Diabetes Epidemiology Flashcards
Diabetes Mellitus
- What is it
Abnormally high glucose levels
- Hyperglycemia
Symptoms of Hyperglycemia
- Polyuria and Polydipsia
- Headache
- Fatigue
- Blurred Vision
- Difficulty Concentrating
- Weight Loss
Type 1 Diabetes Mellitus
- Classification
Pancreatic Beta Cell Destruction, unable to produce insulin
- Prone to Ketoacidosis
Type 2 Diabetes Mellitus
- Classification
Insulin resistance or Deficit in Insulin Secretion
Gestational Diabetes Mellitus
Glucose intolerance with onset of pregnancy or during pregnancy
Diabetes
- Conditions for a Diagnostic
A) Symptomatic Hyperglycemia
- Metabolic Decompensation
- Ketoacidosis
- Ketonuria
B) Confirmatory Lab Test, two different tests must be above diagnostic threshold
Diabetes
- Diagnostic Threshold (FPG)
Fasting Plasma Glucose >= 7.0 mmol/L
No food in last 8 hours
Diabetes
- Diagnostic Threshold (A1c)
A1c >= 6.5 percent
Average amount of sugar in blood in last three months
Diabetes
- Diagnostic Threshold (2hPG)
2 hour post load glucose >= 11.1 mmol/L
After a 75g Oral Glucose Tolerance Test
(2hPG in a 75g OGTT)
Diabetes
- Diagnostic Threshold (Random PG)
Random PG >= 11.1 mmol/L
Taken at any time in the day without regarding the interval from last meal
Hypoglycemia
- Diagnostic
FPG: < 4 mmol/L
Random < 4 mmol/L
OGTT (2h) < 4 mmol/L
Prediabetes
- Diagnostic
FPG (Impaired Fasting Glucose):
- 6.1-6.9
2hPG in a 75g OGTT (Impaired Glucose Tolerance)
- 7.8-11.0
A1c (Prediabetes)
- 6.0-6.4
Diabetes
- Diagnostic
FPG >7.0
Random > 11.1
OGTT (2h) > 11.1
A1c > 6.5
Normal Glucose Levels
- Diagnostic
FPG: 4.1-5.9
Random: 4.1-11
OGTT (2h): 4.1-7.7
Type 1 Diabetes Mellitus
- Screening
No marker for T1DM, no universal test
No evidence that intervention can prevent T1DM
Type 2 Diabetes Mellitus
- Screening
1 in 3 people with diabetes do not know they have T2DM. Can appear 4-7 years before clinical diagnosis
- Screen based on Known Risk Factors
- Screen based on diabetes-associated conditions
Gestational Diabetes
- Screening
50 gm glucose challenge at 24-28 weeks gestation
- Start earlier if at higher risk of GDM
Risk factors for Type 2 Diabetes
- Age older than 40
- First degree relative with T2DM
- Low socioeconomic status
- High risk population (African, Arab, Asian, Hispanic, Indigenous, South Asian)
- History of prediabetes
- History of GDM or delivery of a macrosomic infant
- Presence of end organ damage associated with diabetes
–> Macrovascular
–> Microvascular - Presence of Vascular risk factors
- Presence of Associated diseases
- Use of drugs associated with diabetes
How is Treatment Targets set for Diabetes
Individualized based on Patient
- Age
- Duration of Diabetes
- Presence of Complications (Microvascular, Macrovascular, Neuropathy)
- Risk of Hypoglycemia
A1c Targets for different groups
<= 6.5: For adults if at low risk of hypoglycemia
- More aggressive target for younger patients
<= 7.0: For most adults with T1DM/T2DM
7.1-8.0%: Functionally dependent
7.1-8.5%: Frail elderly/Frequent hypoglycemia/Limited Life Expectancy
End of Life: No target, just avoid hypo/hyperglycemia
Max A1c target
Avoid anything higher than 8.5% as it can lead to risk of hyperglycemia symptoms or acute/chronic complications
A1c Target for End of Life patients
No A1c target, just focus on avoiding hypo/hyperglycemia symptoms
How to achieve A1c Target <= 7.0%
Fasting Blood Glucose or Pre-Prandial Blood Glucose
- 4.0-7.0 mmol/L
Post-Prandial Blood Glucose
- 5.0-10.0 mmol/L
