Diabetes Epidemiology

Question 1

Diabetes Mellitus
- What is it

Answer 1

Abnormally high glucose levels
- Hyperglycemia

Question 2

Symptoms of Hyperglycemia

Answer 2

• Polyuria and Polydipsia
• Headache
• Fatigue
• Blurred Vision
• Difficulty Concentrating
• Weight Loss

Question 3

Type 1 Diabetes Mellitus
- Classification

Answer 3

Pancreatic Beta Cell Destruction, unable to produce insulin
- Prone to Ketoacidosis

Question 4

Type 2 Diabetes Mellitus
- Classification

Answer 4

Insulin resistance or Deficit in Insulin Secretion

Question 5

Gestational Diabetes Mellitus

Answer 5

Glucose intolerance with onset of pregnancy or during pregnancy

Question 6

Diabetes
- Conditions for a Diagnostic

Answer 6

A) Symptomatic Hyperglycemia
- Metabolic Decompensation
- Ketoacidosis
- Ketonuria

B) Confirmatory Lab Test, two different tests must be above diagnostic threshold

Question 7

Diabetes
- Diagnostic Threshold (FPG)

Answer 7

Fasting Plasma Glucose >= 7.0 mmol/L

No food in last 8 hours

Question 8

Diabetes
- Diagnostic Threshold (A1c)

Answer 8

A1c >= 6.5 percent

Average amount of sugar in blood in last three months

Question 9

Diabetes
- Diagnostic Threshold (2hPG)

Answer 9

2 hour post load glucose >= 11.1 mmol/L

After a 75g Oral Glucose Tolerance Test
(2hPG in a 75g OGTT)

Question 10

Diabetes
- Diagnostic Threshold (Random PG)

Answer 10

Random PG >= 11.1 mmol/L

Taken at any time in the day without regarding the interval from last meal

Question 11

Hypoglycemia
- Diagnostic

Answer 11

FPG: < 4 mmol/L
Random < 4 mmol/L
OGTT (2h) < 4 mmol/L

Question 12

Prediabetes
- Diagnostic

Answer 12

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

Question 13

Diabetes
- Diagnostic

Answer 13

FPG >7.0
Random > 11.1
OGTT (2h) > 11.1
A1c > 6.5

Question 14

Normal Glucose Levels
- Diagnostic

Answer 14

FPG: 4.1-6.9
Random: 4.1-11
OGTT (2h): 4.1-7.7

Question 15

Type 1 Diabetes Mellitus
- Screening

Answer 15

No marker for T1DM, no universal test

No evidence that intervention can prevent T1DM

Question 16

Type 2 Diabetes Mellitus
- Screening

Answer 16

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

Question 17

Gestational Diabetes
- Screening

Answer 17

50 gm glucose challenge at 24-28 weeks gestation
- Start earlier if at higher risk of GDM

Question 18

Risk factors for Type 2 Diabetes

Answer 18

• 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

Question 19

How is Treatment Targets set for Diabetes

Answer 19

Individualized based on Patient
- Age
- Duration of Diabetes
- Presence of Complications (Microvascular, Macrovascular, Neuropathy)
- Risk of Hypoglycemia

Question 20

A1c Targets for different groups

Answer 20

<= 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

Question 21

Max A1c target

Answer 21

Avoid anything higher than 8.5% as it can lead to risk of hyperglycemia symptoms or acute/chronic complications

Question 22

A1c Target for End of Life patients

Answer 22

No A1c target, just focus on avoiding hypo/hyperglycemia symptoms

Question 23

How to achieve A1c Target <= 7.0%

Answer 23

Fasting Blood Glucose or Pre-Prandial Blood Glucose
- 4.0-7.0 mmol/L

Post-Prandial Blood Glucose
- 5.0-10.0 mmol/L