prevention techniques for diabetes mellitus type 1 and 2
Download
Skip this Video
Download Presentation
Prevention Techniques for Diabetes Mellitus: Type 1 and 2

Loading in 2 Seconds...

play fullscreen
1 / 18

Prevention Techniques for Diabetes Mellitus: Type 1 and 2 - PowerPoint PPT Presentation


  • 633 Views
  • Uploaded on

Prevention Techniques for Diabetes Mellitus: Type 1 and 2. Stephanie Pike Course: PAS 646 Advisor: Dennis Karounos, M.D. Types of Diabetes:. TYPE 1 DIABETES (T1DM) 5-10% cases Autoimmune disease Requires insulin Spontaneous? Genetic predisposition TYPE 2 DIABETES (T2DM) 90-95% cases

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Prevention Techniques for Diabetes Mellitus: Type 1 and 2' - daniel_millan


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
prevention techniques for diabetes mellitus type 1 and 2

Prevention Techniques for Diabetes Mellitus: Type 1 and 2

Stephanie Pike

Course: PAS 646

Advisor:

Dennis Karounos, M.D.

types of diabetes
Types of Diabetes:
  • TYPE 1 DIABETES (T1DM)
    • 5-10% cases
    • Autoimmune disease
    • Requires insulin
    • Spontaneous?
    • Genetic predisposition
  • TYPE 2 DIABETES (T2DM)
    • 90-95% cases
    • Insulin resistance and beta cell dysfunction
    • Genetic predisposition- Strong
  • OTHERS
prevention of t1dm rubella avoidance
Prevention of T1DM:RUBELLA AVOIDANCE
  • Congenital Rubella Syndrome (CRS)
    • Viral infection that correlates with T1DM
  • STUDY- Infected rabbits with CR
    • Result: Changes in rabbit beta cells similar to those in diabetic mice
      • Direct infection vs. Indirect
        • Indirect- Induces an immune response
        • Study- molecular mimicry
prevention of t1dm rubella avoidance4
Prevention of T1DM:RUBELLA AVOIDANCE
  • Clinically:
    • MMR vaccine prevents infection!
      • Children: 12-15 mo; again 4-6 yrs
    • Question women of childbearing age
      • Vaccinate; avoid pregnancy for 28 days
      • Titer: family planning
      • Susceptible pregnant women: vaccinate after delivery before hospital discharge
prevention of t1dm breast milk vs cow s milk
Prevention of T1DM:BREAST MILK VS. COW’S MILK
  • Breastfeeding- independent protective factor
    • Case controlled dataset
    • T1DM decreased as Breastfeeding increased
    • SO… breastfeeding helps protect from T1DM
      • Duration unclear
prevention of t1dm breast milk vs cow s milk6
Prevention of T1DM:BREAST MILK VS. COW’S MILK
  • Parallel effect: Avoiding cow’s milk
    • Bovine insulin-binding antibodies
    • Cross reacting to induce T1DM
    • Prospective study 200 infants
      • Cow’s milk associated with T1DM
  • Clinically:
      • Breastfeed and avoid cow’s milk for as long as possible up to 12 mo.
prevention of t1dm honeymoon stage
Prevention of T1DM:HONEYMOON STAGE
  • Honeymoon stage
    • Functional recovery of beta cell function
    • Need for exogenous insulin low
  • Continue insulin
    • Low dose basal insulin
    • Endogenous insulin secretion
    • Better metabolic control
  • After honeymoon stage
    • Long honeymoon = Better metabolic control after remission
    • Study 178 diabetic children and adolsecents
prevention of t1dm accelerator hypothesis
Prevention of T1DM:ACCELERATOR HYPOTHESIS
  • Lifestyle factors overlooked in T1DM
    • Autoimmune disease
    • Is this appropriate?
  • T2DM and Obesity
    • Well known correlation
  • Past 35 years…
    • Obesity- doubled
    • T2DM- doubled
    • T1DM- doubled
prevention of t1dm accelerator hypothesis9
Prevention of T1DM:ACCELERATOR HYPOTHESIS
  • Study- retrospective; 94 children in UK
    • Greater BMI at diagnosis T1DM earlier age
  • Overlap of prevention measures
    • Same intense lifestyle changes
  • Don’t believe?
    • Prevent CV disease!
prevention of t1dm clinical trials
Prevention of T1DM:CLINICAL TRIALS
  • DPT-1
    • Large, multicenter
      • Insulin as antigen specific immune therapy
      • Unsuccessful, BUT…
        • Accurate predictions
        • ID Asymptomatic pts
        • Insulin- does not accelerate disease process
  • More…
    • Preclinical trials
      • Successful in mouse model
          • Dosing?
          • Metabolically inactive insulin analog
prevention of t1dm clinical trials11
Prevention of T1DM:CLINICAL TRIALS
  • NIH Trialnet
    • Multi-center, international
      • Natural history studies
      • Diabetes prevention studies
      • Diabetes intervention studies
    • Actively recruiting
      • New onset diabetes
      • First degree relatives
      • www.diabetestrailnet.org
prevention of t2dm lifestyle changes
Prevention of T2DM:LIFESTYLE CHANGES
  • Definitive data
    • Eating healthy + regular exercise
    • STUDY 3234 overweight, non-diabetic individuals
      • Placebo
      • Medication-31%
      • Intense lifestyle changes– 58%
  • Clinically
      • NEDP suggests
        • 30 min physical activity 5 days each week
        • Eating healthier
        • Losing small amt weight
      • THIS IS NOT EASY!!!
prevention of t2dm stop smoking
Prevention of T2DM:STOP SMOKING

