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PUBH211 > Lecture 22: Diabetes > Flashcards

Lecture 22: Diabetes Flashcards

1
Q

what is the WHO definition of diabetes?

A
  • diabetes mellitus is a chronic disease where pancreas doesn’t produce insulin or the insulin produced is ineffective
  • this can result in increase blood glucose concentrations which can cause damage to the body
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2
Q

what are the symptoms of diabetes?

A
  • thirst
  • polyuria
  • weight loss
  • fatigue
  • infections
  • impaired healing

*its important to be aware of these symptoms as diabetes often goes undiagnosed for a long period of time

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3
Q

what types of complications can come as a result of diabetes?

A

microvascular - damage to small BV (capillaries, arterioles)

macrovascular - damage to larger BV (atherosclerosis or thrombosis)

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4
Q

what are some long term complications of diabetes?

A
  • cardiovascular disease including coronary artery disease and stroke
  • retinopathy: damage to back of eyes
  • nephropathy: kidney disease, chronic renal failure
  • neuropathy: decreased sensation - can lead to amputation
  • poor oral health: denitsts often diagnose diabetes
  • cancer: diabetes = high risk
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5
Q

what are the types of diabetes?

A
  • type 1 diabetes
  • type 2 diabetes
  • gestational diabetes
  • other
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6
Q

what is type 1 diabetes?

A

insulin deficiency
- usual onset in childhood and adolescence

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7
Q

what is type 2 diabetes?

A

insulin resistance
- usual onset in adulthood

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8
Q

what is gestational diabetes?

A

diabetes during pregnancy

  • impaired glucose intolerance can lead to large babies
  • this can lead to complex delivery and baby can have problems
  • mother is also more likely to develop type 2 diabetes later in life
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9
Q

what is the best way of testing people for diabetes?why?

A

HbA1c (glycated haemoglobin)

  • from 2011 HbA1c became the preferred test to diagnose diabetes under most circumstances
  • HbA1c reflects average plasma glucose over the previous 8-12 weeks
  • it can be performed at any time of the day and does not require any special preparation such as fasting or performance of glucose tolerance tests
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10
Q

why is it better to measure diabetes in terms of prevalence rather than incidence?

A

diabetes requires chronic management

most adults usually have it for a lot longer before they actually get diagnosed, so prevalence would be more accurate.

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11
Q

what is the diabetes associated Hb1Ac levels in New Zealand and America?

A

NZ: HbA1c ≥50mmol/mol

America: HbA1c ≥ 48mmol/mol

important to consider this difference when comparing data in countries!

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12
Q

what is the Hb1Ac levels for prediabetics?

A

Hb1Ac = 41-48mmol/mol

is considered abnormal or prediabetes

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13
Q

what does this show? what does the data tell us?

A

age-specific diagnosed diabetes rate data from the 2006/07 NZ health survey, 2008/09 NZ adult nutrition survery and virtual diabetes register, by 10 year age groups for women aged 15 years and over.

-

  • shows that prevalence increases with age
  • younger people usually have type 1 while older people usually have type 2
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14
Q

what does this show? why could this be?

A

prevalence of self-reported diabetes is lower than total diabetes based on Hb1Ac

  • important disparities are seen among maori and pacific

reasons for this:

  • some people might not have access to health care to get diagnosed
  • people might be ashamed to self-report that they have diabetes
  • can take a long time for people to recognise they have diabetes
  • high prevalence of prediabetics - exciting and worrying. while a large proportion may go on to be diabetic, it provides opportunity for interventions
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15
Q

what does this show?

A
  • estimated age-adjusted comparative prevalence of diabetes in adults aged 20-79 years in 2021.
  • NZ sits around 5-<7%
  • high prevalence in USA, Canada, Brazil
  • very high rates in mexico >12%
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16
Q

what are the trends of diabetes in western pacific regions?

A
  • high prevalence in western pacific regions
  • pacific island countries don’t have access to renal replacement therapy, insulin, dialysis, retinal laser therapy
  • this is a problem for NZ as we have a stated and moral obligation to support pacific island people, meaning we might need to support them in NZ instead of at home.
17
Q

what does this show?

A
  • there is a high prevalence of diabetes in pacific island countries
  • high case to prevalence ratio
18
Q

what is the aetiology of type 1 diabetes?

A
  • defect in insulin secretion
  • frequently diagnosed in childhood
  • autoimmune
  • ideopathic
  • increasing in prevalence
19
Q

what is the aetiology of type 2 diabetes?

A
  • ‘adult onset’
  • insulin resistance
20
Q

what are the risk factors of type 2 diabetes?

