Podcast
Questions and Answers
Which of the following statements accurately describes Maturity-onset diabetes of the young (MODY)?
Which of the following statements accurately describes Maturity-onset diabetes of the young (MODY)?
What is the recommended screening timeframe for women who may be at risk for diabetes due to gestational diabetes?
What is the recommended screening timeframe for women who may be at risk for diabetes due to gestational diabetes?
In which scenario should a woman be screened for gestational diabetes in her first trimester?
In which scenario should a woman be screened for gestational diabetes in her first trimester?
Which of the following complications is associated with gestational diabetes?
Which of the following complications is associated with gestational diabetes?
Signup and view all the answers
What is the estimated risk of developing Type 2 diabetes later in life for women who had gestational diabetes?
What is the estimated risk of developing Type 2 diabetes later in life for women who had gestational diabetes?
Signup and view all the answers
What is the primary requirement for treatment in patients with Maturity-Onset Diabetes of the Young (MODY) during pregnancy?
What is the primary requirement for treatment in patients with Maturity-Onset Diabetes of the Young (MODY) during pregnancy?
Signup and view all the answers
Why is genetic testing recommended for patients suspected of having MODY?
Why is genetic testing recommended for patients suspected of having MODY?
Signup and view all the answers
What is a significant limitation in the current understanding of diabetes management regarding early diagnosis of MODY?
What is a significant limitation in the current understanding of diabetes management regarding early diagnosis of MODY?
Signup and view all the answers
What factor contributes to the complexity of developing standard guidelines for the treatment of diabetes in older adults?
What factor contributes to the complexity of developing standard guidelines for the treatment of diabetes in older adults?
Signup and view all the answers
What is currently not recommended for diabetes screening in older adults?
What is currently not recommended for diabetes screening in older adults?
Signup and view all the answers
What is the relationship between diabetes and older adults regarding mortality risk and complications?
What is the relationship between diabetes and older adults regarding mortality risk and complications?
Signup and view all the answers
For what reason are screening recommendations for diabetes particularly nuanced in the older adult population?
For what reason are screening recommendations for diabetes particularly nuanced in the older adult population?
Signup and view all the answers
Which of the following statements best describes the recommended approach for screening asymptomatic adults for Type 2 diabetes?
Which of the following statements best describes the recommended approach for screening asymptomatic adults for Type 2 diabetes?
Signup and view all the answers
Which of the following is a secondary cause of diabetes related to the pancreas?
Which of the following is a secondary cause of diabetes related to the pancreas?
Signup and view all the answers
What is a key characteristic of adults who are often asymptomatic in relation to Type 2 diabetes?
What is a key characteristic of adults who are often asymptomatic in relation to Type 2 diabetes?
Signup and view all the answers
What diagnostic criterion is used to confirm diabetes via fasting plasma glucose levels?
What diagnostic criterion is used to confirm diabetes via fasting plasma glucose levels?
Signup and view all the answers
Which finding is NOT an indicator to consider for Type 2 diabetes screening in women post-delivery?
Which finding is NOT an indicator to consider for Type 2 diabetes screening in women post-delivery?
Signup and view all the answers
What is a pro of using fasting plasma glucose testing compared to glycated hemoglobin testing?
What is a pro of using fasting plasma glucose testing compared to glycated hemoglobin testing?
Signup and view all the answers
Which of the following is a common misconception regarding the screening recommendations for Type 2 diabetes?
Which of the following is a common misconception regarding the screening recommendations for Type 2 diabetes?
Signup and view all the answers
What is a common clinical feature of Type 2 diabetes at diagnosis compared to Type 1 diabetes?
What is a common clinical feature of Type 2 diabetes at diagnosis compared to Type 1 diabetes?
Signup and view all the answers
How does the diagnosis of metabolic syndrome relate to diabetes risk?
How does the diagnosis of metabolic syndrome relate to diabetes risk?
Signup and view all the answers
In type 2 diabetes screening, what lab value indicates a higher risk for developing the disease?
In type 2 diabetes screening, what lab value indicates a higher risk for developing the disease?
Signup and view all the answers
Which of the following is true regarding obstetrical complications as a risk factor for Type 2 diabetes?
Which of the following is true regarding obstetrical complications as a risk factor for Type 2 diabetes?
Signup and view all the answers
Study Notes
Diabetes in Older Adults
- Most commonly Type 2 diabetes
- Prevalence increased by 62% between 1997-2010 in the U.S.