Insulin Resistance Atherosclerosis Study

      • 906 subjects
        • Current smokers- 25% T2DM w/in 5 years
        • Never smokers- 14% T2DM w/in 5 years
    • Physician’s Health Study
        • Prospective study
        • Smokers- age adjusted relative risk 2:1 for T2DM
  • Pregnant women
    • Decreased glucose tolerance
    • Inc risk gestational diabetes
  • Children- Second hand smoke
    • 2273 subjects
    • Independently associated with metabolic syndrome
clinical application conclusion
CLINICAL APPLICATION--CONCLUSION:
  • First or second degree T1DM relative
    • Rubella
      • Vaccinate children with MMR
      • Question and Retest titer in women of childbearing age; Vaccinate women if necessary
    • Breast feed 3-12 mo.
    • Honeymoon stage- continue insulin therapy
    • Lifestyle changes- diet and exercise
    • Clinical trials
      • www.diabetestrialnet.org
clinical application conclusion15
CLINICAL APPLICATION--CONCLUSION:
  • T2DM in family Hx; sedentary lifestyle; overweight
    • Intense lifestyle changes
      • Exercise 30 min 5 days/week
      • Eat healthier
      • Goal: BMI < 24.9
    • Stop smoking
      • No smoking during pregnancy
      • Avoid exposing children to second hand smoke
      • Will also reduce risk of cardiovascular disease
references
References:
  • American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2006; 29 (Suppl. 1): S43-S48.
  • Andreoli TE, Carpenter CC, Griggs RC, Loscalzo J, editors. Cecil Essentials of Medicine. 6th Ed.Philadelphia: W. B. Saunders Company; 2004.
  • Endotext, Current Strategies for the Prevention of Type 1 and 2 Diabetes Mellitus- Chapter 41. Available at: www.endotext.org, Accessed on October 30, 2005.
  • England LJ, Levine RJ, Qian C, Soule LM, Schisterman EF, Yu KF, et al. Glucose tolerance and risk of gestational diabetes mellitus in nulliparous women who smoke during pregnancy. Am J Epidemiol 2004; 160: 1205-1213.
  • Foy CG, Bell RA, Farmer DF, Goff DC, Wagenknecht. Smoking and incidence of diabetes among U.S. adults. Diabetes Care 2005; 28: 2501-7.
  • Francis BH, Thomas AK, McCarthy CA. The impact of rubella immunization on the serological status of women of childbearing age: a retrospective longitudinal study in Melbourne, Australia. Am J Public Health 2003; 93: 1274-1276.
  • Greenbaum CJ, Cuthbertson D, Krischer JP, and the Diabetes Prevention Trial of Type 1 Diabetes Study group. Type 1 diabetes manifested solely by 2-h oral glucose tolerance test criteria. Diabetes 2001; 50: 470-476.
  • Hanson RL, Imperatore G, Bennett PH, Knowler WC. Components of the “metabolic syndrome” and incidence of type 2 diabetes. Diabetes 2002; 51: 3120–3127.
  • Karounos DG. Convergence of genetic and environmental factors in the immunopathogenesis of type 1 diabetes mellitus. J Clin Ligand Assay 1998; 3: 262-271.
  • Karounos DG, Bryson JS, Cohen DA. Metabolically inactive insulin analog prevents type 1 diabetes in prediabetic NOD mice. J Clin Invest 1997; 100: 1344-1348.
  • Karounos DG, Wolinsky JS, Thomas JW. Monoclonal antibody to rubella virus capsid protein recognizes a β-cell antigen. J Immunol 1993; 150: 3080- 3085.
more references
More References…
