Epidemiology, aetiology and pathophysiology of diabetes

Question 1

What is primary diabetes?

Answer 1

Consists of Type 1 and Type 2 diabetes

Question 2

What is secondary diabetes?

Answer 2

It is a type of diabetes that occurs due to presence of another medical condition. It only accounts for 1-2% of all diabetes cases.

Question 3

What are some conditions that can induce diabetes?

Answer 3

Liver disease (cirrhosis)
Pancreatic disease (cystic fibrosis, chronic pancreatitis, pancreatic cancer)
Endocrine disease (Cushing’s disease, thryotoxicosis, polycystic ovary syndrome)
Drug induced diabetes (corticosteriods, thiazide diuretics, beta blockers)

Question 4

When does gestational diabetes normally occur?

Answer 4

In the second or third trimester

Question 5

How common is gestational diabetes?

Answer 5

3-4% of all pregnancies

Question 6

How is gestational diabetes normally managed?

Answer 6

Caused by insulin resistance and can usually be managed by diet however some may require insulin therapy.

Question 7

What is one of the major risks with gestational diabetes?

Answer 7

Large birth weight
Increased risk of premature birth
Increased risk of stillbirth
Risk of pre-eclampsia
Polyhydramnios

Question 8

How many cases of diabetes are there worldwide and how does this compare to the UK?

Answer 8

In 2017, it was record there are up to 425 million of cases worldwide
4.7 million cases in the UK with up to a million undiagnosed.

Question 9

What has been in the increase in diabetes in the UK in the last decade?

Answer 9

60% in the last decade

Question 10

How many patients with diabetes have Type 1?

Answer 10

8%

Question 11

Where is the prevalence of Type 1 the highest?

Answer 11

Highest in Caucasians and lowest in Japan and the Pacific areas.

Question 12

What are the two age peaks for Type 1 diabetes?

Answer 12

Between 4-7 and then 10-14 years

Question 13

What is the rate of increase of Type 1 in Europe?

Answer 13

3-4% per year

Question 14

What does the prevalence of Type 2 increase with?

Answer 14

Age and obesity

Question 15

What are the ethnic risk factors for the development of Type 2?

Answer 15

3-4 times more likely in African/Caribbean
4-7 times more likely in Hispanic, South Asian and Arabian with Western lifestyles

All in comparisons to White Europeans
Also tends to develop 10 years earlier than White Europeans

Question 16

What are some of the immunological markers for Type 1 diabetes?

Answer 16

90% of Type 1 diabetes have the human leukocyte antigen present in the form of DR3 and/or DR4.
70% at diagnosis contain islet cell antibodies (present several years before diagnosis)

Question 17

Is Type 1 diabetes hereditary?

Answer 17

Not genetic pre-determined but having a family member increases chance of developing diabetes (increase of about 6% with a parent (from 3-6%) or sibling).

Question 18

Which virus may be associated with Type 1 diabetes?

Answer 18

Coxsackie B4

Question 19

Is the genetic link stronger in Type 2?

Answer 19

Yes for example,
Identical twins, 100%
Child of a type 2, 5-10%

Question 20

How many cases of Type 2 links to obesity?

Answer 20

80%

Question 21

Aside from genetics and obesity, what are the other risk factors for Type 2?

Answer 21

Low birth weight or low birth weight at 12 months which links to poor nutritional status and impaired beta cell function.

Question 22

What does metabolic syndrome include?

Answer 22

Central obesity (greater than 102cm waist in men, 88cm in females)
Increase in cholesterol levels
Increase in hypertension
Increase in blood glucose

All of which increase risk of CVD.

Question 23

How does the mass of remaining B cells differ between Type 1 and Type 2?

Answer 23

5-10% remain in Type 1
50% remain in Type 2

Question 24

What is the treatment aim of Type 2 diabetes?

Answer 24

Augment/ enhance the activity of the remaining 50% of B cells.

Question 25

Aside from reduction in B cells, what other processes occur?

Answer 25

Downregulation of insulin receptors (especially Type 2)
Unregulated hepatic glycogenolysis and gluconeogenesis (both types)

Question 26

What can often occur when a patient with diabetes is ill?

Answer 26

Metabolic disturbances in which there is an increase is counter-regulatory hormones such as glucagon and cortisol.
This increases the hepatic glucose production
At the same time:
Increase in lipolysis and fatty acids
These are normally uptaken by the liver to produce acetyl CoA to be removed from the body
This is then exceeded in a diabetic patient and as a result ketone bodies are released resulting in diabetic ketoacidosis.