I.
INTRODUCTION
A. Diabetes statistics
B. Diabetes trends
II.
KEY PLAYERS OF GLUCOSE REGULATION:
A. Tissues:
1. liver: regulates plasma glucose levels and stores excess as glycogen
2. pancreas: beta-cells create the hormone, insulin, required for glucose uptake
3. insulin-requiring tissues: (muscles, fat)
B. Hormones:
1. insulin: lowers plasma glucose:
III. Type 2: 90% of diabetics in U.S./ 50% over 60 years of age are undiagnosed
1. Etiology:
unknown
2. Pathogenesis: insulin resistance of tissue and impaired insulin secretion
3. Heredity:
as high as 75% risk factor
4. Onset:
insidious
5. Age of onset: can be as young as children
6. Race:
African-American, Native American, Hispanic, Asian-American
7. Metabolic syndrome
IV. LABORATORY TESTS:
A. Criteria for the diagnosis of diabetes mellitus:
1. FBS :
(Fasting Blood Sugar): > 126 mg/dl
2. RBS:
(Random Blood Sugar): > 200 mg/dl with associated symptoms
3. 2-h PG: (2-h postload glucose): > 200mg/dl
4. Abnormality must be confirmed on a subsequent day by any of these tests
B. Criteria for the diagnosis of pre-diabetes:
1. Impaired fasting glucose (IFG)
100-125mg/dl
2. Impaired glucose tolerance (IGT) 140-199 mg/dl
V.
THE BIG PICTURE
VI. OBESITY
A. Statistics
B. Actual causes of death
C. Body Mass Index (BMI): ) wt(lbs)/ ht(in)2 x 704.5
1. a relationship of height and weight that is very highly correlated to body fat
2. Normal: 18.5
3. Overweight > 25
4. Obesity > 30
5. Severe or Morbid Obesity > 40
D. Obesity trends
VII. Metabolic Syndrome: significant risk for type 2 diabetes and heart disease
A. AKA: obesity syndrome, Syndrome X, insulin resistance syndrome
B. 25% of adult Americans have metabolic syndrome and approaching 50% in elderly
C. Diagnosis includes three or more components below. (ATP III) NCEP
a) insulin resistance IFG: > 110mg/dl
b) lipid abnormalities
(1) triglycerides > 150 mg/dl
(2) low HDL men >40 mg/dl
women >50 mg/dl
c) hypertension > 130/80 mmHg
d) upper body obesity: men > 40”
women >30”
D. Other findings
1. polycystic ovarian syndrome (PCOS)
2. acanthosis nigricans (AN)
VIII. DELAY OR PREVENTION OF TYPE 2 DIABTES?
A. Diabetes Prevention Program Research Group Study
1. 58% relative reduction of diabetes compared to control by lifestyle modification
2. 5-10% weight reduction
3. Moderate physical activity: 30 minutes/day 5 times a week
IX. PATIENT EDUCATION
A. Target blood sugar of less than 150mg/dl (A1C of less than 7%)
B.
C.
D.
E.
Aggressive control of blood pressure (less than 130/80 mmHg)
Lipid management: LDL < 100 mg/dl
Smoking cessation
Diabetes education
X.
ASPIRIN THERAPY
A. Reduces thromboxane synthesis
B. Reduction of macrovascular complications
C. ECASA 81-325mg/day to reduce cardiovascular events by 30-40%
XI. SUMMARY
XII. READING REFERENCES
1. Diabetes Control and Complications Trial Research Group: The effect of intensive
treatment of diabetes on the development and progression of long-term
complications in insulin-dependent diabetes mellitus. NEJM 329:977-986, 1993.
2. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control
with sulphonylureas or insulin compared with conventional treatment and risk of
complications in patients with type 2 diabetes (UKPDS33). Lancet 352:837-853,
1998.
3. American Diabetes Association: Diabetes Care 2005 28, Supplement 1 (Clinical
Practice Recommendations).
4. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of
High Blood Cholesterol in Adults (Adult Treatment Panel III)
5. Diabetes Prevention Program Research Group. Reduction in the Incidence of
Type 2 Diabetes with Lifestyle Intervention or Metformin. NEJM 346:393-403, 2002