diabetes Flashcards
What is prediabetes?
Blood sugars are higher than usual, but not high enough to be diagnosed with T2DM.
Are at a high risk of developing T2DM.
(Not a clinical term recognised by WHO → Starting to be used more by healthcare professionals and in the media to describe people who are at high risk of T2DM.
What are other names for prediabetes?
Borderline Diabetes
Impaired Glucose Regulation (IGR)
Non-diabetic hyperglycaemia
Impaired fasting glucose (IFG) together with Impaired Glucose Tolerance (IGT)
What are the symptoms of prediabetes?
Don’t have any symptoms.
If you start to have any symptoms of T2DM it means you have probably already developed it.
List of modifiable factors that increase risk of diabetes
Smoking
History of high BP
Being overweight, especially with centripetal obesity
Sedentary lifestyle (physically inactive → Not doing enough physical activity; sedentary → sitting or lying down for long periods).
Alcohol
List of non-modifiable factors that increase risk of diabetes
Older age; more at risk of white and over 40 OR over 25 and Afro-Caribbean, Black African or South Asian.
Having a parent, brother, sister or child with diabetes
Polycystic Ovary Syndrome (PCOS associated with insulin resistance)
Mental health conditions (e.g. schizophrenia, bipolar disorder, depression)
Antipsychotic medication (risk is quite low)
Roughly what % of people who have diabetes have T2DM?
90%
(Can come on slowly (Insidious onset), usually over the age of 40. Signs may not be obvious or there may be no signs at all, therefore it might be up to 10 years before diagnosis
What is the NHS diabetes prevention programme?
Joint commitment from NHS England, Public Health England and Diabetes UK, to deliver at scale, evidence based behavioural interventions for individuals identified as being at high risk of developing T2MD.
Why implement the NHS diabetes prevention programme?
Strong international evidence that behavioural interventions can significantly reduce risk of developing condition, through reducing weight, increasing physical activity and improving the diet of those at high risk
Diabetes treatment → 10% of annual NHS budget.
What are the aims of the programme?
- To reduce the incidence of Type 2 diabetes;
- To reduce the incidence of complications associated with diabetes -
heart, stroke, kidney, eye and foot problems related to diabetes; and - Over the longer term, to reduce health inequalities associated with
incidence of diabetes.
How was the NHS DPP developed?
Developed by delivery team from NHS England, Public Health England, and Diabetes UK.
Interventions and goals:
The NHS DPP behavioural intervention is underpinned by three core goals:
* achieving a healthy weight
* achievement of dietary recommendations
* achievement of CMO physical activity recommendations
DPP model specification
- must be made up of at least 13 sessions
- at least 16 hours face to face contact time
- spread across min 9 months
- each session lasts between 1-2 hours
people will receive support on setting and achieving goals to making positive changes to lifestyles in order to reduce risk of developing T2DM.
Who is eligible to go on DPP?
Individuals eligible for inclusion have ‘non-diabetic hyperglycaemia’ (NDH), defined as having an HbA1c 42 – 47 mmol/mol (6.0 – 6.4%) or a fasting plasma glucose
(FPG) of 5.5 – 6.9 mmol/l.
The blood result indicating NDH must be within the last 12 months to be eligible for referral and only the most recent blood reading can be used.
Referral routes to DPP:
- Those who have already been identified as having an appropriately
elevated risk level (HbA1c or FPG) in the past and who have been
included on a register of patients with high HbA1c or FPG; - The NHS Health Check programme, which is currently available for
individuals between 40 and 74. NHS Health Checks includes a diabetes
filter, those identified to be at high risk through stage 1 of the filter are
offered a blood test to confirm risk; and - Those who are identified with non-diabetic hyperglycemia through
opportunistic assessment as part of routine clinical care.
Which cells release insulin and which release glucagon?
Beta-cells → Insulin → Converts glucose into glycogen.
Alpha-cells → Glucagon → Converts glycogen into glucose.
What are the core defects in T2DM?
Insulin resistance in muscle and liver (hyperinsulinemia)
Impaired insulin secretion by the pancreatic Beta-cells
List causes of hyperglycaemia
- increased glucose reabsorption
- decreased glucose uptake
- increased lipolysis
- inflammation
- NT dysfunction
- increased glucagon secretion
- increased hepatic glucose production
- decreased insulin secretion
- vascular insulin resistance
- decreased incretin effect
Mechanism for increased glucose reabsorption
^ renal glucose reabsorption by sodium/glucose co-transporter 2 (SGLT2) and the ^ed threshold for glucose spillage in the urine contribute to the maintenance of hyperglycaemia.
Mechanism for decreased glucose uptake
Beta-cell failure therefore less insulin secreted
Mechanism for increased lipolysis
Insulin resistance in adipocytes results in accelerated lipolysis and ^ed plasma FFA levels, both of which aggravate the insulin resistance in muscle and the liver and contribute to Beta-cell failure.
What are the additional functional effect of insulin on the liver, muscle and fat?
