Endocrinology 11th November 2016 Diabetes Mellitus 1. Understand the different types of diabetes and how hormones and receptors are involved 2. Be aware of the links between obesity and type 2 diabetes 3. Understand how common treatments for diabetes work around the endocrinological basis of the disease What is Diabetes Mellitus? Diabetes - flow through Mellitus - urine (sweet urine) Diabetes inspitous is a different form (non-sweet urine) It is a collection of diseases of glucose homeostasis being deregulated: - Type 1 Diabetes (T1DM) - Type 2 Diabetes (T2DM) - Maturity Onset Diabetes of Young - Gestational Diabetes - T2D Mellitus in Young adult - And many others It accounts for 10% of NHS budget - spending over 10,000,000 pounds! It is associated with serious complications and shortens lifespans, and accelerates ageing WHO classification Type 1 diabetes (B-cell destruction) · Immune mediated · Idiopathic · Formerly insulin-dependent diabetes Type 2 diabetes · Insulin resistance with inadequate insulin secretion · Formerly non-insulin-dependent diabetes Secondary diabetes · Diabetes secondary to pancreatic disease: · Chronic pancreatitis · Haemochromatosis · Pancreatic surgery or trauma · Cystic fibrosis · Diabetes secondary to endocrine disease: · Acromegaly · Cushing syndrome · Phaeochromocytoma · Diabetes secondary to drugs and chemicals: · Glucocorticoids · Diuretics · Antipsychotics · B-blockers · Diabetes secondary to genetic abnormalities: · Genetic defects of B-cell function: MODY (maturity-onset diabetes of the young): Glucokinase mutations Hepatic nuclear factor mutations Insulin promoter factor 1 mutations GATA6 mutations (neonatal diabetes) Mitochondrial DNA 3243 mutation Genetic defects of insulin action: Leprechaunism Type A insulin resistance 1 Rabson-Mendenhall syndrome Lipoatrophic diabetes Other genetic syndromes: Down syndrome Prader-Willi syndrome DIDMOAD (Wolfram) syndrome · Infections: · Congenital rubella · Cytomegalovirus Mumps Gestational diabetes
Endocrinology 11th November 2016 Diabetes diagnosis - OGTT Measure their glucose levels: Take a fasting glucose level: greater than 7 is what defines diabetes 2 hours oral glucose intolerance test: measure glucose over the 2 hours Fasting plasma glucose (mmol/L or mg/dL) <6.1 <110 26.1-6.9 27.0 ?110-125 ?126 2-h plasma <7.8 glucose following <140 a 75-g oral glucose tolerance ?7.8-11.0 test ?140-200 (mmol/L or mg/dL) ?11.1 ?200 Normal Impaired glucose Impaired fasting glycaemia and Diabetes tolerance impaired glucose tolerance Diabetes Diabetes Diabetes Impaired fasting glycaemia* Diabetes 2010 Country/ Millions territory India 50.8 China 43.2 USA USA Russian 9.6 Federation Brazil 7.6 Germany 7.5 Pakistan 7.1 Japan 7.1 Bangladesh 10.4 Indonesia 7.0 2030 Country/ territory India 87.0 China 62.6 26.8 Pakistan 13.8 Brazil 12.7 Indonesia 12.0 Mexico 11.9 Russian 10.3 Federation es Association defines impaired fasting glucose as between 110 and 125mg/dL (5.6-6.9mmol/L). diagnosed if a random plasma glucose is ?11.1 mmol/L (200 mg/dL). Millions 36.0 Number of people Impaired fasting glycaemia Normal 53 37 2 Worldwide Diabetes prevelence 66 55 52 101 5. 27 59 Mexico 6.8 Egypt 8.6 113 *The 10 countries with the highest numbers of people with diabetes are listed. Data from IDF Atlas 2009 (http://www.idf.org/ diabetesatlas/downloads) 24 77 30 12 18 2010 (millions) 2030 (millions) World 2010: 285 million 2030: 438 million 54%