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Questions and Answers
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?
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?
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What is the estimated risk of developing Type 2 diabetes later in life for women who had gestational diabetes?
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What is the primary requirement for treatment in patients with Maturity-Onset Diabetes of the Young (MODY) during pregnancy?
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Why is genetic testing recommended for patients suspected of having MODY?
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What is a significant limitation in the current understanding of diabetes management regarding early diagnosis of MODY?
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What factor contributes to the complexity of developing standard guidelines for the treatment of diabetes in older adults?
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What is currently not recommended for diabetes screening in older adults?
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What is the relationship between diabetes and older adults regarding mortality risk and complications?
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For what reason are screening recommendations for diabetes particularly nuanced in the older adult population?
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Which of the following statements best describes the recommended approach for screening asymptomatic adults for Type 2 diabetes?
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Which of the following is a secondary cause of diabetes related to the pancreas?
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What is a key characteristic of adults who are often asymptomatic in relation to Type 2 diabetes?
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What diagnostic criterion is used to confirm diabetes via fasting plasma glucose levels?
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Which finding is NOT an indicator to consider for Type 2 diabetes screening in women post-delivery?
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What is a pro of using fasting plasma glucose testing compared to glycated hemoglobin testing?
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Which of the following is a common misconception regarding the screening recommendations for Type 2 diabetes?
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What is a common clinical feature of Type 2 diabetes at diagnosis compared to Type 1 diabetes?
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How does the diagnosis of metabolic syndrome relate to diabetes risk?
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In type 2 diabetes screening, what lab value indicates a higher risk for developing the disease?
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Which of the following is true regarding obstetrical complications as a risk factor for Type 2 diabetes?
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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 (++ )
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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.
