Diabetes Flashcards
Learning Objectives
- Describe how diabetes is defined, diagnosed and classified
- Understand the key trends and patterns in the distribution of type 2 diabetes in adults globally
- Appreciate the burden of mortality and morbidity associated with diabetes
- Describe the key upstream and downstream risk factors for type 2 diabetes
- Consider and evaluate different strategies to prevent type 2 diabetes in different parts on the world
Define diabetes mellitus
A metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
What are the effects of diabetes?
The effects of diabetes mellitus include long term damage, dysfunction and failure of various organs
Describe the production of insulin and its action
VD quite useful
What are the major complications of diabetes
- Infectious diseases! HIV/Malaria, Tuberculosis
- Other NCDs: Cancer, Chronic respiratory disease, Cardio-vesicular disease
- Human development: life changes, mental health, under nutrition, poverty
- Economic sustainability: Health systems costs, Human capital, Lost productivity
- Environmental sustainability: Urbanisation, Climate changes, Food security, Life changes
What are the diagnostic cut points
- Possible approaches to defining cut points:
- Statistical
- Physiological
- Clinical
- However, it is increasingly clear that the risk of cardiovascular disease increases even at levels of blood glucose below these cut-points for diagnosing diabetes – the relationship is graded and continuous
Describe the WHO’s criteria for the diagnosis of diabetes and intermediate hyperglycaemia?
- Symptomatic: Polyuria, polydipsia, unexplained weight loss
- A single fasting plasma glucose >7 OR A single random plasma glucose >11.1
- Asymptomatic:
- A fasting glucose ≥7 on two separate
occasions or A random glucose ≥11.1 on two separate
occasions OR An HbA1c ≥6.5% (48mmol/mol) on two
separate occasions
What is the overlap between diabetes diagnosed on fasting and 2 hours post challenge glucose?
- Fasting glucose: 41%
- Overlap: 28%
- 2 hour post challenge glucose: 31%
How is undiagnosed diabetes in the US dealt with?
- 3 different diagnostic tests
- A1C 1.6%, 2-h glucose 4.6%, FPG 2.5%
- No diabetes: 86.9%
- Diagnosed diabetes: 7.8%
What is the most prevalent type of diabetes in adults >20?
Type 2 Diabetes - T2DM - accounts for 85-95% of diabetes globally
What does prevalence estimate?
- Prevalence estimates and projections
- Mortality impact
- Economic impact • Guidance on management, prevention and policy implications
- Resources for action
Describe the burden of diabetes
- In 2021, the IDF 10 Edition of the Atlas estimates that 1 in 10 people aged 20-79 have diabetes
- This equates to 537 million people in the world
- By 2045, this number will increase to 784 million
- Some estimates even higher (Lancet 2024; 04: 2077–93) NCD-Risc - an estimated 828 million adults 18+ had diabetes, an increase of 630 million from 1990
- Limited data in some parts of the world
Provide a summary for the global diabetes epidemic
- Diabetes increasing rapidly worldwide
- Ageing and increasing levels of key risk factors especially obesity
- T2DM increasing in every country
- 80% of adult cases reside in LMIC
- Younger age – half are aged 40-50
- Up to half undiagnosed with DM
What are the further global issues regarding diabetes?
- Complications e.g. retinopathy much higher in developing countries - e.g. prevalence at diagnosis, 15.7% Egypt vs 6.2% Australia
- Rural to urban migration
- Reduced physical activity, increased BMI;
- e.g. Tanzania study: vigorous physical activity declined (79.4% (26.5% men, 37.8% 1 5.6% women,
- Weight increased (2.3 kg)
Describe the social determinants of diabetes
- DM widely perceived 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 and access to energy rich diets
Describe the mortality and morbidity attributes to diabetes
- 5 million disease from diabetes in 2015
- 1.5 million died from HIV/AIDS in 2013
- 1.5 million died from tuberculosis in 2013
- 600k died from malaria in 2013
What are the problems with treatment for low income countries?
- Weak or absent financial systems • Weak patient information systems affecting referrals, follow-up, patient records
- Lack of training, career development, loss of staff
- Emerging private health care, increasing inequality
- Little population based public health (intersectoral
collaboration)
View diagrams for diabetes coverage and affordability
What are the modifiable and non-modifiable risk factors of diabetes?
- Modifiable: Overweight, obesity, physical activity, dietary factors, alcohol consumption, tobacco smoking, previously identified glucose tolerance, Prenatal and early life influences
- Non-modifiable risk factors: Age, sex, family history of T2DM, Genes, previously gestational diabetes, Ethnicity
How does obesity act as a “marker” for behavioural factors?
- Overweight/Obesity -> Increased risk of poor health
- Overweight/Obesity -> Physical inactivity or aspects of diet -> Increased risk of poor health
How can we reduce risk of type 2 diabetes?
- With Moderate physical activity
- Brisk walking, Leisure cycling, Playing golf, Gardening
- 10 cohort studies
- Even after allowing for BMI, risk of T2DM reduced by 17% with moderate physical activity
What are the advantages and disadvantages to high risk approaches to prevention?
- 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
What are the advantages and disadvantages to the population approaches to prevention?
- 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
What are the types of population level interventions
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