This document provides information about an upcoming event celebrating World Diabetes Day hosted by the Egyptian Society of Metabolic Syndrome. It includes contact information for Dr. Usama Ragab, who is a speaker at the event. The event will take place on November 16, 2023 at the Sharkia Medical Syndicate. The document also contains slides on topics related to diabetes classification, diagnosis, and epidemiology.
Diabetes Mellitus type 1 major comorbidity now days.
Insulin injection being the major treatment Diabetes Mellitus.
Some other drugs used to treat the Diabetes Mellitus are Tablet Metformin 500 mg and other hypoglycemic drugs.
Diabetes Mellitus and Hypertension how they are interlinked.
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.
With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.
Diabetic Peripheral Neuropathy and Vitamin B12 IssueUsama Ragab
Diabetic Peripheral Neuropathy and Vitamin B12 Issue
By Dr. Usama Ragab Youssif
Diabetic neuropathies are the most prevalent chronic complications of diabetes
Central and Peripheral Precocious PubertyUsama Ragab
Precocious Puberty
By Dr. Usama Ragab Youssif
Precocious puberty (PP) is defined as the development of pubertal changes (2ry sexual characters), at an age younger than the accepted lower limits for age of onset of puberty.
Diabetes Mellitus type 1 major comorbidity now days.
Insulin injection being the major treatment Diabetes Mellitus.
Some other drugs used to treat the Diabetes Mellitus are Tablet Metformin 500 mg and other hypoglycemic drugs.
Diabetes Mellitus and Hypertension how they are interlinked.
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.
With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease.
Similar to Classification & Diagnosis of Diabetes (20)
Diabetic Peripheral Neuropathy and Vitamin B12 IssueUsama Ragab
Diabetic Peripheral Neuropathy and Vitamin B12 Issue
By Dr. Usama Ragab Youssif
Diabetic neuropathies are the most prevalent chronic complications of diabetes
Central and Peripheral Precocious PubertyUsama Ragab
Precocious Puberty
By Dr. Usama Ragab Youssif
Precocious puberty (PP) is defined as the development of pubertal changes (2ry sexual characters), at an age younger than the accepted lower limits for age of onset of puberty.
Algorithms for Diabetes Management for StudentsUsama Ragab
Algorithms for Diabetes Management for Students
By Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Type 2 Diabetes 101
Incretin based therapy
Algorithms of management
Email: usamaragab@medicine.zu.edu.eg, usama.ragab.zu@gmail.com
SlideShare: https://www.slideshare.net/dr4spring/
Facebook: https://www.facebook.com/doc.usama
Facebook Clinic: https://www.facebook.com/usamaclinic
Mobile: 00201000035863
Renal System - History Taking
By Dr. Usama Ragab Youssif
Lecturer of Medicine, Zagazig University
Email: usamaragab@medicine.zu.edu.eg, usama.ragab.zu@gmail.com
SlideShare: https://www.slideshare.net/dr4spring/
Facebook: https://www.facebook.com/doc.usama
Facebook Clinic: https://www.facebook.com/usamaclinic
Mobile: 00201000035863
Clinical Endocrinology Round
By Dr. Usama Ragab Youssif
Lecturer of Medicine
Zagazig University
Acromegaly
Cushing
Diabetes
Thyroid
Addison
Techniques and clinical insights
Functional Bowel Disorders
By Dr. Usama Ragab
Esophageal Disorders
Gastroduodenal Disorders
Bowel disorders
Centrally Mediated Disorders of GI Pain
Gallbladder and Sphincter of Oddi Disorders
Anorectal disorders
Childhood Functional GI Disorders: Neonate/Toddler
Childhood Functional GI Disorders: Child/Adolescent
Heat, Cold and High Altitude Related illnessUsama Ragab
Heat, Cold and High Altitude Related illness
By Dr Usama Ragab
Lecturer of Medicine
Topics are heat and cold related illness and high altitude medical disorders
Imeglimin, What is new?
