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Endocriknowlogy > DM: Diagnosis Classification Pathophysiology > Flashcards

DM: Diagnosis Classification Pathophysiology Flashcards

1
Q

Impaired fasting glucose

A. 100-124
B. 100-125
C. 100-126

A

B. 100-125 mg/dL

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2
Q

Impaired glucose tolerance

A. 140-199
B. 141-199
C. 140-200
D. 140-200

A

A. 140-199 mg/dL

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3
Q

Prediabetes

A. 5.6-6.4
B. 5.7-6.4
C. 5.6-6.5
D. 6.6-6.5

A

B. 5.7-6.4%

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4
Q

Site of mutation in MODY 1

A

Hepatocyte nuclear transcription factor (HNF) 4 alpha

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5
Q

Site of mutation in MODY 2

A

Glucokinase

Patients have mild-to-moderate, but stable hyperglycemia, that DOES NOT RESPOND TO OHAs

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6
Q

Site of mutation in MODY 3

A

Hepatocyte nuclear transcription factor (HNF) 1 alpha

Patients have a progressive decline in glycemic control but MAY RESPOND TO SULFONYLUREAS

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7
Q

This percentage of people who develop DM after age 30 actually has Type 1 DM

A

5-10%

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8
Q

Maturity-onset diabetes of the young (MODY) and Monogenic diabetes are characterized by: (3)

A
  1. Autosomal dominant inheritance
  2. Early onset of hyperglycemia (<25 years; sometimes in neonatal period)
  3. Impaired insulin secretion
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9
Q

Risk of DM in women who have had GDM (in the next 10-20 years)

A

35-60%

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10
Q

Highest incidence of type 1 DM

A

Scandinavia

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11
Q

Lowest incidence of type 1 DM

A

Pacific Rim

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12
Q

Intermediate incidence of type 1 DM

A

Northern Europe and United States

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13
Q

Highest incidence of type 2 DM

A

Pacific Islands and Middle East

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14
Q

Intermediate incidence of type 2 DM

A

India and United States

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15
Q

mg/dL and mmol/L conversion

A

To convert mg/dL to mmol/L - divide by 18

To convert mmol/L to mg/dL - multiply by 18

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16
Q

DM is defined by

A. Deviation from the population-based mean
B. Level of glycemia at which diabetes-specific complications occur
C. Both
D. Neither

A

B. Level of glycemia at which diabetes-specific complications occur

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17
Q

Most reliable and convenient tests for identifying DM in asymptomatic individuals

A. Fasting plasma glucose
B. HbA1c
C. 75g OGTT
D. Random blood sugar
E. A and B
F. C and D
G. A and C
A

E. FPG and HbA1c

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18
Q

4 Criteria for diagnosis of DM

A
  1. RBS >=200 mg/dL or 11.1 mmol/L + Symptoms (polyuria, polydipsia, weight loss)
  2. FPG >=126 mg/dL or 7 mmol/L
  3. HbA1c >=6.5%
  4. 2h plasma glucose >= 200 mg/dL or 11.1 mmol/L (75g OGTT)

(In the absence of unequivocal hyperglycemia and acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day)

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19
Q

Minimum number of hours of fasting for FBS (NO CALORIC INTAKE)

A

8 hours

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20
Q

HbA1c test should be done in a lab using a method approved by the National Glycohemoglobin Standardization Program and correlated to the reference assay of the ___________

A

Diabetes Control and Complications Trial

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21
Q

Glucose load used in diagnosis of DM

A

75g anhydrous glucose dissolved in water

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22
Q

ADA recommendation for DM screening in all individuals

A

All aged >45 every 3 years, OR earlier if overweight and with 1 additional risk factor

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23
Q

Risk factors for type 2 DM

A
  1. Family history of diabetes
  2. Overweight or obese (BMI >= 25; 23 in Asian Americans)
  3. Physical inactivity
  4. Race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
  5. Previously identified with IFG, IGT, or HbA1c 5.7-6.4%
  6. History of GDM
  7. Hypertension (BP>=140/90)
  8. HDL <35 mg/dL and/or a triglyceride level >250 mg/dL
  9. PCOS or acanthosis nigricans
  10. History of cardiovascular disease
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24
Q

