22 Diabetes Case Study Quiz

Diabetes Mellitus Overview

• Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels.
• Insulin is essential for maintaining normal blood glucose levels and is crucial for growth and overall bodily functions.
• Type 1 Diabetes (T1D) is primarily an autoimmune disease where immune system attacks the insulin-producing beta cells in the pancreas.
• Type 2 Diabetes (T2D) is characterized by insulin resistance, where cells do not respond effectively to insulin. This often develops gradually, sometimes without presenting symptoms, and frequently occurs in combination with obesity.

Learning Outcomes

• Define Diabetes Mellitus
• Compare and contrast the pathophysiology of type 1 and type 2 diabetes.
• Discuss the principles of diagnosis and classification of diabetes.
• List the cardinal symptoms and signs of diabetes (e.g., excessive thirst, frequent urination, blurred vision, sudden weight loss).
• Identify risk factors for the rising prevalence of type 2 diabetes (e.g., obesity, family history, and ethnicity).
• Recognize the importance of prevention and early intervention in the management of type 2 diabetes.
• Outline the overarching principles of investigation and management of diabetes.
• Evaluate the implications of diabetes, including its impact on quality of life and healthcare costs.
• Identify the role of interdisciplinary care in the management of diabetes.

Patient Case Study (Patient MF)

• A 22-year-old male presented to A&E with worsening polyuria, polydipsia, fatigue, and unintentional weight loss.
• The symptoms persisted despite drinking significant amounts of soda and fruit punch daily.
• His height and weight suggest a normal BMI of 21.5 kg/m².
• Patient has a mother with hypothyroidism.
• Plasma glucose level was 26 mmol/L (4-7.8 mmol/L).

Type 1 Diabetes (T1D)

• An autoimmune process where the body's immune system attacks the insulin-producing beta cells in the pancreas.
• The beta cells die, resulting in very little or no insulin production.
• Pathogenesis is characterized by: lymphocyte attack (insulitis), beta cell death, and fibrosis of the islet.
• T1D occurs more often in children and young adults, but it is not exclusive to these age groups.

Type 2 Diabetes (T2D)

• A condition of impaired insulin secretion and or insulin resistance leading to chronic hyperglycemia.
• This often results from a combination of genetic susceptibility and environmental factors.
• Pathogenesis of T2D includes: increased hepatic glucose production, insulin resistance, and decreased insulin response.
• T2D is generally associated with older individuals.
• T2D is strongly linked with genetics and environmental factors.

Health Impact of Diabetes

• Diabetes is a significant cause of disability, including renal failure, blindness, and nontraumatic amputations.
• Cardiovascular disease and life expectancy are negatively impacted.
• There is a significant burden of morbidity and significant resource use related to treating diabetes.

Diabetes Prevalence

• Approximately 537 million adults are currently living with diabetes (20-79 years).
• The prevalence is expected to rise to 643 million by 2030 and 783 million by 2045.
• A high proportion of individuals with diabetes live in low- and middle-income countries.

Insulin

• Insulin is a peptide hormone produced by beta cells in the pancreatic islets of Langerhans.
• It is crucial for proper glucose metabolism by regulating the uptake/utilization of glucose, contributing to lipid and protein synthesis, and is critical for normal development.
• Insulin function requires intact islet B-cell mass, insulin synthesis, and proper insulin signaling and secretion.

Diabetes Classification

• Type 1 diabetes: auto-immune (Type 1a) and non-autoimmune (Type 1b)
• Type 2 diabetes (~90% of cases)
• Gestational diabetes
• Latent Autoimmune Diabetes in Adults (LADA)
• Monogenic diabetes
• Diabetes secondary to other conditions (endocrinopathies, drug-induced, primary pancreatic disease)
• Other specific types

T1D vs T2D

• Type 1 diabetes is characterized by absolute insulin deficiency and has a rapid onset, sometimes presenting with diabetic ketoacidosis (DKA).
• Type 2 diabetes is characterized by insulin resistance with relative insulin deficiency and typically develops gradually, with an initially "silent" or asymptomatic phase.

Diagnosis of Diabetes

• Diagnosis of diabetes is based on various criteria including fasting plasma glucose, HbA1c, and oral glucose tolerance test (OGTT) results.
• Diagnostic criteria involve specific thresholds for glucose levels.

Presentation of Diabetes

• Common symptoms of diabetes include increased thirst, frequent urination, blurred vision, unexplained weight loss, fatigue and/or constant hunger.
• Potential complications/presentations can also include diabetic ketoacidosis, wounds that do not heal and/or sexual problems.

Treatment of Type 1 Diabetes

• Treatment for type 1 diabetes focuses on insulin replacement therapy to maintain proper blood glucose levels.
• Insulin replacement therapy needs to adjusted based on carbohydrate intake, exercise regimen, and blood glucose profile.

Treatment of Type 2 Diabetes

• Lifestyle changes (diet, exercise, weight loss, sleep, mental health) aimed at improving insulin sensitivity.
• May involve oral medications, non-insulin injections, additional weight loss strategies (e.g., medications, bariatric surgery), and modifying cardiovascular risk factors.

Role of Interdisciplinary Care in DM Management

• A team involving endocrinologists, general practitioners, dietitians, diabetes educators, podiatrists, ophthalmologists, and mental health professionals is essential for comprehensive and effective diabetes management.

Prediabetes

• Impaired glucose tolerance and/or impaired fasting glucose.
• A critical precursor to type 2 diabetes, presenting with a higher risk of developing type 2 diabetes.
• Important for early intervention to prevent/delay/reduce the progression to type 2 diabetes.

Preventing Progression of Diabetes

• Lifestyle modifications including diet and exercise are key components for preventing the progression of prediabetes and/or reducing the risk/likelihood of developing diabetes.

Diabetes Prevention Program

• Lifestyle modifications in diabetes prevention programs (DPP) was shown to be more effective in preventing type 2 diabetes than metformin treatment alone.

Glycemic Targets of Diabetes

• Recommended targets for blood glucose control, including A1C , pre-prandial, and peak post-prandial values.

High Rates of Micro- and Macrovascular Complications

• Early tight glycemic control helps reduce both microvascular and macrovascular complications of diabetes.
• Multiple clinical trials (e.g., UKPDS, ACCORD, ADVANCE, VADT) show the importance of early aggressive management to reduce the likelihood of long-term complications.

Pancreatic Transplantation and Islet Cell Transplantation

• In specific cases where standard approaches are not sufficient, pancreas/islet cell transplantation may be a treatment option.

Epidemiology of Type 1 & 2 Diabetes

• Type 1 diabetes is most common in Northern Europe, but also shows a regional prevalence difference.
• Rates of type 2 diabetes are rising in younger age groups worldwide.
• Both forms show a strong genetic component related to risk.

Mechanisms of Type 1 Diabetes

• The pathogenesis of type 1 diabetes often involves a combination of genetic susceptibility and environmental factors, such as a viral infection, triggering an autoimmune response that destroys the beta cells in the pancreas.