A
  • family history
  • obesity
  • gestational diabetes
  • ethnicity
  • intergenerational effecs
  • poverty
  • food insecurity
  • poor housing and access to greenspace and other facilities
  • obesogenic environments
  • colonisation and intergenerational trauma (indiginoues people world wide have higher prevalence, could be due to colonisation and intergenerational trauma)
21
Q

what is the stigma that comes along with diabetes?

A
  • Highly stigmatized condition due to association of being overweight with diabetes
  • Is important to look beyond the lack of self control ‘life style” model, but look at the wider range of risk factors
  • Poverty has a huge impact on having a nutritious diet - buying a pizza is cheaper than a lettuce.
  • Having a healthy life-style is a privilege for many communities
22
Q

what is the association of diabetes and mortality?

A
  • diabetes is associated with a 2 fold increased risk of death
  • likely because of CVD e.g. elevated blood pressure and poor diabetes control
  • other causes include renal disease, cancer and acute complications
23
Q

what is the issue with diabetes mortality?

A
  • underestimated because the immediate cause of death is often not diabetes (usually it is CVD or kidney failure)
  • but mortality is increasing worldwide
24
Q

what is the mortality of diabetes like in NZ?

A
  • diabetes under-reported on death certificaes
  • audit of otago diabetes regiser 1998-2003 showed that of 508 deaths of diabetic patients:
  • almost 50% of deaths due to CVD (heart disease or stroke)
  • 5 people under 50 years died from acute complications of type 1 diabetes
  • diabetes was mentioned on death certificates of 55% of patients
25
Q

how does NZ cause of death certification impact diabetes morality rates?

A
  • When someone dies in NZ someone has to fill out a death certificate
  • If the death is predicted by the medical team, they can fill out the form without a post mortem exam
  • Diabetes often doesn’t get recorded
  • Diabetes associatesd mortality is underrecorded
26
Q

what are prevention programmes for type 2 diabetes?

A

several RCTs have demonstrated that Type 2 diabetes can be prevented or delayed in high risk individuals

  • Diabetes Prevention Programme (USA)
  • Diabetes Prevention Programme (India)
  • Diabetes Prevention Study (Finland)
  • China Da Qing Diabetes Prevention Study
  • DiRECT Study also shows that remission can be achieved with weight loss
27
Q

what was involved in the diabetes prevention study (finland)?

A
  • RCT
  • control: dietary advice and exercise advice
  • intervention: individualised dietary counselling from nutritionist and resistance training

findings:

  • after 4 years the cumulative incidence of diabetes was 11% in intervention group and 23% in control group
  • risk of diabetes reduced by 58%
28
Q

what does this show about the findings in the diabetes prevention study (finland)?

A

after a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years

  • risk of diabetes continued to decrease as time went on
29
Q

what was involved in the China Da Qing Diabetes Prevention Study?

A
  • 20 year follow up!
  • 577 adults with impaired glucose tolerance from 33 clinics in China were randomly assigned to either the control group or to one of the three lifestyle intervention groups (diet, exercise, or diet + exercise)
  • active intervention took place over 6 years from 1986 until 1992
  • in 2006, study participants were followed up again
30
Q

what does this show about the findings of the China Da Qing Diabetes Prevention?

A
  • cumulative incidence of diabetes during the follow up increased significantly less in the intervention group than the control group
31
Q

what does this show about the findings of the China Da Qing Diabetes Prevention?

A

there was an overall decreased risk of death from diabetes in the intervention group
- but there was some overlap in the CI

32
Q

what does this show about the findings of the China Da Qing Diabetes Prevention?

A

intervention group had reduced cumulative incidence of CVD events and death

33
Q

how do individual approaches and population approaches differ for diabetes?

A
  • Weight loss, good diet and physical activity is effective on an individual basis
  • Population strateiges are also important because of our obesogenic environement
  • we need effective food and urban design policies to promote healthy eating and physical activity. Need to consider wider determinants of health - poverty, income, inequality, colonization, racism and stigma

Many people think of diabetes as a “choice or lifestyle choice” but don’t think of other determinants

34
Q

what were the aims, methods and results of the DiRECT Study (UK)?

A

Aim: identify predictors of type 2 diabetes remission in the intervention arm of DiRECT (diabetes remission clinical trial)

Methods: participants were aged 20-65 years, with type 2 diabetes duration of less than 6 years and BMI 27-45kg/m2, and were not receiving insulin. weight loss was initiated by total diet replacement (825-853kcal/day, 3-5 momnths, shakes/soups), and weight loss maintenance support was provided for 2 years.

results: weight loss was the strongest predictor of remission at 12 months (adjusted odds ratio per kg weight loss 1.24, 95% CI 1.14, 1.34) and 24 months (adjusted OR 1.23, 95% CI 1.13,1.35).

35
Q

what are common treatments for diabetes?

A
  • diet and physical activity
  • medications
  • insulin
  • blood sugar testing
  • living with complications

PUBH211 (31 decks)

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