Podcast Beta
Questions and Answers
What is the relative risk (RR) associated with shoulder dystocia in women with gestational diabetes?
What factors should lead to screening women for gestational diabetes in their first trimester?
What percentage of women with gestational diabetes may have persistently abnormal glucose tolerance at 6-12 weeks postpartum?
In women with gestational diabetes, what is the likelihood of the child being overweight in childhood or adolescence?
Signup and view all the answers
What waist circumference is considered a risk factor for Type 2 diabetes in men?
Signup and view all the answers
Which of the following is a common symptom of Type 2 diabetes at diagnosis?
Signup and view all the answers
What is the screening recommendation for adults with a body mass index (BMI) of ≥25 kg/m²?
Signup and view all the answers
What aspect of lifestyle or pharmacologic interventions was noted about Type 2 diabetes in the long term?
Signup and view all the answers
Which of the following factors is NOT commonly associated with Type 2 diabetes?
Signup and view all the answers
What does the term 'Metabolic Syndrome' primarily identify?
Signup and view all the answers
What is a potential benefit of screening for Type 2 diabetes according to long-term studies?
Signup and view all the answers
Which symptom is more prominent in Type 1 diabetes compared to Type 2 diabetes?
Signup and view all the answers
What term is used to describe the presence of increased visceral fat in patients with Type 2 diabetes who do not exhibit overt obesity?
Signup and view all the answers
Which factor is NOT associated with impaired insulin signaling in adipose tissue?
Signup and view all the answers
Which symptom is specifically related to a chronic skin condition seen in Type 2 diabetes?
Signup and view all the answers
What is the financial burden for the majority of patients with diabetes regarding out-of-pocket spending on medications?
Signup and view all the answers
Which population demographic is associated with a higher prevalence of diabetes among individuals who have not completed high school?
Signup and view all the answers
Which chronic skin condition is known to occur in males with Type 2 diabetes?
Signup and view all the answers
What percentage of Canadians with Type 2 diabetes feel uncomfortable disclosing their disease to others?
Signup and view all the answers
Which environmental factor is linked to the secretion of adipokines that impair insulin signaling?
Signup and view all the answers
What percentage of pregnancies were comprised by gestational diabetes in 2020?
Signup and view all the answers
Which method has a higher sensitivity for diagnosing gestational diabetes?
Signup and view all the answers
What is the recommendation for screening gestational diabetes to reduce complications?
Signup and view all the answers
Which factor is known to increase the prevalence of gestational diabetes?
Signup and view all the answers
What is the typical outcome associated with a diagnosis of gestational diabetes?
Signup and view all the answers
What is a criterion for a positive result in the three-hour fasting 100g glucose challenge test?
Signup and view all the answers
What is the comparison of diagnosis rates between one-step and two-step testing for gestational diabetes?
Signup and view all the answers
What is the specificity of the cutoff of 140 mg/dL for diagnosing gestational diabetes?
Signup and view all the answers
What is the generally accepted age for defining older adults in diabetes studies?
Signup and view all the answers
Which of the following conditions is NOT a secondary cause of diabetes?
Signup and view all the answers
Which testing method may identify more undiagnosed diabetes cases than HbA1c?
Signup and view all the answers
Why is screening for diabetes in older adults not currently routinely recommended?
Signup and view all the answers
What is the diagnostic criterion for diabetes from a fasting plasma glucose test?
Signup and view all the answers
When considering the management of diabetes in older patients, which factor is least relevant?
Signup and view all the answers
Which of the following describes Maturity-Onset Diabetes of the Young (MODY) correctly?
Signup and view all the answers
Which statement about diabetes in older adults is accurate?
Signup and view all the answers
What recent trend was observed in the prevalence of diabetes in older adults from 1997 to 2010 in the U.S.?
Signup and view all the answers
Which of the following is NOT a goal of diabetes screening in older adults?
Signup and view all the answers
Study Notes
Subcutaneous Abdominal Fat
- Subcutaneous abdominal fat is less correlated with insulin resistance.
- "Metabolic obesity" is a term for when patients with Type 2 diabetes have increased visceral fat, but don't have overt obesity
Type 2 Diabetes Epidemiology
- Adipocytes release abnormal levels of adipokines such as adiponectin and resistin, which can impair insulin signaling
- Adipose tissue activates macrophages and other immune cells, which release TNF-alpha and IL-6 that also impair insulin signaling
Type 2 Diabetes Signs and Symptoms
- Many patients are asymptomatic, and are initially diagnosed after glycosuria or hyperglycemia is found on routine lab tests.
- At the time of diagnosis, patients may already have neuropathic or cardiovascular complications.
- Prevalence of diabetes in the lowest income group is 4.9 times higher than in the highest income group
- Prevalence of diabetes in adults who have not completed high school is 5.2 times higher than in adults with a university education
- Prevalence of diabetes in adults who are unable to work is 2.9 times higher than in employed adults
- Most people with diabetes pay >3% of their income (>$1500) for medications, devices, and supplies out-of-pocket.
