Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Global PrevalenceDiabetes in childrenDiabetes Costs and ComplicationsThe major diabetic complicationsDefinitionBlood Glucose RegulationTypes of DiabetesDiabetes – Type 1 (Symptoms)Types of DiabetesSlide 16Glucose Tolerance TestType II Diabetes ProgressionAnother way to measure glucose control HbA1cSlide 20Slide 21Type II Diabetes ProgressionRisk factorsSlide 24Slide 25Insulin resistanceSlide 27Risk factors-ObesityObesity: Overall and abdominalWeight loss and risk for diabetesDiabetes-Lecture 1Kin 247 Fall 20172009Diabetes trends No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% 19942011 data: > 20 years = 11.3% > 65 years = 26.9%Age-adjusted prevalence of physician-diagnosed diabetes mellitus in adults ≥20 years of age by race/ethnicity and sex (National Health and Nutrition Examination Survey: 2009–2012). Dariush Mozaffarian et al. Circulation. 2015;131:e29-e322Copyright © American Heart Association, Inc. All rights reserved.Age-adjusted prevalence of physician-diagnosed diabetes mellitus in adults ≥20 years of age by race/ethnicity and years of education (National Health and Nutrition Examination Survey: 2009–2012). Dariush Mozaffarian et al. Circulation. 2015;131:e29-e322Copyright © American Heart Association, Inc. All rights reserved.Trends in the prevalence of diagnosed and undiagnosed diabetes mellitus (calibrated hemoglobin A1c levels >6.5%), by race/ethnic group. Dariush Mozaffarian et al. Circulation. 2015;131:e29-e322Copyright © American Heart Association, Inc. All rights reserved.Diabetes mellitus awareness, treatment, and control in adults ≥20 years of age (National Health and Nutrition Examination Survey: 2009–2012). Dariush Mozaffarian et al. Circulation. 2015;131:e29-e322Copyright © American Heart Association, Inc. All rights reserved.Global Prevalence•Affected at least 366 million (2011) •Projected to affect 552 million by 2030•Previously termed as a disease of the ‘West’Diabetes in childrenDiabetes Costs and Complications•Estimated costs of diabetes–$174 Billion 2007–$245 Billion 2012 (~51 billion direct cost)•Other complications from diabetes•Heart disease and stroke•Hypertension•Blindness•Kidney disease•Nervous system disease •AmputationsThe major diabetic complicationsVisual impairment:diabetic retinopathy,cataract and glaucomaKidney disease(diabetic nephropathy)Sexual dysfunctionSensory impairment(peripheral neuropathy)UlcerationStroke(cerebrovascular disease)Heart disease(cardiovascular disease)Bacterial and fungalinfections of the skinSevere hardening of the arteries (atherosclerosis)Autonomic neuropathy(including slow emptyingof the stomach and diarrhea)GangrenePoor blood supply to lower limbs (peripheral vascular disease)Definition•Metabolic disease characterized by hyperglycemia –insulin secretion, insulin action, or both.–Hyperglycemia:High glucose concentration in blood –Insulin•Naturally occurring hormone –Pancreas- β cells– uptake of glucoseBlood Glucose RegulationMuscle, fatTypes of DiabetesType-I•Juvenile onset diabetes•Destruction of pancreatic β cells-autoimmune–Less production of insulin•Injections•Genetic predisposition•5-10 % of diabetics–Idiopathic diabetes (type 1B) – unknown origin– genetic predisposition– triggered by environment – need for insulin changes over timeDiabetes – Type 1 (Symptoms)•Loss of or inadequate production of insulin•Loss or impairment of cells ability to absorb glucose•Tissues become ‘glucose starved’ despite presence of high levels of blood glucose•Acute effect: following meal high in carbohydrates, blood glucose is so elevated that kidneys cannot reclaim all glucose and glucose ‘spills’ into urine–This limits ability of kidneys to conserve water (extra water excreted with glucose)Symptoms:Polyuria – huge urine outputPolydipsia – excessive thrist Polyphagia – excessive hunger and food consumption Dehydration leads to neural disturbances Blurred vision, tingling sensations, fatigue, muscle weaknessTypes of DiabetesType-II (T2DM, NIDDM)•90 to 95%•Insulin resistance: decreased glucose clearance–Diminished capacity of pancreas over time•Adult onset?•Prevalence of T2D in adolescents is increasing•45% of new pediatric cases•Disease progression over time•Obesity–Non-obese-: increased abdominal fat• Genes may play a role –But 80% of T2DM is preventableCriteria for the Diagnosis of Diabetes Mellitus1. Symptoms of diabetes + casual blood glucose ≥ 200 mg/dLOR2. Fasting plasma glucose ≥ 126 mg/dLOR3. 2-hour plasma glucose ≥ 200 mg/dL during an oral glucose tolerance test (OGTT)The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 26 (supplement 1):S5-S20, 2003.Glucose Tolerance TestType II Diabetes ProgressionFPG criteria OGTT criteriaAnother way to measure glucose controlHbA1cType II Diabetes ProgressionHealthy – normal glucose, normal insulinSome insulin resistance – normal glucose, elevated insulinMore insulin resistance – normal fasting glucose, high glucose during OGTT, elevated insulinEven more insulin resistance – high fasting and OGTT glucose, insulin starts to decreaseFull blown T2D –Risk factors–Age (over 45)–Family History–Race (Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, American Indians and Alaskan Natives) –Over-weight/Obesity–High triglycerides, Low HDL–High blood pressure–Impaired glucose tolerance (IGT)–Impaired fasting glucose (IFG) –Physical inactivityInsulin resistance•Less glucose uptake for given insulin concentration–Liver•Glucose production: Decreased suppression after a meal–increased glycogenolysis – –increased gluconeogenesis – •Glucose uptake: Decreased after a meal–Muscle and fat tissue•Glucose uptake after meal: Decreased removal–Long term effect•Increased insulin secretion•β-cell death–Obesity: major contributorAge-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m2)Diabetes1994199420002000 No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0% No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%CDC’s Division of Diabetes Translation. National Diabetes