By Dr. Usama Ragab Youssif
Lecturer of Medicine - Zagazig University
Agenda
Mitochondrial function and dysfunction
Mitochondrial (dys)function in diabetes
Diabetes core defects and Imeglimin
Imeglimin drug development and approval
Imeglimin and Heart
Diabetes and Gut interplay
By Dr. Usama Ragab Youssif
In Gastro Canal Association Annual Conference
Agenda
Diabetes as the main player
Gut as the main player
Diabetes and gut in a separate game
Gut as game changer
Tips and tricks: diabetes drugs
Guidelines in Obesity management
By Dr. Usama Ragab Youssif
Obesity-related counseling should be offered to those with BMI ≥25 kg/m2
A 3% to 5% weight loss can result in meaningful reductions in triglycerides, blood glucose, hemoglobin A1c, and the risk of developing type 2 diabetes
Set an initial weight loss goal of 5% to 10% of current body weight over 6 mo
After 6 mo, focus on weight maintenance before attempting further weight loss
Participating in a weight loss program long-term can help improve weight maintenance
Intensification Options after basal Insulin RevisitedUsama Ragab
Intensification Options revisited
By Dr. Usama Ragab Youssif
Add an OAD
Add a short-acting insulin at mealtime
Switch to premixed insulins
Novel insulin combinations
Basal insulin/GLP-1 RA combinations
Insulin Lispro Revisited
By Dr. Usama Ragab Youssif
The discovery of insulin was one of the most dramatic and important milestones in medicine - a Nobel Prize-winning moment in science.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
3. Represents 2 million people.
Diabetes is mostly (85–95%) T2D.1
• T2D approximately doubles the risk
of death2
• Diabetes caused 6.7 million deaths
in 20211
• CVD is the principal cause of death
in T2D2,3
1.76
1.85
1 1.5 2.0
T2D is increasingly prevalent and CVD is the leading
cause of death in this population
3
1. IDF Diabetes Atlas, 2021. 10th Edition. http://www.idf.org/diabetesatlas.
2. Nwaneri et al. Br J Diabetes Vasc Dis 2013;13:192–207. 3. Morrish et al. Diabetologia 2001;44(suppl 2):S14–21.
• Globally, 537 million people are living
with diabetes1
• Rising to 783 million by 20451
Relative risk for
all-cause mortality
Relative risk for
CV mortality
5. 5 | IDF Diabetes Atlas 2021– 10th edition www.idf.org @IntDiabetesFed
Top 10 countries with diabetes
In adults aged 20–79 years and diabetes-related health expenditure, 2021
6. Top 10 countries or territories for number of adults (20–79 years)
with diabetes in 2021 and 2045
7. Definition
Diabetes is a chronic, metabolic disease characterized by elevated
levels of blood glucose
Affects also fat and protein metabolism
Which leads over time to serious damage to the heart, blood
vessels, eyes, kidneys and nerves.
10. Diabetes can be classified into the
following general categories
1. Type 1 diabetes
2. Type 2 diabetes
3. Specific types of diabetes due to other causes
4. Gestational diabetes mellitus (diabetes diagnosed in the second
or third trimester of pregnancy that was not clearly overt
diabetes prior to gestation)
Classification and Diagnosis of Diabetes: Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
12. Type 1 DM
•Immune mediated
•Idiopathic
•Includes LADA
Pancreatic beta
cell destruction,
usually leading
to absolute
insulin
deficiency
13. | 13
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Classification and Diagnosis of Diabetes: Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
14. | 14
Type 1 Diabetes
CLASSIFICATION AND DIAGNOSIS OF DIABETES
2.5 Screening for presymptomatic T1D using screening tests that
detect autoantibodies to insulin, glutamic acid decarboxylase
(GAD), islet antigen 2, or zinc transporter 8 is currently
recommended in the setting of a research study or can be
considered an option for first-degree family members of a proband
with type 1 diabetes. B
2.6 Development of and persistence of multiple islet
autoantibodies is a risk factor for clinical diabetes and may serve as
an indication for intervention in the setting of a clinical trial or
screening for stage 2 type 1 diabetes. B
Classification and Diagnosis of Diabetes: Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
15. Type 2 DM
Due to a non-autoimmune progressive loss of
adequate ß-cell insulin secretion frequently on
the background of insulin resistance and
metabolic syndrome
May range from
• predominantly insulin resistance with relative insulin
deficiency to
• predominantly insulin secretory defect with insulin
resistance
16. Sometimes diabetes cannot
fit onto certain category
T1D before 6 months of age
Young obese child
Young NON obese, NON catabolic,
MILD, with family history
Diabetes developing after
intervention
17. Specific types of Diabetes
1. Genetic defects of beta -cell function= monogenic diabetes
syndromes (such as neonatal diabetes and maturity-onset diabetes of
the young)
2. Genetic defects in insulin action e.g., insulin dystrophy
3. Diseases of the exocrine pancreas (such as cystic fibrosis and
pancreatitis)
4. Drug- or chemical-induced diabetes (such as with glucocorticoid use,
in the treatment of HIV/AIDS, or after organ transplantation)
5. Endocrinopathies e.g., Cushing syndrome…
6. Genetic syndromes associated with diabetes e.g., Down syndrome
18. Monogenic
diabetes
• Certain genetic defect
• Mostly AD
• Defect leads to abnormal beta
cell function
• Different types
• Includes neonatal diabetes and
MODY
19. The diagnosis of
monogenic
diabetes should
be considered in
children and
adults
diagnosed with
diabetes in early
adulthood with
the following
Diabetes diagnosed within the first 6 months of life
(with occasional cases presenting later, mostly INS and
ABCC8 mutations)
Diabetes without typical features of type 1 or type 2
diabetes (negative diabetes-associated autoantibodies,
no obesity, lacking other metabolic features, especially
with strong family history of diabetes)
Stable, mild fasting hyperglycemia (100–150 mg/dL
[5.5–8.5 mmol/L]), stable A1C between 5.6% and 7.6%
(between 38 and 60 mmol/mol), especially if no obesity
20.