- 33% of Canadians with Type 2 diabetes don't feel comfortable disclosing their disease to others.
- Patients with chronic skin conditions are at higher risk for diabetes, such as:
- Vulvovaginal candidiasis in women
- Balanoposthitis in men
- Acanthosis nigricans
- Eruptive xanthomas
Type 2 Diabetes Weight Gain
- Many patients are either overweight or obese
- Patients often have a centripetal fat distribution
- Higher waist circumference is a common issue(>40 inches for men, >35 inches for women)
Type 2 Diabetes Obstetrical Complications
- Women who report delivering a baby over 9lb (4.1kg) or have had polyhydramnios, preeclampsia, or unexplained fetal losses should be considered for screening.
Type 2 Diabetes Screening
- Screening is highly recommended for Type 2 diabetes.
- Early intervention can help reduce disease progression and complications.
- Screen asymptomatic adults who are at risk with a body mass index ≥25 kg/m2 and one or more of the following:
- A1c > 5.7%
- Impaired glucose tolerance
- Impaired fasting glucose
Type 1 vs. Type 2 Diabetes
- Polyuria and thirst are more common in Type 1 than Type 2 diabetes
- Weakness or fatigue seen in both
- Polyphagia with weight loss is more common in Type 1, whereas Type 2 patients tend to gain weight
- Recurrent blurred vision is more common in Type 2
- Vulvovaginitis or pruritis is more common in Type 2
- Peripheral neuropathy is seen in both
- Nocturnal enuresis is more common in Type 1, it is not common in Type 2
- Type 1 diabetes is often symptomatic, while Type 2 is frequently asymptomatic at the time of diagnosis
Metabolic Syndrome
- Metabolic syndrome is a cluster of risk factors associated with diabetes and cardiovascular disease
- Its usefulness as a diagnostic or management tool is unclear.
- There is no clear pathophysiologic basis for metabolic syndrome.
- Other measures, such as the Framingham risk score and fasting glucose, are more useful than the use of the "metabolic syndrome" label.
Gestational Diabetes
- It comprised 7.8% of all pregnancies in 2020 in the U.S.
- Prevalence increases with advancing age and higher pre-pregnancy BMI.
- 2.5% of women aged 40 years suffer from gestational diabetes.
- Only 2 in 5 women in the U.S. had a normal BMI prior to pregnancy.
- Screening typically occurs between 24-28 weeks’ gestation with a non-fasting 50g glucose challenge test
- A positive result occurs if blood glucose is >140 mg/dL (7.8 mmol/L). A 3-hour fasting 100g glucose challenge test should then be performed.
- To confirm the diagnosis with this second test, at least one abnormal value should be present (≥180, 155, 140 mg/dL for 1-, 2-, and 3-hour fasting glucose levels, respectively)
- A threshold value of 130 mg/dL (7.2 mmol/L) has higher sensitivity (99%) but lower specificity (77%) than a cutoff of 140 mg/dL (85% sensitivity, 86% specificity)
- One-step testing uses a single fasting 75g oral glucose tolerance test
- Two-step testing uses a non-fasting 50g oral glucose tolerance test followed by a 3-hour fasting 100g glucose tolerance test if the result exceeds 130-140 mg/dL (7.2-7.8 mmol/L)
- Diagnosis of gestational diabetes is more common with one-step screening (16.5%) than two-step screening (8.5%), but there are no statistically significant differences in perinatal or maternal complications.
- Diagnosis of gestational diabetes is associated with increased psychological and emotional burden.
- The two-step testing approach was found to provide equivalent benefits to one-step testing with fewer associated harms, so it is considered more suitable for screening.
Gestational Diabetes Screening Recommendations
- Recommended to reduce maternal and fetal complications.
- Complications include preeclampsia, caesarean delivery, congenital malformations, macrosomia, childhood or adolescent obesity, nerve palsy, bone fracture, jaundice, and infant death.
- Screen women in the first trimester if any risk factors are present.
- Risk factors include obesity, age >35 years, previous history of gestational diabetes, family history of diabetes, high-risk ethnicity (including black, Hispanic, American Indian, or Asian).
- Screen asymptomatic patients at or after 24 weeks’ gestation.
Gestational Diabetes Complications
- Gestational Diabetes can result in:
- Gestational hypertension (RR=1.6)
- Preeclampsia (RR=1.5)
- Cesarean delivery (RR=1.3)
- Shoulder dystocia (RR=2.9)
- Macrosomia (RR=1.6)
- Birth defects (RR=1.2)
- 7 times greater maternal risk of developing Type 2 diabetes later in life (RR=7.4)
- 1.5 times greater risk of the child being overweight in childhood/adolescence (RR=1.5)
- In high-risk populations, diabetes develops in up to 50% of women with gestational diabetes.
