Diabetes- Epidemiology, aetiology & Pathophysiology Flashcards
What are the two types of Diabetes Mellitus?
Primary and secondary diabetes
What are the two types of primary diabetes?
- Type 1 (Formerly insulin-dependent diabetes mellitus - IDDM)
- Type 2 (Formerly non-insulin-dependent diabetes mellitus- NIDDM)
What percentage of new diabetes cases are secondary diabetes?
1-2%
Name 4 examples of secondary diabetes.
- Liver disease (e.g. cirrhosis)
- Pancreatic disease (e.g. cystic fibrosis)
- Endocrine disease (e.g. Cushing’s syndrome, Thryotoxicosis)
- Drug induced (e.g. thiazide diuretics, corticosteroids)
What is Gestational Diabetes?
- Diabetes during pregnancy (usually in 2nd or 3rd trimester)
- Occurs in 3-4% of all pregnancies
- Risk of large birth weight baby
- Usually return to normal following delivery
What causes Gestational diabetes and how is it managed?
- It is caused by insulin resistance
- It is usually managed by diet but may need insulin
Overall worldwide (2017), how many people had diabetes?
425 million
Overall, in the UK (2005), how many people had diabetes?
2.1 million
Overall, in the UK (2015), how many people had diabetes?
3.3 million
Overall, in the UK (2019), how many people had diabetes?
4.7 million
Overall, in the UK, how many people have undiagnosed diabetes?
Up to 1 million
What percentage of people with diabetes have Type 1 diabetes?
8%
In which ethnic group is Type 1 diabetes the highest?
Highest in Caucasians (especially Finland & other North European countries)
In which country is Type 1 diabetes the lowest?
Lowest in Japan & Pacific area
At what age would Type 1 diabetes present?
- May present at any age, but prominent disease of childhood, peaking at puberty.
- 50-60% present < 20yrs
Which type of diabetes is most common, Type 1 or Type 2?
Type 2
What percentage of patients with diabetes have Type 2 diabetes?
90%
Type 2 diabetes is higher risk with ______ and __________.
Age and Obesity
Type 2 diabetes is high risk within which ethnicities?
- 3-4 x higher : African/Caribbean
- 4-7 x higher : Hispanic American + S.Asia/Arabian with Western lifestyles
What does aetiology mean?
The cause or origin of disease
What percentage of people with type 1 diabetes carry HLA-DR3 &/or DR4
> 90%
What is HLA-associated immune-mediated disease?
People with certain HLA antigens are more likely to develop certain autoimmune diseases, such as type I diabetes
Which type of diabetes is likely to be caused if HLA antigens are present?
Type 1
What are the 4 causes/aetiology for Type 1 diabetes?
- HLA-associated immune-mediated disease
- Autoantibodies versus pancreatic cells
- Not genetically pre-determined but high susceptibility to disease may be inherited
- Environmental
What are the 3 causes/aetiology for Type 2 diabetes?
- Stronger genetic relationship than Type 1
- Obesity (occurs in ~80%)
- Low birth weight & weight at 12 months
Why is obesity a cause of type 2 diabetes?
- Increased insulin resistance
- Low number of beta-cells
Why is low birth weight & weight at 12 months a cause of type 2 diabetes?
- Poor nutrition in early life -> impaired beta-cell development and function
What is metabolic syndrome?
Combination of medical disorders when occurring together increases the risk of cardiovascular disease and Type 2 diabetes mellitus.
- High Blood pressure
- High Blood glucose
- Central abdominal obesity (men > 102cm , women >88cm)
- High cholesterol
What does pathophysiology mean?
Pathophysiology describes the changes that occur during a disease process
What 4 changes/pathophysiology occurs for diabetes?
- Lower mass of beta-cells
- Type 1 : 5-10% remaining
- Type 2 : ~50% remaining
- Down regulation of insulin receptors
- Especially Type 2 due to “insulin resistance”
- Unregulated hepatic glycogenolysis & gluconeogenesis
- All mainly leading to HYPERGLYCAEMIA
What is Glycogenolysis?
Glycogen breaks down into glucose-1-phosphate and glucose
What is Gluconeogenesis?
The process of making glucose from its own breakdown products or from the breakdown products of lipids (fats) or proteins
What is Hyperglycaemia?
High blood glucose. Hyperglycemia is blood glucose greater than 125 mg/dL while fasting and greater than 180 mg/dL 2 hours postprandial.