ADA

AACE

Americna Diabetes Association

American Association of Clinical Endocrinologists

Diabetes Stats

1.  Total number (estimate)

2.  Total diagnosed

3.  How many unaware

4.  What % of US population with DM?

1.  25.8 million

2.  18.8 million

3.  7 million unaware

4.  8.3% of US population has DM

1.  hyperglycemia

2.  Microvascular, macrovascular, and neuropathic complications

1.  Type I DM is usually diagnosed before what age?

2.  What is the patho going on in TIDM?

1.  Before age 30

2.  Autoimmune destruction of Beta-cells causes insulin deficiency 

TIDM

1.  Requires ___ insulin for treatment

2.  What is often the first manifestation of the disease

3.  AKA (2)

4.  What % of diabetic population

5.  2 HLA markers

6.  Define "honeymoon" period

1.  Exogenous

2.  DKA

3.  Insulin-dependent; Juvenile-onset

4.  5-10%

5.  HLA-DR3 and DR4

6. At T1DM diagnosis 10% of Beta cell function still present so the patient may require significantly less insulin

1.  Type 1.5 DM?

2.  Type 3 DM?

1.  May actually exist in some individuals over 30 yo with insulin Abs present

2.  What some people refer to T2 becomming insulin dependent as

T2DM

1.  What % of DM

2.  Is ___ in development

3.  Often preceded by

4.  Key problems with T2DM (3)

1.  90-95%

2.  Progressive

3.  Prediabetes

4.  Insulin deficiency, insulin resistance, other hormonal irregularities (glucagon)

T2DM

1.  Where is diminished insulin sensitivity/resistance noted?

2.  What happens to insulin after meals?

3.  When is dx usually made (2)

1.  Liver, muscle, adipose

2.  Increased insulin secretion, but it isn't used right

3.  Glucose in urine or in women after chronic vaginal infections

1.  >45 yo

2.  BMI>25, severe obesity, acanthosis nigricans

3.  Habitual physical inactivity

4.  FH of DM (1st degree relative)

5.  High risk ethnicity (African Am, Latino, Native Am)

6.  Hx of gestational DM (GDM) or baby >9lbs

7.  HTN (BP> 140/90)

8.  HDL <35 mg/dL and/or TG>250 mg/dL

9.  Hx of vascular disease

10.  Polycystic ovary syndrome (PCOS)

11.  Hx or presence of PreDiabetes (impaired fasting glucose or impaired glucose tolerance)

Comparing T1 and T2 DM

1.  Age of onset

2.  Rate of onset

3.  FH

4.  Islet cell Abs

5.  Body type

6.  Insulin

7. Sx

1.  1:  childhoold <20yo; 2 >40 yo

2.  1:  abrupt; 2: gradual

3.  Both show FH component

4.  1:  yes; 2: no

5.  1:  think, lean, undernourished; 2:  overweight, obese

6.  1:  insulin Rx mandaory; 2:  insulin not necessary initially

7.  1:  wt loss, inc thirst, urination, hunger; 2:  asymptomatic

C-Peptide Levels

1.  What is indicative of T1 and T2 DM

Gestational Diabetes

1.  Define

2.  What % of pregnancies does it occur in?

3.  What % of chance to moms with this have of T2DM development

4.  When do you screen

5.  What are the BG cutoffs fasting, 1, 2, and 3 hr after 100 g glucose load

1.  Diabetes first presenting during pregnancy

2.  2-10%

3.  30-60%

4.  At first prenatal visit if BMI 30 or higher and b/t 24-28 wks everyone

5.  Fasting:  95 mg/dL

1 hr post:  180 mg/dL

2 hr post:  155 mg/dL

3 hr post:  140 mg/dL

1.  Infant hpoglycemia

2.  Hperbilirubinemia

3.  Complications associated with delivery of a large baby

Pre-betus

1.  How many people thought to have it?

2.  How to prevent full on diabetes?

3. Values for impaired fasting glucose

4.  Values for glucose tolerance

1.  79 million or 35% of population

2.  Lose weight and increase physical activity

3.  100 mg/dL - 125 mg/dL

4.  140-199 mg/dL

1.  Urination

2.  Thirst

3.  Hunger

4.  Unexplained wt loss (T1DM)

5. Unusual fatigue

6.  Sores that won't heal

7.  Blurred vision

1.  Increased hepatic glucose production

2.  Relative insulin deficiency

3.  Insulin resistance

4.  Increased gastric emptying rate

5.  Neuroendocrine dysfunction (Impaired incretin effect, decreased amylin secretion)

1.  B-cell insulin deficiency

2.  Muscle:  Insulin resistance

3.  Liver:  increased gluconeogensis

4.  Fat:  accelerated lipolysis

5.  GI:  Incretin deficiency

6.  Alpha cell:  hyperglucagonemia

7.  Kidney:  increased glucose absoprtion

8.  Brain:  NT dysfunction

Diagnostic Levels for Diabetes, Pre-diabetes, and Normal

1.  A1c

2.  FPG

3.  OGTT

1.  Diabetes:  >6.5%

Pre:  5.7-6.4%

2.  Diabetes:  >126 mg/dL

Pre:  100-125 mg/dL

3.  Diabetes:  >200 mg/dL

Pre:  140-200 mg/dL

Clinical Interpretations of Plasma Glucose Concentration

1.  Normal fasting

2.  Impaired fasting/prebetus

3.  Overt DM

4.  2-hr post glucose 75 g normal

5.  2 hr post glucose 75 g impaired/prebetus

6.  2-hr post glucose 75 g overt DM

1.  <100

2.  100-125

3. >126

4.  <140

5.  140-199

6.  >200

HbA1c Goals

1.  ADA

2.  AACE

1.  <7% or up to 7.5-8% if patient is without complications

2.  <6.5%, but if severe hypoglycemia occurs, you can shoot for 7-8%

ADA Glycemia Goals

1.  A1c target and how often to evaluate

2.  Estimated avg glucose (eAG)

3.  Preprandial plasma glucose

4.  Peak Postprandial plasma glucose

1.  <7%; Q3 months until goal then Q6 months

2.  <154 mg/dL

3.  70-130 mg/dL

4.  <180 mg/dL

Goal <130/80

Evaluate at every visit

ADA Lipid Goals

1.  How often to evaluate?

2.  LDL

3.  HDL

4.  TGs

1.  At least yearly

2.  <100 mg/dL or <70 mg/dL if high risk

3.  >40 mg/dL male and 50 mg/dL female

4.  <150 mg/dL

ADA Monitoring for Complications

1.  Eyes

2.  Feed

3.  Urinary Microalbumin

1.  Dilated eye exam yearly

2.  Feed examined daily by pt and at every visit with physician

3.  Yearly

ADA vs AACE

*All the BP and Lipid goals are identical

Differences ADA vs AACE in A1c, eAG, Preprandial, Post prandial peak

1.  7 vs 6.5%

2.  154 mg/dL vs 140 mg/dL

3.  70-130 vs 70-110

4.  <180 vs <140

1.  Set goals for glycemia, BP, and lipids

2.  Regular complications monitoring

3.  Education

4.  Diet and exercise modifications

5.  Self monitoring of blood glucose (SMBG)

6.  Medicaitons

7.  Regular lab assessment for glkycemia goals and safety and efficacy of medications