Gestational Diabetes Management
- Long-term follow-up is critical.
- Screening at 6-12 weeks postpartum with a fasting glucose measurement or a 75g 2-hour glucose tolerance test is recommended.
- Up to 36% of women with gestational diabetes may have persistently abnormal glucose tolerance.
- Women with a history of gestational diabetes should be screened every 3 years for overt diabetes.
Diabetes in Children and Adolescents
- Types include Type 1 diabetes, Type 2 diabetes, and Maturity-onset diabetes of the young (MODY)
- In 2018, an estimated 210,000 children and adolescents in the U.S. had diabetes.
- MODY patients generally do not require treatment except in pregnancy.
MODY Screening Recommendations
- Consider genetic testing and referral to an endocrinologist and/or a clinical genetics consultant.
- Accurate diagnosis of MODY will determine treatment and management plans.
- However, there is a lack of evidence from randomized trials to show that early diagnosis and appropriate therapy improve patient outcomes.
Diabetes in Older Adults
- Generally considered to be >65 years of age
- From 1997-2010, the U.S. prevalence of diabetes in older adults increased by 62%.
- 21.4% of adults aged ≥65 years in the U.S. have a known diagnosis of diabetes, and 16% aren't aware of their condition.
- Older individuals are most commonly affected by Type 2 diabetes.
- This population is heterogeneous in regards to race/ethnicity, duration of diabetes, comorbidity, and functional status.
- Diabetes increases mortality, cardiovascular and microvascular complications, and other geriatric conditions (cognitive impairment, frailty, unintentional weight loss, polypharmacy, and functional impairment).
Diabetes in Older Adults Screening Recommendations
- No current recommendations for routine screening.
- Screening is dependent on whether treatment would improve quality of life or life expectancy
- Consider screening to prevent complications that may lead to functional impairment.
- Treatment decisions should be made based on age, life expectancy, functional status, and the presence of chronic co-morbid diseases.
Secondary Causes of Diabetes
- Causes include:
- Exocrine pancreas diseases
- Endocrinopathies
- Drug- or chemical-induced insulin resistance
- Other genetic diseases
- Any disorder that damages the pancreas can result in diabetes.
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 syndrome
- Klinefelter syndrome
- Turner syndrome
- Wolfram syndrome
- Type A insulin resistance
- Leprechaunism
- Rabson-Mendenhall syndrome
- Lipoatrophic diabetes
Diagnostic Testing
- Fasting plasma glucose levels (FPG)
- Oral glucose tolerance test (OGTT)
- Glycated hemoglobin (HbA1c)
- Additional tests (urine, self-monitoring, continuous glucose monitoring, autoantibody, and genetic)
Fasting Plasma Glucose (FPG)
- 100-125 mg/dL (5.6-6.9 mmol/L) is considered impaired fasting glucose tolerance, which increases risk of developing diabetes (“pre-diabetes”)
- ≥126 mg/dL (7.0 mmol/L) on more than one occasion, after at least 8-hour fasting, is diagnostic of Type 2 Diabetes
- Diagnosis may be made with signs and symptoms of hyperglycemia, plus >200 mg/dL (11.1 mmol/L) and repeated testing is required to confirm
- Pros: may identify one-third more undiagnosed cases than A1c
- Cons: fasting is required
Oral Glucose Tolerance Test (OGTT)
- Perform if FPG is:
-
100 mg/dL (5.6 mmol/L) or if there are hyperglycemia signs and symptoms
- If there is a suspicion of diabetes despite a normal FPG
-
- OGTT involves drinking a concentrated glucose drink and blood glucose levels are measured at regular intervals during the test
- 140-199 mg/dL (7.8-11.0 mmol/L), 2 hours after the glucose drink, suggests impaired glucose tolerance ("pre-diabetes")
- ≥200 mg/dL (11.1 mmol/L) on two separate occasions is diagnostic of diabetes
- Pros: it is a good diagnostic test for diabetes.
- Cons: takes a longer time to complete, and requires extra steps for preparation
Glycated Hemoglobin (HbA1c)
- It is an accurate measure of average blood glucose levels over the past 2-3 months.
- It is a useful tool for monitoring diabetes and assessing glycemic control long term.
- ≥6.5% is diagnostic of diabetes
- 5.7-6.4% is considered impaired glucose tolerance ("pre-diabetes")
- Pros: doesn't require fasting, can be used to monitor the long term management of diabetes
- Cons: patients with a high turnover of red blood cells such as pregnant women or sickle cell anemia may not have accurate results.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz covers key topics related to Type 2 diabetes, including the role of subcutaneous abdominal fat, epidemiology, and common signs and symptoms. It highlights how adipokines affect insulin signaling and the socioeconomic factors influencing the prevalence of diabetes. Test your knowledge on this critical health issue!