Most important regulator of glucose homeostasis

A

Insulin

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25
Q

Major portion of postprandial glucose is used by

A

Skeletal muscle

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26
Q

Organ that most notably uses glucose in insulin-independent fashion

A

Brain

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27
Q

Insulin is initially synthesized by the beta cells as ______

A

Preproinsulin (single-chain 86-amino-acid precursor polypeptide)

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28
Q

Removal of amino-terminal signal peptide from preproinsulin yields_________

A

Proinsulin (structurally related to IGF I and II)

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29
Q

Cleavage of an internal 31-residue fragment from proinsulin generates ________

A

C-peptide with A (21 amino acids) and B (30 amino acids) chains of insulin connected by disulfide bonds

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30
Q

A 37-amino-acid peptide co-secreted by pancreatic beta cells along with insulin

A

Islet amyloid polypeptide (IAPP) or amylin

31
Q

Level of glucose (key regulator of insulin secretion) that stimulate insulin synthesis

A

> 70 mg/dL or 3.9 mmol/L

32
Q

Rate-limiting step that controls glucose-regulated insulin secretion

A

Glucose phosphorylation by glucokinase

33
Q

Inhibition of this channel induces beta cell membrane depolarization

A

Inwardly rectifying K+ channel protein (Kir6.2)

34
Q

Pattern of insulin secretion

A

Small secretory bursts occurring about every 10 mins, superimposed upon greater amplitude oscillations of about 80-150 mins

35
Q

Percent of insulin that is removed and degraded by the liver

A

50%

36
Q

Activation of this pathway stimulates translocation of facilitative glucose transporter that is crucial for glucose uptake by skeletal muscle and fat

A

Phosphatidylinositol-3’-kinase (PI-3-kinase) pathway

37
Q

Stage 1 in the development of type 1 DM:

A

Development of two or more islet cell autoantibodies but the maintenance of normoglycemia

38
Q

Stage 2 in the development of type 1 DM:

A

Continued autoimmunity and the development of dysglycemia

39
Q

Stage 3 in the development of type 1 DM:

A

Development of hyperglycemia that exceeds the diagnostic criteria for the diagnosis of diabetes

40
Q

When does the “honeymoon phase” of diabetes occur?

A

In the first 1 or 2 years after the onset of diabetes

41
Q

Percentage of concordance of type 1 DM in identical twins

A

40-60%

42
Q

Major susceptibility gene for type 1 DM

A

HLA region on chromosome 6 (account for 40-50% of the genetic risk)

This region contains genes that encode the class II MHC molecules

43
Q

Which HLA haplotype is most common in type 1 DM patients?

A

HLA DR3 and/or DR4

44
Q

Specific haplotypes most strongly associated with type 1 DM

A

DQA1*0301

DQB1*0302

DQB1*0201

(Present in 40% of children with type 1 DM)

45
Q

Haplotypes that appear to provide protection from type 1 DM

A

DQA1*0102

DQB1*0602

(Extremely rare in type 1 DM <1%)

46
Q

Risk of developing type 1 DM in relatives of individuals with the disease (% if the one with DM is the parent or sibling)

A

3-4% if parent has type 1 DM

5-15% if sibling

47
Q

Percent of individuals with type 1 DM who do not have a first-degree relative with this disorder

A

75%

48
Q

Term that refers to modest infiltration of pancreatic islets with lymphocytes

A

Insulitis

49
Q

What do you call a composite of several different antibodies directed at pancreatic islet molecules that serve as a marker of the autoimmune process of type 1 DM and are present in >85% of those with new-onset type 1 DM

A

Islet cell autoantibodies (ICAs)

50
Q

Most prominent viruses that are thought to trigger the onset of DM (3)

A

Coxsackie, rubella, enteroviruses

51
Q

Putative environmental triggers of DM

A

Viruses (coxsackie, rubella, enteroviruses most prominently), bovine milk proteins, nitrosurea compounds, vitamin D deficiency, and environmental toxins

52
Q

Which trial concluded that administering insulin (IV or PO) to individuals at high risk for developing type 1 DM did not prevent type 1 DM

