Diabetes Mellitus, causes and cure: an overview Simona Tuluc Diabetes Specialist Nurse June 2018
Objectives • What is Diabetes Mellitus (DM)? • Prevalence • Risk factors, symptoms • Classification, Types of diabetes and Causes • Is there a cure? • What support is available for patients? • Closing: Thank you & Open for questions
What is Diabetes Mellitus? Diabetes UK defines Diabetes Mellitus (DM) ‘’as a serious, lifelong condition where the blood glucose levels is too high resulting in chronic vascular complications’’ (Diabetes UK, 2018). Diabetes Mellitus is a group of metabolic diseases characterized by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action or both. It is associated with long-term irreversible damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels (American Diabetes Association, 2018)
Diabetes Mellitus explained https://www.youtube.com/watch?v=X9ivR4y03DE
Global estimates for 2015-2040 Recent estimates suggest that the number of people with diabetes across the world will increase from 415million in 2015 to 642million by 2040. The global cost of diabetes is set to almost double to $2.5 trillion by 2030 finds research from King’s College London (March, 2018). It suggests that even if countries meet internationally set management targets, the global economic burden from the disease will still increase by 88%. This is calculated by looking at costs from medical care and costs incurred through loss of productivity and earnings in 180 countries across the world.
Diabetes Watch on-line tool NHS West Essex CCG ( 2015-16) Population of 242,088 Percentage of people >17 diagnosed with diabetes 6% of the registered population : 14,610 The total number of people with diabetes in WECCG to rise to 27,301 by 2035 A further 27,769 are at risk of developing Type 2 Diabetes in WECCG according to statistics from PHE (2015), NHS DPP(non-diabetic hyperglycaemia)
Risk factors Age Ethnicity Family history and Genetics Environmental Infections Lifestyle and acquired behaviours : smoking, harmful chronic alcohol consumption, Western diet, chronic excess of refined sugars, high sat fat and high calorie intake coupled with a sedentary lifestyle leads to obesity and insulin resistance Psychological or physical trauma (i.e.car accidents)
Higher risks Following a heart attack or a stroke In patients with schizophrenia, bipolar illness or depression, or patients receiving treatment with antipsychotic medication In patients with chronic respiratory diseases receiving steroids In inherited familial hypercholesterolemia In women with polycystic ovaries syndrome (PCOS), gestational diabetes, or having a baby weighing over 10 pounds.
Symptoms The common symptoms of diabetes Frequent urination, especially at night (Polyuria). Excessive thirst (Polydipsia) Polyphagia Increased Tiredness Unintentional weight loss Genital itching or thrush ( Chronic Candidiasis). Slow wound healing Blurred vision.
WHO Diagnostic criteria • Diabetes symptoms and: • a random venous plasma glucose concentration (RPG) ≥ 11.1 mmol/l or • a fasting plasma glucose concentration(FPG) ≥ 7.0 mmol/l or (whole blood ≥ 6.1 mmol/l) or • two hour plasma glucose concentration ≥ 11.1 mmol/l two hours after ingestion of 75g anhydrous glucose in an oral glucose tolerance test (OGTT).
Haemoglobin A1c (HbA1c) Haemoglobin A1c (HbA1c) testing to diagnose diabetes since 2011 An HbA1c of 48mmol/mol (6.5%) is recommended as the cut off point for diagnosing diabetes. A value of less than 48mmol/mol (6.5%) does not exclude diabetes (high risk) and repeat test after 6 months
Impaired Glucose Regulation (IGR) IGR- risk factor for future diabetes and adverse outcomes Above euglycaemia but not high enough to diagnose Type 2 Diabetes Impaired Fasting Glucose (IFG) 6.1-6.9mmol/L Impaired Glucose Tolerance (IGT) defined as IFG<7.0 and 2hr-PG (after 75g Glucose load) 7.8-11.0mmol/L
Classification of DM & causes Type 2 Diabetes Mellitus~ 90% Slow progressive decrease in insulin secretion associated with insulin resistance Overweight/obese Treated initially with diet, physical activity, then OHA’s and other insulin or non-insulin injectable medication Type 1 Diabetes Mellitus~ 10% • Immune-mediated destruction of pancreatic beta-cells • Prevalent throughout life • Requires insulin replacement therapy for life • Short onset of 1-2 weeks, accelerated weight loss • DKA at presentation
