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diabetes mellitus

Other references


  • juvenile onset autoimmune type 1 diabetes
  • adult onset diabetes:
    • type 1 diabetes:
      • severe autoimmune diabetes (SAID), including type 1 diabetes and latent autoimmune diabetes in adults (LADA)
    • type 2 diabetes:
      • severe insulin-deficient diabetes (SIDD)
      • severe insulin-resistant diabetes (SIRD)
      • mild obesity-related diabetes (MOD)
      • mild age-related diabetes (MARD)

Risk factors for developing diabetes

  • genetic factors
    • especially for type 1 diabetes and MOD
    • having a parent, brother, or sister with type 1 diabetes is a risk factor for juvenile onset type 1 diabetes
    • in the United States:
      • White people are more likely to develop type 1 diabetes than African American and Hispanic or Latino people
      • higher risk for type 2 diabetes is in those who are African American, Hispanic or Latino, American Indian, or Alaska Native person as well as Pacific Islanders and Asian American people
    • however, genes promoting childhood adiposity are largely distinct from those promoting diabetes during adulthood.1)
  • other risk factors for type II diabetes:
    • childhood obesity:
      • 62% increased risk of LADA, a doubling of the risk of SIDD, a near-trebling of the risk of SIRD, and a 7-times increased risk of MOD 2)
    • adult obesity, non-alcoholic fatty liver disease
    • have prediabetes
    • increasing age over 45yrs
    • sedentary lifestyle
    • PCOS - is associated with insulin resistance and more than half of women with PCOS develop type 2 diabetes by age 40
    • history of gestational diabetes which is more likely if
      • FH type 2 diabetes
      • overweight
      • polycystic ovary syndrome (PCOS)
      • an African American, Hispanic or Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander person
      • NB. having gestational diabetes increases the risk of the baby developing childhood obesity and later type 2 diabetes

Mortality associated with type 2 diabetes

  • a 50 year old with type 2 diabetes with no history of vascular disease has life expectancy reduced by 6 years compared to non-diabetics (these compares to 7 years reduction for smokers vs non-smokers)3)
    • ~40% of the years lost from diabetes can be attributed to nonvascular conditions including 10% attributable to death from cancer
    • vascular, cancer and noncancer, nonvascular mortality rises with fasting glucose above 6 mmol/L to 50% greater at levels of 7mmol/L, and 100% greater for vascular deaths at levels of 8mmol/L or higher.
  • intensive glucose lowering with HbA1c target of < 6% instead of usual 7-7.9% target resulted in INCREASED 5 year mortality in type 2 diabetics.4)

RAAS blockade and chronic renal impairment

  • agents which block the renin-angiotensin-aldosterone-system (RAAS) have been used in the hope that they will reduce risk of chronic renal impairment in diabetics.
  • in 2013, several trials of dual therapy (eg. ACEI with aldosterone inhibitor) called this strategy into question as risks of hyperkalaemia and episodes of acute renal failure appeared to outweigh benefits despite showing increased efficacy at lowering BP and decreasing albuminuria 5):
    • VA NEPHRON-D trial: ARB +/- ACEI - trial stopped for safety reasons
    • ALTITUDE: (ACEI or ARB) + aliskiren (a direct renin inhibitor) - trial stopped for safety reasons
dm.txt · Last modified: 2023/03/01 09:01 by gary1

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