A

Diabetes Prevention Trial - Type 1

53
Q

Concordance of type 2 DM in identical twins

A

70-90%

54
Q

Percentage risk of DM if both parents have type 2 DM

A

40%

55
Q

Pattern of metabolic changes in type 2 DM

A

Progressive insulin resistance –> Hyperinsulinemia –> Impaired glucose tolerance –> Type 2 DM

56
Q

TRUE OR FALSE: Adiponectin (produced by adipocytes) is reduced in obesity

A

TRUE. Adiponectin is an insulin-sensitizing peptide. Decreased adiponectin in obesity contributes to hepatic insulin resistance.

57
Q

Overall beta cell function is reduced by as much as __% at the onset of type 2 DM

A

50%

58
Q

Beta cell mass is decreased by ~__% in individuals with long-standing type 2 DM

A

50%

59
Q

Type A or Type B Syndrome of Severe Insulin Resistance: Affects young women, characterized by severe hyperinsulinemia, obesity, and features of hyperandrogenism. Have an undefined defect in the insulin-signaling pathway.

A

Type A

60
Q

Type A or Type B Syndrome of Severe Insulin Resistance: Affects middle-aged women, characterized by severe hyperinsulinemia, features of hyperandrogenism, and autoimmune disorders. Have autoantibodies directed at the insulin receptor.

A

Type B

61
Q

Diabetes Prevention Program: Intensive changes in lifestyle (diet and exercise for 30 min/d five times/week) in individuals with IGT prevented or delayed the development of type 2 DM by __% compared to placebo

A

58%

62
Q

Diabetes Prevention Program: Metformin prevented or delayed diabetes by __% compared to placebo.

A

31%

63
Q

ADA suggests that metformin be considered in individuals with both IFG and IGT who are at very high risk for progression to diabetes, such as _______ (3)

A

Age <60 years, BMI >=35 kg/m2, and history of GDM

64
Q

Site of mutation in MODY 5

A

Hepatocyte nuclear transcription factor (HNF) 1 beta

(Patients have progressive impairment of insulin secretion and hepatic insulin resistance, and REQUIRE INSULIN TREATMENT with MINIMAL RESPONSE TO SULFONYLUREAS)

65
Q

Site of mutation in MODY 4

A

Pancreatic and duodenal homeobox 1

66
Q

Which mutation is the most common cause of pancreatic agenesis?

A

Transcription factor GATA6

67
Q

Designation given to a number of mutations in the coding sequence of the insulin gene that interfere with proinsulin folding, processing, and bioactivity

A

Mutant Ins-gene-induced Diabetes of Youth (MIDYs)

68
Q

ADA recommendation for target HbA1c in women prior to conception

A

<6.5%

69
Q

What level of blood pressure is considered hypertension in individuals with diabetes?

A

> 130/80 mmHg

70
Q

Based on ADA recommendations, when do we start annual screening for autonomic neuropathy in type 1 and type 2 DM?

A

5 years after diagnosis of type 1 DM;

At the time of diagnosis of type 2 DM

71
Q

Typical characteristics of type 1 DM

A
  1. onset of disease prior to age 30 years
  2. lean body habitus
  3. requirement of insulin as initial therapy
  4. propensity to develop ketoacidosis
  5. increased risk of other autoimmune idsorders such as autoimmune thyroid disease, adrenal insufficiency, pernicious anemia, celiac disease, and vitiligo
72
Q

Typical characteristics of type 2 DM

A
  1. diabetes onset after the age of 30 years
  2. usually obese (80%)
  3. may not require insulin therapy initially
  4. may have associated conditions such as insulin resistance, hypertension, cardiovascular disease, dyslipidemia, or PCOS
73
Q

“Latent autoimmune diabetes of the adult” refers to

A

Individuals with the phenotypic appearance of type 2 DM and do not have absolute insulin deficiency but have autoimmune markers (GAD and other ICA autoantibodies) suggestive of type 1 DM

74
Q

Individuals with IFG, IGT, or HbA1c 5.7-6.4% should be monitored how frequently to determine if diagnostic criteria for diabetes are present?

A

Annually

Endocriknowlogy (9 decks)

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