Module 1 Flashcards
Diabetes Prevention and Management
Requires engagement with:
policy makers politicians economists scientists the pharmaceutical industries
Type 1 Diabetes
previously known as Insulin Dependent Diabetes Mellitus or IDDM
autoimmune disease characterized by a lack of insulin production
commonly presents in children and young adults
requires insulin therapy to maintain life.
10% of the total burden
Scandinavian and Northern European countries having a relatively high incidence
Type 2 diabetes
Non-Insulin Dependent Diabetes or NIDDM
insulin resistance and a gradually decreasing amount of insulin from the pancreas
used to be thought of as a ‘late onset’, now children and many young people
benefit from insulin.
The number of people suffering from diabetes in 2016.
463 million
The global prevalence of diabetes among adults over 18 years in 2014
8.5%
WHO projects that diabetes will be the ____ leading cause of death in 2030.
7th
In 2016, an estimated______deaths globally were directly caused by diabetes.
1.6 million
Risk Factors for Type 2 Diabetes
Age over 45
Men , woman’s risk rises at menopause
Ethnicity (Native American
Australian Indigenous
African American
Hispanic
Pacific Islander
Asian )
Increased waist size in both men and women (80 cm for women and 94 cm for Caucasian men)
Babies exposed to intrauterine hyperglycemia
Family history
Physical inactivity
overweight (BMI 25-29 kg/m2) or obese (BMI 30+
History of gestational diabetes(7 times more likely)
Medication(steroids, some antipsychotic agents, thiazides, beta-blockers and statins)
Heavy cigarette smokers, (20+ a day)
BP = > 140/90 mmHg
History of cardiovascular disease
HDL-Cholesterol; <35 mg/dL (0.9 mmol/L) Triglycerides >250 mg/dL (2.8 mmol/L)
(PCOS)
Heavy drinking
a ‘Western diet’ that contains higher levels of sugar, saturated fats and red meat
The Basic Tests for Diabetes
Oral glucose tolerance test (OGTT)
Fasting plasma glucose test (FPG)
Glycated haemoglobin (HbA1c)> 6.5% (48 mmol/mol).
Random tests
Oral glucose tolerance test (OGTT)
2-hr PG ≥200 mg/dL (11.1 mmol/L) during OGTT (75-g)*anhydrous glucose
this test can be unpleasant
less accurate and harder to standardize
the patient needs to refrain from smoking
storage of samples over the two-hour period
Fasting plasma glucose test (FPG)
FPG ≥126 mg/dL (7.0 mmol/L)*
Fasting is defined as no caloric intake for ≥8 hours
Random tests
Random PG ≥200 mg/dL (11.1 mmol/L) In individuals with symptoms of hyperglycaemia or hyperglycemic crisis
In the absence of unequivocal hyperglycemia results
No clear clinical diagnosis?
repeat the same test on a different day
In the absence of unequivocal hyperglycemia results
Same test with same or similar results?
diagnosis confirmed
In the absence of unequivocal hyperglycemia results
Different tests above diagnostic threshold?
diagnosis confirmed
In the absence of unequivocal hyperglycemia results
*Discordant results from two separate tests?
Repeat the test with a result above diagnostic cut-point.
Diagnosing Type 1 Diabetes
polydipsia (excess thirst) polyuria (excessive urinating), fatigue, or weight loss due to an acute rise in glucose.
Diagnosis is by blood glucose testing rather than HbA1c
Diagnosing Gestational Diabetes
diagnosed in the 2nd or 3rd trimester, may or may not persist beyond her pregnancy
type 2 diabetes, persisting beyond her pregnancy.
no existing diagnosis of diabetes found to have diabetes in her first trimester of pregnancy (< 12 weeks gestation
Diagnosing Prediabetes
people with impaired fasting glucose (IFG) or glucose tolerance (IGT)
What is the difference between capillary and plasma glucose?
Fasting plasma glucose is higher than capillary plasma glucose by almost 12%
Impaired fasting glucose (IFG)/ prediabetic?
fasting glucose is between 108 and 126 mg/dl (6.0 and 6.9mmol/L)
impaired glucose tolerance (IGT)?
diagnostic criteria for IGT are that a blood test taken at the two-hour point of a glucose tolerance test is at least 140 mg/dL (7.8 mmol/L) and not more than 199 mg/dL (11 mmol/L).
The WHO defines screening as
process of identifying those individuals who are at sufficiently high risk of a specific disorder to warrant further investigation or direct action
Screening process
a screening strategy ( by risk factor, by criteria, by public place to promote self-refer
test sensitivity and specificity
sensitivity of the test
proportion of people with diabetes or prediabetes who test positive
A very sensitive test ( High sensitivity) is unlikely to miss someone who does have diabetes
specificity of a test
proportion of people who do not have diabetes and correctly test negative
A very specific test ( high specificity) is unlikely to suggest that someone who does not have diabetes tests positive
specificity Vs sensitivity
In reality, specificity is less important that sensitivity
all positive test followed up by full diagnostic testing
Principles and practice of screening for disease
10 screening criteria
1]important health problem
2]an accepted treatment for patients
3]Facilities should be available.
4]recognizable latent or early symptomatic stage
5]suitable test or examination
6]The test should be acceptable to the population
7]natural history adequately understood
8]agreed policy on whom to treat as patients
9]The cost of case-finding economically balanced
10]Case finding continuing process
