenge assumptions

Platform for economic analysisand policy senario analysis, including prevalence forcast

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12
Q

What are the key parameters for diabetes research

A
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13
Q

What are the projections for TIIDM?

A

Type 2 diabetes prevalence among Qataris was projected to increase from 16.7% in 2012 to 24.0% by 2050, an increase of 43%

The rise in type 2 diabetes is most prominent in age groups 45-49 and 50-54 years

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14
Q

What are some further global issues regarding diabetes?

A

Complications like retinopathy much higher in developing countries

E.g. prevalence at diagnosis (15.7% in Egypt vs 6.2% Australia)

Rural to urban migration (reduced physical activities; increased BMI) like in Tanzania (physical activity declined and weight increased by 2.3kg)

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15
Q

What are the social determinants of diabetes?

A
  • DM widely percieved as ‘disease of affluence’
  • Most common in poor in high income countries
  • poor urban populations up to 15% prevalence of DM
  • Similar prevalence in urban/rural parts of China/India
  • Obesogenic environments:low levels of physical activity & access to energy rich diets
    • E.g. 1971 to 1997 Syria/Tunisia calorie intakes rose to 40% (from 2300 to 3300 per day)
      *
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16
Q

Name the statistics from diabetes

A
17
Q

What is the problem in LICs/LMICs?

A
  • Weak or absent financial systems
  • Weak patient info systems affecting referrals, follow-up, patient records
  • Lack of training, career development, loss of staff
  • Emerging private health care, inequality increasing
  • Little population based on public health (intersectoral collaboration)_
18
Q

Describe the availability of some diagnostic tests for diabetes in UGANDA

A
19
Q

Describe the availability and price of medicines to treat diabetes

A

In early 2016, WHO offices in 14 low- and middle-income countries piloted a smart-phone/tablet-based app to survey the price and availability of specific medicines.

190 facilities were surveyed, including tertiary hospitals, primary health clinics and private pharmacies

inadequate availability of access to essential medicines to treat diabetes including insulin, oral hypoglycaemic and cardiovascular medicines in most countries surveyed

20
Q

What are some of the other health problems associated with

A
21
Q

What are some key risk factors for TIIDM?

A
22
Q

What is obesity in relation for behavioural factors?

A

obesity leads to both increased risk of poor health and physical inactivity

Physical inactivity also leads to poor health

23
Q

What are the effects of moderate physical activity and the risk of TIIDM?

A
24
Q

what is the incidence of tiidm and cardio respiratory fitness

A
25
Q

DIABETES PREVENTION

A
26
Q

POPULATION WIDE INTERVENTION

A
27
Q

What are the advantages and disadvantages to high risk approaches to prevention?

A

Advantages:

  • –Interventions appropriate to individual
  • –Motivation?
  • –Cost-effective?
  • –Risk / benefit ratio favourable

Disadvantages

  • –Large efforts to identify high risk persons (screening)
  • –Does not eliminate underlying cause
  • –Limited potential for individual and pop
  • –Behaviourally inappropriate (social norms)
28
Q

What are the advantages and disadvantages of population wide interventions

A

Widely accepted within public health that determinants of behavioural risk factors like diet, physical acitivty, smoking etc within structure of modern soceities – social determinants of health

Advantages

  • –Addressing the underlying cause of the disease
  • –Behaviourally appropriate
  • –Large potential for populations

Disadvantages

  • –Poor motivation (of individuals, and doctors)
  • –Risk benefit ratio less favourable
  • –Small benefit for individuals
29
Q

What are example of potential proximal and distal interventions to reduce the burden of TIIDM

A
30
Q

Availability of diabetes drugs/insulin in 17 Low-, Middle-, and High-Income Countries

A

Annual medication costs were US$216 on average (median $91), and average annual inpatient costs were US$709 (median US$680).

Lowest priced generic of metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries.

31
Q

types of interventions:

A
32
Q

Differences between high agency and low agency interventions?

A

•High agency interventions

–Require individual engagement (agency), motivation, action to be effective

•Eg mass media campaigns to be more physically active, or eat a healthier diet

•

•Low agency interventions

–Require no or little individual engagement to be effective

•E.g. Reducing salt in processed foods; using taxation to increase price of harmful products; restricting/banning advertising of harmful products; changing the school food environment

•

•Evidence that:

–Low agency interventions are more effective

–Policy makers (and other key stakeholders) prefer high agency interventions

Note spectrum of interventions by agency.

High agency – politically easier? – personal respondibility that seek changes in underlying structures e.g. fiscal, leiglsaltive measures

Global Health diseases (30 decks)

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