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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

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prevention techniques for diabetes mellitus type 1 and 2

Prevention Techniques for Diabetes Mellitus: Type 1 and 2

Stephanie Pike

Course: PAS 646


Dennis Karounos, M.D.

types of diabetes
Types of Diabetes:
    • 5-10% cases
    • Autoimmune disease
    • Requires insulin
    • Spontaneous?
    • Genetic predisposition
    • 90-95% cases
    • Insulin resistance and beta cell dysfunction
    • Genetic predisposition- Strong
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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • NIH Trialnet
    • Multi-center, international
      • Natural history studies
      • Diabetes prevention studies
      • Diabetes intervention studies
    • Actively recruiting
      • New onset diabetes
      • First degree relatives
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
  • 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
clinical application conclusion15
  • 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
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more references
More References…
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more references18
More References…
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  • 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.
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