T2DM Diabetes epidemiology and pathophysiology

Question 1

Genetics of T2DM (3)

Answer 1

40% lifetime risk in offspring

Concordance rate in monozygotic twins 76% at 15 year follow-up: high even when “separated at birth”

Many predisposing genetic variants discovered in last 5 years, mainly via Genome Wide Association Studies

Question 2

BMI range (7)

Answer 2

9 out of 10 people with type 2 diabetes are overweight or obese (BMI of 25 or above)

underw- under 18
healthyw- 18-24.9
overw- 25-29.9
obese 1 -31-34.9
obese 2- 36-39.9
morbidly obese 3- over 40

Question 3

Pathophysiology of T2DM (5)

Answer 3

1.Obesity,Lack of activity

2.Adiposity exceeding fat storage threshold
Increased Free fatty acids and adipokines

3.Vulnerable beta-cells (genetics)

4.Inability to respond and produce more insulin

5.Diabetes

Question 4

Insulin Resistance (5)

Answer 4

90% of people with type 2 diabetes have insulin resistance

Insulin resistance is also associated with
Hypertension
Hyperlipidaemia
Hyperglycaemia – even in absence of diabetes
Polycystic Ovarian Syndrome (in women)

Question 5

Risks associated with insulin resistance (6)

Answer 5

In Scandinavia 70% patients with Type 2 diabetes have the combination of IR, hypertension and hyperlipidemia

Metabolic syndrome is associated with
3x risk CHD
3x risk myocardial infarction
3x risk stroke
3-5x risk of cardiovascular death