Type 2 Diabetes Flashcards
What is type 1 diabetes?
Beta-cells which make insulin are destroyed, common in childhood
What is type 2 diabetes?
Insulin resistance and beta cell dysfunction, most common in obesity
What are the 2 hybrid forms of diabetes?
Slow evolving immune-mediated diabetes of adults
Ketosis-prone type 2
What is slowly evolving immune mediated diabetes of adults?
Features of a metabolic syndrome
GAD autoantibody
Retains greater b-cell function
What is ketosis prone diabetes?
Presents with ketosis and insulin deficiency
Not immune-mediated
What are monogenic diabetes
Specific gene mutation
Determines chances of development and treatment
What is the diagnostic criteria for diabetes?
Fasting plasma at more than 7.0mmol/L
Hba1c at more than 48mmol/mol
What is Hba1c?
How much glucose is attached to the haemoglobin in the red blood cells
How is type 2 disease a complete trait?
Involves both genetic predisposition and life style choices
How many specific gene loci were associated with gene loci?
Over 600
What is the function of FTO gene?
Increase weight and BMI
What increases the genetic risk of type 2 diabetes?
Having multiple polymorphisms that are associated with disease risk.
Recent studies have tried to put a number on the effect of diet compared to genetic risk of type 2 diabetes, how is this done?
Novel polygenic scores to evaluate the presence of additive or multiplicative gene or diet interactions on the development of T2D
What was the result of the polygenic risk score study for type 2 diabetes?
For each Standard Deviation of the polygenic risk score your risk of T2D increased by 29%
According to the polygenic risk score study how much do genetics which affect the beta cell dysfunction increase the risk of type 2 diabetes?
26%
According to the polygenic risk score study how much do genetics which affect the impaired insulin synthesis increase the risk of type 2 diabetes?
14%
According to the polygenic risk score study how much do genetics which affect the obesity mediated insulin resistance increase the risk of type 2 diabetes?
9%
According to the polygenic risk score study how much do genetics which affect the body fat distribution increase the risk of type 2 diabetes?
23%
According to the polygenic risk score study how much do genetics which affect the lipid or hepatic metabolism increase the risk of type 2 diabetes?
11%
How to assess diet quality?
AHEI score
Alternative healthy eating index
According to the polygenic risk score study how much does a lower diet quality increase?
Estimated at 30% for low, intermediate, high genetic factors.
Found to not significantly be connected
Does healthy diet reduce the risk of type 2 diabetes?
Found to decrease the risk of diabetes by 30% for all genetic risk individuals.
Is insulin resistance the same for the whole population?
No some individuals can have higher insulin resistance but their pancreas matches that of
What is the function of insulin in the muscles?
Glucose uptake and storage increases
This is called glycogenolysis
What is the function of insulin on the liver?
Increase glucose storage
Decrease glucose production (glycogenesis)
What is the function of insulin in adipose tissue?
Decrease fat breakdown (lipolysis)
What is the single cause that links insulin resistance and impaired beta cell function
Dysregulation in storage of fat (in the liver)
What is the twin cycle hypothesis?
An acute negative energy balance (surgery eg) will normalise insulin sensitivity and restore normal insulin response
What is a normal amount of liver fat?
Less than 5%
Where is the first place fat is moved from when an individual loses a significant amount of weight?
The liver
Can weight loss surgery affect muscle insulin sensitivity?
No, only affected by genetics and physical activity.
Why use a liquid diet for weight loss?
Safe and effective
Complete nutrition
Lack of hunger
Complete break from food decision
Motivation from rapid weight loss
Break habits
Triggers stand out
Blank slate
Does liquid diet work for diabetes remission
Yes due to high weight loss
What does it mean for someone to be in diabetes remission?
Must be measured at least 3 months after stopping glucose lowering medications
Hba1c below 48mmol/mol
Main principles of remission.
Type 2 diabetes
More likely in short duration
Significant weight loss
Not a cure
Maintaining lower weight
Why could some people not achieve remission?
Insufficient weight loss
Damage to beta cells too high
Going back to old habits
How long does remission last after bariatric surgery?
5 years
How long did the liquid low calorie diet offer remission?
2 years
Why is temporary remission worth it?
People who achieved it even for short periods of time continued to benefit from lower exposure to hyperglycaemia lower the risk of cardiovascular disease
Requires weight loss of 10%
How many people with a BMI over 40 don’t have diabetes?
70%
What percentage of T2D people have a normal BMI?
15%
What is the personal fat threshold hypothesis?
Proposes that we all have a level of body fat that we can cope with and if we go above me increase our risk of type 2 diabetes even if not overweight.
For normal BMI participants what was the level of remission for the weight loss study?
70%
