P3. p 135 - 158
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In terms of diabetes in the USA: 1) What is the overall prevalence of diabetes & prediabetes (2015) ? 2) What ethnic groups have an increased/decreased risk 3) In children born after 2000, approx what proportion will develop NIDDM 4) What are the medical costs compared to those without diabetes ? BR 146
1) Diabetes prevalence 9.3%, prediabetes ~ 33% (84 million) => 10% & 30% 2) Increased in American Indian (15%), blacks (12.7%), Hispanics (12.1%). Less in Asian (8%), whites (7.4%). 3) Born after 2000 risk of diabetes is 33% in males, 39% in females and 50% in Blacks/Hispanics => 30% males, 40% females, 50% black/Hispanic 4) Medical costs are 2.3 X higher (vs non-diabetics) and average $ 16,750/yr of which $ 9,600 is attributed to diabetes.
In terms of global rates of NIDDM 1) What were the global rates in 1980 and 2014 ? 2) What is the anticipated global increase by 2025 ? 3) In India, how many people have diabetes and what are the cost implications ? BR 147
1) Global rate went from ~ 5% to 8.5% from 1980 to 2014 2) By 2025 anticipated global increase is 55% 3) In India currently, 100 million have diabetes; when present the cost of care consumes about 25% of the family’s income.
In the ACCORD trial Describe the: Aim, population, intervention, outcomes List 3 outcomes/complications of study NEJM 2008:358(24):254
Aim: whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factor Population: 10,251 pts with median HbA1c of 8.1% Interventions: Intensive Rx to get HbA1c below 6.0% vs standard therapy with target HbA1c of 7.0-7.9% Primary outcome: Composite vascular: of nonfatal MI, nonfatal CVA or death from CV causes Results: 1) At 1 yr median HbA1c acheived was 6.4% vs 7.1% 2) At 3.5 yrs HR of primary outcome was 0.90 (P=NS) however mortality HR was 1.22 (P=0.04) => primary -10%, mortality + 20% 3) Hypoglycemia requiring assistance and weight gain of > 10 kg were more common in the intensive therapy group. ACCORD: Action to COntrol CV Risk in Diabetes
What is meant by ‘reversal of type 2 diabetes’ ? BR 148
Reversal of NIDDM: 1) Normalization of blood sugar and HbA1c 2) Discontinuation of all diabetes medications (oral & injectable).
What is the role of leptin in NIDDM ? BR 149
• leptin is produced by adipocytes • Leptin resistance results in the inability to detect satiety signals which further drives the sensation of hunger => consume more calories. • Leptin is also pro-angiogenic meaning it triggers new blood vessel growth which can increase the risk of cancer cell growth and metastases.
What is the possible role of heme iron in NIDDM BR 150
• Heme iron & diets high in red and processed meat are associated with an increased risk of NIDDM & insulin resistance. • Heme iron stores are pro-oxidants.
What is the role of beta cells and associated factors in NIDDM ? List factors which can contribute to beta cell death BR 150
• beta cells in the pancreas produce insulin. • beta cell death can be due to: 1) Hyperlipidemia - VLDL & LDL are pro-apoptotic 2) Hyperglycemia 3) Cytokines: NF kappa B, JNK pathways 4) Leptin => stimulates cytokine pathways => apoptosis 5) Oxidative stress and free fatty acids (via NF kappa B & JNK pathways).
Name 5 ways in which a Whole Food Plant-based diet protects beta cells. BR 158
S - Stabilises immune System via multiple pathways H - Hyperglycemia avoided - protects against apoptosis I - Inflammatory pathways downregulated L - Lipid profile normalised L - Leptin/adiponectin pathway normalised Mnemonic - ‘SHILL’.