- 21.4% of U.S. adults aged 65+ have a known diagnosis
- 16% are unaware of their diabetes
- Older diabetic population is diverse in race/ethnicity, diabetes duration, comorbidity, and functional status
- Diabetes increases the risk of mortality, cardiovascular and microvascular complications, cognitive impairment, frailty, unintentional weight loss, polypharmacy, and functional impairment
- No current recommendations for routine screening
- Screening is dependent on improving overall quality of life or life expectancy
- Consider screening to prevent complications leading to functional impairment (ADA)
- Decisions regarding treatment should be made based on age, life expectancy, functional status, and chronic comorbidities
Diabetes in Children and Adolescents
- Type 1 diabetes
- Type 2 diabetes
- Maturity-onset diabetes of the young (MODY)
Maturity-Onset Diabetes of the Young (MODY)
- Consider genetic testing and referral to endocrinologist/clinical genetics consultant
- Accurate diagnosis determines treatment and management plan
- Lack of evidence from randomized trials to show early diagnosis and therapy improve patient outcomes
Gestational Diabetes
- Screen women during their first trimester if risk factors are present: such as obesity, advanced maternal age (>35 years old), history of gestational diabetes, family history of diabetes, high-risk ethnicity
- Screen all asymptomatic patients at or after 24 weeks’ gestation
- Complications - gestational hypertension, preeclampsia, Cesarean delivery, shoulder dystocia, macrosomia, and birth defects
- Increased risk of Type 2 diabetes for mothers, increased risk of childhood/adolescent obesity for children
- In high-risk populations, diabetes develops in up to 50% of women with gestational diabetes
- Screen women at 6-12 weeks postpartum with a fasting glucose measurement or a 75g 2-hour glucose tolerance test
- Up to 36% of women with gestational diabetes may have persistently abnormal glucose tolerance
Type 2 Diabetes
- Screen asymptomatic adults BMI ≥ 25 kg/m2, and one or more additional risk factors
- A1c > 5.7%
- Impaired glucose tolerance
- Impaired fasting glucose
- Screening IS recommended (USPSTF)
- Lifestyle changes and medications can reduce disease progression
Type 2 Diabetes: Signs and Symptoms
- Weight gain
- Overweight or obese
- Centripetal fat distribution
- Waist circumference >40 inches for men, >35 inches for women
- Obstetrical complications
- Consider Type 2 diabetes in women who have delivered babies over 9 lb (4.1 kg) or have had polyhydramnios, preeclampsia, or unexplained fetal losses
"Metabolic Syndrome"
- Individuals at higher risk for developing diabetes and cardiovascular disease
- Preeclampsia, caesarean delivery, congenital malformations, macrosomia, childhood or adolescent obesity, nerve palsy, bone fracture, jaundice, and infant death
Secondary Causes of Diabetes
- Exocrine pancreas diseases
- Endocrinopathies
- Drug- or chemical-induced insulin resistance
- Genetic diseases
- Any disorder that damages the pancreas can result in diabetes
- E.g. liver cirrhosis, hemochromatosis, hemosiderosis
Secondary Causes of Diabetes: Examples
- Exocrine Pancreas Diseases - Pancreatitis, Cystic Fibrosis
- Endocrinopathies - Somatostatinoma, Pheochromocytoma, Acromegaly, Cushing syndrome, Glucagonomia
- Drug- or Chemical-induced Insulin Resistance - Corticosteroids, Sympathomimetics, Niacin, Alpelisib, Sirolimus, Thiazide diuretics, Phenytoin, Atypical antipsychotics
- Genetic Syndromes - Down, Klinefelter, Turner, Wolfram syndrome, Type A insulin resistance, Leprechaunism, Rabson-Mendenhall syndrome, Lipoatrophic diabetes
Diagnostic Tests
-
Fasting Plasma Glucose (FPG)
- 100-125 mg/dL (5.6-6.9 mmol/L) = impaired fasting glucose tolerance, increased diabetes risk
- ≥126 mg/dL (7.0 mmol/L) on more than one occasion, after at least 8-hour fasting = Diagnostic
- Diagnosis may be made with hyperglycemia signs and symptoms, PLUS >200 mg/dL (11.1 mmol/L) – and testing should be repeated to confirm
- Pros: may identify one-third more undiagnosed cases than A1c
- Cons: fasting is required
-
Oral Glucose Tolerance Test (OGTT)
-
Glycated hemoglobin (HbA1c)
-
Additional tests (urine, self-monitoring, continuous glucose monitoring, autoantibody, genetic)
Type 1 Diabetes: Clinical Features at Diagnosis
- Polyuria and thirst (++ )
- Weakness or fatigue (++ )
- Polyphagia with weight loss (++ )
- Recurrent blurred vision (+)
- Vulvovaginitis or pruritis (+)
- Peripheral neuropathy (+)
- Nocturnal enuresis (++ )
Type 2 Diabetes: Clinical Features at Diagnosis
- Polyuria and thirst (+)
- Weakness or fatigue (+)
- Polyphagia with weight loss (-)
- Recurrent blurred vision (++ )
- Vulvovaginitis or pruritis (++ )
- Peripheral neuropathy (++ )
- Nocturnal enuresis (-)
- Often asymptomatic (++ )
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the impact of diabetes on different age groups with a focus on older adults and children. This quiz covers the prevalence, risks, and considerations for treatment and screening for both Type 2 and Type 1 diabetes. Understand the diversity in diabetes diagnosis and management across various populations.