Type 1 DM: genetics Auto-immune destruction of beta-cells Genetic predisposition ( HLA-DQA1, DQB1, DRB1variants) related to environmental factors poorly defined The HLA (human leukocyte antigen) complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders, such as viruses and bacteria. Auto-immune disorders • Grave’s disease • Hashimoto’s thyroiditis • Addison’s disease • Vitiligo • Celiac disease • auto-immune hepatitis • Myasthenia Gravis • Pernicious anaemia
T2DM: genetics Gene associated with T2 TCF7L2, which affects insulin secretion and glucose production ABCC8, which helps regulate insulin CAPN10, which is associated with type 2 diabetes risk in Mexican-Americans GLUT2, which helps move glucose into the pancreas GCGR, a glucagon hormone involved in glucose regulation Gene mutations • These include genes that control: • production of glucose • production and regulation of insulin • how glucose levels are sensed in the body
Classification of DM and causes Gestational Diabetes (GDM) Other types : LADA, Ketone prone Diabetes (Flatbush) Genetic defects of the beta-cells: maturity-onset diabetes of the young (MODY) characterized by impaired insulin secretion with minimal or no defects in insulin action. Abnormalities on different chromosomes have been identified. Genetic defects in insulin action associated with mutations of the insulin receptors (hyperinsulinemia and hyperglycaemia) Diseases of the exocrine pancreas (pancreatitis, trauma, infection, pancreatectomy, pancreatic CA). Endocrinopathies Drug- or chemical-induced diabetes Uncommon forms of immune-mediated diabetes (The Stiff-Man Sdr) Other genetic syndromes (chromosomal abnormalities of Down’s, Turner’s, Klinefelter’s Syndroms, autosomal recessive disorder -Wolfram's Sdr, insulin-deficient diabetes) sometimes associated with diabetes
Is there a cure for DM? Type 2 DM: Understanding genetic mechanisms & diabetes pathobiology VLCD: DiReCT study route to T2DM remission Type 1 DM: • Artificial pancreas: CGM, Computer controlled algorithm, Insulin pump, patient effect • Vaccine
Daniel Darkes, from Daventry, was diagnosed with Type 1DM in 2010, but recent test results showed his blood sugar levels were below average, suggesting his pancreas may have started working. Speaking to The Daventry Express the 30-year-old said: “The doctors aren’t sure really, it could be because I do a lot of running. They reckon a lot of vitamin C and D can also cause cells to be reproduced in the organs. I’ll get a better picture once I’m over in America.”
Support from Diabetes UK Education and Information: Diabetes UK produces a range of free booklets and resources for patients with diabetes Guides and leaflets Online learning tools Health checks & management information Support for patients covers: Staying informed Patient rights Events Emotional support (confidential line support)
PAH Diabetes services Consultant and nurse led clinics Consultant and nurse led telephone clinics Consultant and nurse inpatient led ward rounds Consultant and specialist midwives GDM clinics and telephone clinic Diabetes/Vascular MDT for ‘the diabetic foot’ Specialist diabetes dietician clinics Joint Renal/Diabetes consultant led clinics MD adult and paediatrician for the adolescent transition clinics Associate psychologists support for inpatient and outpatient services Links with EPUT Diabetes Community Services for patient structured education referrals
Thank you Any Q?
Web-links: https://www.diabetes.org.uk/preventing-type-2-diabetes/diabetes-risk-factors [Accessed 01/06/2018] http://diabetes.diabetesjournals.org/content/54/6/1615 https://www.nhs.uk/conditions/nhs-health-check/ [Accessed 01/06/2018] https://www.diabetes.org.uk/professionals/information-support-for-your-patients[Accessed 01/06/2018] Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030(Diabetes Care 2018 Feb) available at: https://doi.org/10.2337/dc17-1962 https://www.diabetes.org.uk/Professionals/Position-statements-reports/Statistics?_ga=2.94237725.1652234643.1527871710-2026116254.1518562680 https://www.diabetes.org.uk/professionals/position-statements-reports/statistics/diabetes-prevalence-2017 https://www.diabetes.org.uk/professionals/diabetes-risk-score-assessment-tool https://www.healthline.com/health/type-2-diabetes/genetics#prevention https://ghr.nlm.nih.gov/condition/type-1-diabetes#definition http://diabetestimes.co.uk/type-1-man-no-longer-requires-insulin/ Int J Environ Res Public Health. 2018 Jan; 15(1): 78. Published online 2018 Jan 5. doi:10.3390/ijerph15010078 https://www.diabetes.org.uk/research/our-research-projects/scotland/the-direct-route-to-type-2-remission