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Endocrine system > What is Diabetes Mellitus - Epidemiology > Flashcards

What is Diabetes Mellitus - Epidemiology Flashcards

1
Q

Define diabetes mellitus

A

“A group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both”

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2
Q

What are some symptoms of hyperglycaemia?

A 
polydipsia - excessive thirst
polyuria - excessive urination
blurred vision
weight loss
infections
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3
Q

What are some microvascular complications associated with hyperglycaemia in diabetes?

A

retinopathy
neuropathy
nephropathy

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4
Q

What are some macrovascular complications associated with hyperglycaemia in diabetes?

A

stroke
MI
PVD

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5
Q

What are the diagnostic plasma glucose levels for diabetes?

A

Diagnostic glucose levels (venous plasma):
• Fasting ≥ 7.0 mmol/l
• Random ≥ 11.1 mmol/l

OGTT 2h after 75g CHO ≥ 11.1 mmol/l

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6
Q

What is the diagnostic plasma glucose level following an oral glucose tolerance test for diabetes?

A

OGTT 2h after 75g CHO ≥ 11.1 mmol/l

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7
Q

What is the diagnostic HbA1c level in plasma for diabetes?

A

Diagnostic HbA1c ≥ 48 mmol/mol.

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8
Q

What are the diagnostic plasma glucose and HbA1c levels for intermediate diabetes?

A

Impaired fasting glucose 6.1-7 mmol/l

Impaired glucose tolerance 2h glucose ≥7.8 and <11mmol/l

HbA1c 42-47mmol/mol

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9
Q

What is required for diagnosing diabetes?

A

ONE diagnostic lab glucose plus symptoms

TWO diagnostic lab glucose or HbA1c levels without symptoms

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10
Q

What is HbA1c?

A

Glycated haemoglobin

HbA1c is a measure of the beta-N-1-deoxy fructosyl component of hemoglobin

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11
Q

What is the clinical significance of HbA1c?

A

HbAic is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration.

The test is limited to a three-month average because the lifespan of a red blood cell is four months (120 days). However, since RBCs do not all undergo lysis at the same time, HbA1C is taken as a limited measure of 3 months.

It is formed in a non-enzymatic glycation pathway by hemoglobin’s exposure to plasma glucose.

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12
Q

When can HbA1c levels not be used for diagnosing diabetes?

A
  • All children and young people.
  • Pregnancy—current or recent (< 2 months).
  • Short duration of diabetes symptoms.
  • Patients at high risk of diabetes who are acutely ill
  • (HbA1c ‡ 48 mmol⁄ mol confirms pre-existing diabetes, but a value < 48 mmol ⁄ mol does not exclude it and such patients must be retested once the acute episode has resolved).
  • Patients taking medication that may cause rapid glucose rise; for example, corticosteroids, antipsychotic drugs (2 months or less). HbA1c can be used in patients taking such medication long term (i.e. over 2 months) who are not clinically unwell.
  • Acute pancreatic damage or pancreatic surgery.
  • Renal failure.
  • Human immunodeficiency virus (HIV) infection.
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13
Q

What medications can cause rapid increases in glucose levels?

A

Corticosteroids

Antipsychotics (only in first 2 months of taking it, after is fine to measure HbA1c)

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14
Q

What % of those with diabetes are type 1?

A

10.9%

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15
Q

What % of those with diabetes are type 2?

A

88.2%

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16
Q

What % of those with diabetes have other types of diabetes (aka not type 1 or 2)?

A

0.9%

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17
Q

If an individuals monozygotic twin has type 1 DM, what are the chances they have it as well?

A

30-50% concordance

18
Q

If an individuals father has type 1 DM, what are the chances they have it as well?

A

6% risk

19
Q

If an individuals mother has type 1 DM, what are the chances they have it as well?

A

1% risk

20
Q

If an individuals sibling has type 1 DM, what are the chances they have it as well?

A

8% risk

21
Q

If an individuals non-identical twin has type 1 DM, what are the chances they have it as well?

A

10% risk

22
Q

If an individuals parents both have type 1 DM, what are the chances they have it as well?