  • Kibirige M, Renuka R, Metcalf B, Wilkin TJ. Testing the accelerator hypothesis. Diabetes Care 2003; 26: 2865-2870.
  • Kliegman RM, Jenson HB, Marcdante KJ, Behrman RE. Nelson Essentials of Pediatrics.5th Ed. Philadelphia: Elsevier Saunders; 2006.
  • Knip M, Sakkinen A, Huttunen NP, Kaar ML, Lankela S, Mustonen A, et al. Postinitial remission in diabetic children—an analysis of 178 cases. Acta Paediatr Scand. 1982; 71: 90-98.
  • Knowler WC, Barrett-Conner E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. The Diabetes Program Prevention Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.
  • Kobayashi T, Maruyama T, Shimada A, Kasuga A, Kanatsuka A, Takei I, et al. Insulin intervention to preserve β cells in slowly progressive insulin-dependent (type 1) diabetes mellitus. Ann NY Acad Sci 2002; 958: 117-130.
  • Malcova H, Sumnik Z, Drevinek P, Venhacova J, Lebi J, Cinek O. Absence of breast-feeding is associated with the risk of type 1 diabetes: a case-control study in a population with rapidly increasing incidence. Eur J Pediatr 2006; 165: 114-119.
  • Manson JE, Ajani UA, Liu S, Nathan DM, Hennekens CH. A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. Am J Med 2000; 109: 538-542.
  • Menser MA, Forrest JM, Bransby RD. Rubella infection and diabetes mellitus. Lancet. 1978; 1: 57-60.
  • National Institutes of Health, National Diabetes Education Program. Available at: http://ndep.nih.gov/, Accessed on October 30, 2005.
  • Palmer JP. Beta cell rest and recovery-does it bring patients with latent autoimmune diabetes in adults to euglycemia? Ann NY Acad Sci 2002; 958: 89-98.
more references18
More References…
  • Rayfield EJ, Kelly KJ, Yoon JW. Rubella virus-induced diabetes in the hamster. Diabetes. 1986; 35(11): 1278-1281.
  • Sadauskaite-Kuehne V, Ludvigsson J, Padaiga Ž, Jašinskinenė E, Samuelsson U. Longer breastfeeding in an independent protective factor against development of type 1 diabetes mellitus in childhood. Diabetes Metab Res Rev 2004; 20: 150-157.
  • Schoenhoff DD, Lane TW, Hansen CJ. Primary prevention and rubella immunity: overlooked issues in the outpatient obstetric setting. Infect Control Hosp Epidemiol 1997; 18: 633-636.
  • Sklyer JS, Brown D, Chase HP, Collier E, Cowie C, Eisenbarth GS, et al. Diabetes Prevention Trial- Type 1 (DPT-1) Diabetes Study Group. Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med 2002; 346: 1685-1691B.
  • The Diabetes Control and Complications Trial (DCCT) Research Group. Effect of intensive therapy on residual β-cell function in patients with type 1 diabetes in the diabetes control and complications trail. Ann Intern Med 1998; 128: 517-523.
  • Trialnet. Available at: www.diabetestrialnet.org, Accessed on February 3, 2006.
  • Vaarala O, Knip M, Paronen J, Hämäläinen A, Muona P, Väätäinen M, et al. Cow’s milk formula feeding induces primary immunization to insulin in infants at genetic risk for type 1 diabetes. Diabetes 1999; 48: 1389-1394.
  • Waston JC, Hadler SC, Dykewicz CA, Reef S, Phillips L. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Reccom Rep 1998; 47: 1-57.
  • Weitzman M, Cook S, Auinger P, Florin TA, Daniels S, Nguyen M, et al. Tobacco smoke exposure is associated with the metabolic syndrome in adolescents. Circulation 2005; 112; 862-869.
ad