CEXP 538 Diabetes Mellitus Fall 2024 Module 9 PDF

CEXP 538 DIABETES MELLITUS Fall 2024 Module 9 OUTLINE DIABETES MELLITUS ETIOLOGY RISK FACTORS TREATMENT PHYSICAL ACTIVITY METABOLIC SYNDROME RESEARCH IN PHYSICAL ACTIVITY DIABETES MELLITUS: INTRODUCTION  DIABETES MELLITUS Et...

CEXP 538 DIABETES MELLITUS Fall 2024 Module 9 OUTLINE DIABETES MELLITUS ETIOLOGY RISK FACTORS TREATMENT PHYSICAL ACTIVITY METABOLIC SYNDROME RESEARCH IN PHYSICAL ACTIVITY DIABETES MELLITUS: INTRODUCTION  DIABETES MELLITUS Etiology A condition characterized by an elevated blood glucose concentration (i.e., hyperglycemia) as a result of defects in insulin secretion and/or an inability to use insulin Sustained elevated blood glucose levels place individuals at risk for long-term complications: microvascular diseases (e.g., retinopathy, nephropathy), macrovascular comorbidities (e.g., coronary artery disease [CAD], peripheral artery disease) neuropathies (peripheral and autonomic) Higher prevalence of other elevated CVD risk factors (e.g., dyslipidemia, inflammatory markers) compared to those without DM  DIABETES MELLITUS Etiology Common terms from the American Diabetes Association (2023): https://diabetes.org/about-diabetes/common-terms Type 1 diabetes A condition characterized by high blood glucose (blood sugar) levels caused by a lack of insulin. Occurs when the body's immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Type 1 diabetes develops most often in young people but can appear in adults. In the United States, White people are more likely to develop type 1 diabetes than African American and Hispanic or Latino people Type 2 diabetes A condition characterized by high blood glucose (blood sugar) levels caused by either a lack of insulin or the body's inability to use insulin efficiently Type 2 diabetes develops most often in middle-aged and older adults but can appear in young people. Gestational diabetes A type of diabetes that develops only during pregnancy and usually disappears upon delivery, but increases the risk that the mother will develop diabetes later. GDM is managed with meal planning, activity, and, in some cases, insulin. Secondary diabetes A type of diabetes caused by another disease or certain drugs or chemicals. Insulin A hormone that helps the body use glucose for energy. When needed, it is taken to manage blood glucose (blood sugar)  DIABETES MELLITUS Prevalence CDC (2024) 2 million Americans have type 1 diabetes The percentage of Americans age 65 and older remains high, at 29.2%, or 16.5 million seniors (diagnosed and undiagnosed). Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness. In the last 20 years, the number of adults diagnosed with diabetes has more than doubled.  DIABETES MELLITUS Prevalence CDC (2024) 13.6% of American Indians/Alaskan Native adults 12.1% of non-Hispanic Black adults 11.7% of Hispanic adults 9.1% of Asian American adults 6.9% of non-Hispanic White adults  DIABETES MELLITUS Mortality American Diabetes Association (2021): Diabetes was the eighth leading cause of death in the United States based on the 103,294 death certificates in which diabetes was listed as the underlying cause of death Cause of death in a total of 399,401 certificates Emerging Risk Factors Collaboration (2023) A 50-year-old with diabetes, diagnosed at age 30, 40, or 50 years died on average 14, 10, or 6 years earlier, respectively, than an individual without diabetes  DIABETES MELLITUS Financial trends American Diabetes Association (2023):  DIABETES MELLITUS Prevalence American Diabetes Association (2024) National health care costs attributable to diabetes have increased by $80 billion in the past 10 years—from $227 billion in 2012 to $307 billion in 2022 After adjusting for inflation, the total cost of insulin and other medications to manage blood glucose increased by 26% from 2017 to 2022. Despite having a lower prevalence rate, women with diabetes spend more on average than men on annual health care expenditures. Black Americans with diabetes pay the most in direct health care expenditures. People with diabetes above the age of 65 spend roughly double on per capita annual health care expenditures than any other age group above the age of 18. DIABETES MELLITUS: ETIOLOGY  DIABETES MELLITUS Etiology  DIABETES MELLITUS Etiology Type 1 Diabetes Caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin, called beta cells. Immune system mistakenly treats the beta cells in your pancreas that create insulin as foreign invaders and destroys them When enough beta cells are destroyed, your pancreas can’t make insulin or makes so little of it that you need to take insulin to live Take insulin every day Currently can't be prevented, but it can be treated effectively High tendency for ketoacidosis "Honeymoon" period–a brief period of time where your body is producing enough insulin to lower blood glucose levels. The honeymoon phase usually happens after you start taking insulin and you may not need as much to manage your blood glucose.  DIABETES MELLITUS Etiology Type 2 Diabetes Insulin resistance The body's inability to respond to and use the insulin it produces. Dysfunction mainly occurs in skeletal muscle, adipose tissue and the liver where cells are unable to take up glucose Pancreas increases insulin secretion to compensate but eventually can’t keep up High levels of plasma glucose result in beta-cell dysfunction Increases free fatty acid levels in blood and fat storage in the liver and muscle, which lead to impaired insulin action and elevated glucose output by the liver Result is impaired glucose tolerance (IGT) Metabolic condition characterized by higher than normal blood sugar levels, which fall short of meeting the criteria for diabetes Type II diabetes develops in about 40-50% of patients with IGT Insulin resistance is associated with triglyceride and fatty acids stored in skeletal muscle, which is reversible by fat loss Researchers are unsure of the causes  DIABETES MELLITUS Etiology Type 2 Diabetes Insulin resistance Researchers are unsure of the causes but risk factors include: High blood sugar levels. High triglycerides (a kind of fat found in the blood). High LDL (bad) cholesterol. Low HDL (good) cholesterol. Family history of type 2 diabetes. Physical inactivity. Reversible  DIABETES MELLITUS Etiology Type 2 Diabetes Causes Overweight and obesity Not being physically active Insulin resistance Genetics (lifestyle or genes) Health care provider may need to prescribe oral and injectable medications (including insulin) as treatment  DIABETES MELLITUS Etiology Consequences Leading cause of: CVD Chronic Kidney Disease (CKD) Retinopathy (blindness) Neuropathy (Peripheral or Autonomic) Foot (Ulcers, Skin, Circulation, Calluses, Amputation) Skin (Bacterial & Fungal Infections, Itching) Oral (Teeth, Bad breath, Gingivitis,Periodontitis) Hearing Loss (2x higher risk with DM, 30% higher for prediabetes) Stroke (2x higher risk with DM)  DIABETES MELLITUS Etiology Symptoms Urinating often Feeling very thirsty Feeling very hungry—even though you are eating Extreme fatigue Blurry vision Cuts/bruises that are slow to heal Weight loss—even though you are eating more (type 1) Tingling, pain, or numbness in the hands/feet (type 2)  DIABETES MELLITUS Etiology Diagnosis Blood test–HbA1C Glycosylated hemoglobin Measures the binding of glucose with the iron in red blood cells Most accurate test for prediabetes & diabetes Is not affected by acute plasma changes Related to long-term exposure of of red blood cells to blood glucose level over the past two to three months 45 years of age or if are younger and have other cardiometabolic risk factors Goal with diabetes diagnosis is