A

30% risk

23
Q

What is involved in the development of type 1 DM?

A

o Genetic pre-disposition plus
o Trigger e.g.? Viral infection
o Auto immunity

24
Q

What are some symptoms and signs of type 2 DM?

A 
Symptoms (may have none of the following):
o	Thirst
o	Tiredness
o	Polyuria / nocturia
o	Sometimes weight loss
o	Blurred vision
o	Symptoms of complications e.g. CVD

Signs:
o Not ketotic
o Usually overweight but not always
o Low grade infections, thrush / balanitis
o May have microvascular/macrovascular complications

25
Q

What risk factors are used in screening tests for diabetes?

A

Risk factors—any two present
o Overweight
o Family history
o Over age 30 years if Maori ⁄ Asian (Indian subcontinent)⁄ Pacific Island descent
o Over age 40 years if European
o Previous history of diabetes in pregnancy
o Had a big baby (more than 4 kg)—not in immediate post-natal period
o Inactive lifestyle, lack of exercise
o Previous high blood glucose ⁄ impaired glucose tolerance

26
Q

What other types of diabetes are there from type 1 and type 2 DM?

A
  • Maturity onset Diabetes in the Young (MODY)
  • Gestational diabetes
  • Secondary diabetes
27
Q

What is Maturity onset Diabetes in the Young?

A

Autosomal dominant
? 5% of people with diabetes
Impaired beta-cell function
Single gene defect, which results in either:
o Glucokinase mutations
o Transcription factor mutations (HNF-1a, HNF-1b, HNF-4a)

28
Q

What % of people with diabetes have MODY?

A

5%

29
Q

How do those with MODY that have a single gene defect in glucokinase differ to those with mutations in TFs?

A 
Glucokinase mutations results in:
o	Onset at birth
o	Stable hyperglycaemia
o	Diet treatment
o	Complications rare
TF mutations:
o	Adolescence/young adult onset
o	Progressive hyperglycaemia
o	1/3 diet, 1/3 OHA, 1/3 Insulin
o	Complications frequent
30
Q

When do those with glucokinase mutations in MODY usually present, and what with?

A

o Onset at birth

o Stable hyperglycaemia

31
Q

When do those with TF mutations in MODY usually present, and what with?

A

Adolescence/young adult onset

Progressive hyperglycaemia

32
Q

How do you treat those with Glucokinase mutations in MODY?

A

Diet treatment

Complications rare

33
Q

How do you treat those with TF mutations in MODY?

A

1/3 diet, 1/3 oral hypoglycaemic drugs (OHA), 1/3 Insulin

Complications frequent

34
Q

What TFs are involved in MODY?

A

Hepatocyte nuclear factors:

HNF-1a, HNF-1b, HNF-4a

35
Q

What can cause secondary diabetes mellitus?

A 
Drug therapy e.g corticosteroids
Pancreatic destruction
•	Haemochromatosis- excess iron deposition
•	Cystic fibrosis 
•	Chronic pancreatitis
•	Pacreatectomy
Recognised genetic syndromes - DIDMOAD
Rare endocrine disorders e.g. Cushings syndrome, Acromegaly, Pheochromocytoma
36
Q

What drug can cause secondary DM?

A

Corticosteroids

37
Q

What can cause pancreatic destruction and result in secondary DM?

A

Haemochromatosis- excess iron deposition
Cystic fibrosis
Chronic pancreatitis
Pacreatectomy - removal of pancreas

38
Q

What endocrine disorders can cause secondary diabetes?

A

Cushings syndrome - prolonged cortisol exposure
Acromegaly - increased GH from pituitary
Pheochromocytoma - tumour of adrenal gland

39
Q

When does gestational diabetes usually present?

A

In 2nd or 3rd trimester

40
Q

What neonatal problems are associated with gestational diabetes?

A

macrosomia (baby born big)
respiratory distress
neonatal hypoglycaemia

41
Q

How much CHO is given in a OGTT, and how long after do you take a reading of plasma glucose?

A

75g CHO

1/2 hrs post feed

Endocrine system (27 decks)

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