diabetes

Question 1

impaired glucose tolerance?

Answer 1

Fasting blood glucose <7 mmol/l 2hr blood glucose 7.8-11.0 mmol/l 17% of 35-65 year olds Associated with significant Cardiovascular risk

Question 2

what causes type 1 diabetes?

Answer 2

Autoimmune (anti-GAD, IA2, ZnT8, islet cell Abs) T cell mediated selective destruction of the beta cells Genetics: Caucasian HLA DR3/4 predisposition 2/3 male Environment ? hygiene

Question 3

loci contibuting to type 2?

Answer 3

Obesity/insulin resistance FTO PPARG Odds ratios 1.1 – 1.5 Pancreas development /islet function TCF7L2 KCNJ11, HHEX/IDE, CDKAL1, CDKN2 IGF2BP2, SLC30A8

Question 4

treat diabetes?

Answer 4

Diet: CHO even input (type 1), reduce calories (Type 2) NB: Bariatric surgery (type 2) Exercise (esp Type 2) Insulin sensitising agents (Type 2 only) Metformin (Glitazones) Insulin secreting agents (Type 2 only) Sulphonylureas Increting mimetics/DPPIV inhibitors INSULIN (Type 1 – essential; also Type 2)

Question 5

effects of glucagon like peptide?

Answer 5

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Question 6

incretin therapy?

Answer 6

Incretin mimetics – (injected) – exenatide, liraglutide DPPIV inhibitors (tablets) – e.g. “-gliptins” e.g. sitagliptin

Question 7

future treatments?

Answer 7

TYPE 1 DIABETES Closed loop insulin pumps Immunotherapy to prevent beta cell destruction Stem cell therapy to replace beta cells TYPE 2 DIABETES Public health interventions to reduce obesity Appetite modulators New drugs