Mar1 M1-Diabetes Prevention Flashcards
gestational diabetes pathophgy
insulin resistance
diabetes prevalence dx vs prevalence overall
prevalence dx = 7% pop
prevalence overall = 13%
kids epi of diabetes
type 1 most common. type 2 incidence rising
gestational diabetes charact
- higher phgy demand of sugar
- resolves postpartum
- strong risk factor for future type 2 DM
prediabetes prevalence
third of adults. strong risk factor. type 2 DM predictor
DM values for dx
fasting = over 7
2 hr after 75g = over 11.1
AIC over 6.5%
GDM dx
- 75g oral test
- fasting = over 5.1
- 1 hour after meal = over 10
- 2 hr after meal = over 8.5
main complications of diabetes (5)
- retinopathy
- kidney failure
- stroke
- heart disease
- amputations
GDM management
have to treat it
why treat GDM
-neonate can have growth problem (macrosomia = large baby). insulin is a growth hormone (remember GDM = insulin resist so higher insulin)
associations of GDM
- postpartum diabetes in mom (**added risk with gestational htn)
- diabetes in fathers
expensive test for diabetes
insulin-glucose ratio in blood (tells for insulin resist) (HOMA-IR test. over 2 = insulin resistance)
most important time in diabetes prevention
prediabetes period. is most responsive to change (lifestyle, etc.)
general principles for preventing T2DM, GDM and prediabetes
-weight loss
-phys activity
-improved dietary quality
-metformin, acarbose
TO REDUCE INSULIN RESISTANCE
american diabetes prevention program in pts with impaired glucose: they tried to prescribe what
7% weight loss
150 minutes activity each week
850 mg metformin twice daily
eating frequency principle
1 big meal a day is bad. better to eat more smaller meals (+ eat slowly, low fat, low calories, food guide)
best between metformin and lifestyle changes
lifestyle changes are better to reduce risk of diabetes (metformin reduce risk too but less)
what happens if weight regained, lifestyle change stopped and metformin stopped
reduced risk is MAINTAINED for life (metabolic memory)
alternative dietary patterns in T2DM patients + effect
Mediterranean (olive oil), vegan, pulses (beans, peas, lentils), htn diet: DO NOT lead to weight loss. REDUCE risk of diabetes
balanced plate
half vegetables, quarter protein, quarter starch
canadian diabetes association exercise recommendations
- 150 min per week: aerobic vigorous exercise
- 3 resistance exercise sessions per week
walk 2-3 hrs each week reduces type 2 DM risk of how much
50%
how many steps usually set as goal to stay active
10 000 steps or more per day
steps program effect on CVD
2000 steps a day reduces CV event risk by 10%
(imp?) program with steps and follow up effects on diabetes
**A1C reduction
IFG and IGT meaning
IFG = impaired fasting glucose
IGT = impaired glucose tolerance
so IFG = fasting, IGT = after eat
recommendations of canadian diabetes association
lifestyle: moderate weight loss, physical activity. will reduce risk of type 2 DM with any of A1C 6 to 6.4, IGT or IFG
diet note in diabetes prevention
don’t go below 900kcal per day. will go back to high calorie diet
weight loss goal canadian diabetes association
1-2 lbs per week
(imp?) 5 populations that need diabetes prevention especially
- high-risk (Indigenous, african, asian, hispanic, south asian)
- those with 1st degree relative with T2DM
- history of GDM
- history of prediabetes
- history of delivery of macrosomic infant
other people that need diabetes prevention
- people with associated disease (OSA, HIV, psychiatric, polycystic ovarian syndrome,..)
- secondary cause of diabetes (glucocorticoids, atypical antipsychotics, …)
important diabetes risk factors
age, educational level, male gender, BMI
Eeyou Istchee region diabetes program results
increase of number of steps. no weight loss