21.
22. PERSONAL USE ONLY
*Neonatal diabetes is a form of diabetes with onset <6 months of age, requires genetic testing, and may be amenable
to therapy with oral sulfonylurea in place of insulin therapy
Clinical
features
Type 1 diabetes Type 2 diabetes Monogenic diabetes
Age of onset
(yrs)
Most <25 by can occur at any age (but
not before the age of 6 months)
Usually >24 but incidence increasing in
adolescents, paralleling increasing rate of
obesity in children & adolescents
Usually <25
Neonatal diabetes <6 months*
Weight Usually thin, but with obesity epidemic,
can have overweight or obesity
>90% at least overweight Similar to general population
Islet auto-
antibodies
Usually present Absent Absent
C-peptide Undetectable/low Normal/high Normal
Insulin
production
Absent Present Usually present
First line
treatment
Insulin Non-insulin antihyperglycemic agents,
gradual dependence on insulin may occur
Depends on subtype of MODY
Family history
of diabetes
Infrequent (5-10%) Frequent (75-90%) Multigenerational, autosomal
pattern of inheritance
DKA Common Rare Rare (except for neonatal
diabetes*)
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic
Syndrome 2018
23. Pancreatic diabetes
• Commonly misdiagnosed as T2D
• Has been called “type 3c diabetes” or pancreoprivic diabetes
• Easily use pancreatic diabetes as umbrella term
• Due to loss of structural and functional insulin secretion in context of
exocrine pancreatic dysfunction
• It includes:
Pancreatitis (acute and chronic),
trauma or pancreatectomy,
neoplasia,
fibrocalculous pancreatopathy
idiopathic forms
24. Post
Pancreatitis
Diabetes
Mellitus
(PPDM)
Even single but may lead to PPDM
Both acute and chronic pancreatitis can
lead to PPDM
Risk is highest with recurrent bouts.
PPDM versus T1DM: pancreatic exocrine
insufficiency
Risk of microvascular complication is the
same
25. Cystic
fibrosis–
related
diabetes
(CFRD)
CFRD is the most common comorbidity in
people with cystic fibrosis
CFRD occur in about 20% of adolescents
and 40–50% of adults.
Worse nutritional status, more severe
inflammatory lung disease, and greater
mortality.
Insulin insufficiency is the primary defect in
CFRD.
Moran A, et al. Pediatr Diabetes 2018;19(Suppl. 27):64–74
28. Diabetes in Pregnancy: 2 Categories
Pregestational diabetes Gestational diabetes
Pregnancy in
pre-existing diabetes
• Type 1 diabetes
• Type 2 diabetes
Diabetes diagnosed in
pregnancy
2018 Diabetes Canada CPG – Chapter 36. Diabetes and Pregnancy
29. PERSONAL USE ONLY
Universal screening for GDM
@ 24-28 weeks gestational age
Screen earlier if risk factors for GDM
2018 Diabetes Canada CPG – Chapter 36. Diabetes and Pregnancy
Gestational Diabetes (GDM)
Screening
30. Screening of
GDM
The “one-step” 75-g OGTT derived from the
IADPSG criteria, or
The older “two-step” approach with a 50-g
(non-fasting) screen followed by a 100-g OGTT
for those who screen positive based on the
work of Carpenter-Coustan’s interpretation of
the older O’Sullivan and Mahan criteria.
33. Because the old definition is sometimes having limitations
BG threshold should be in mind
rather than timing
Risk for DM or prediabetes
should always be in mind
37. | 37
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
38. PERSONAL USE ONLY
Confirmatory test NOT required
• In the case of symptomatic hyperglycemia, the diagnosis has been made
and a confirmatory test is not required before treatment is initiated.
• To avoid rapid metabolic deterioration in individuals in whom type 1
diabetes is likely (younger or lean or symptomatic hyperglycemia,
especially with ketonuria or ketonemia), the initiation of treatment should not
be delayed in order to complete confirmatory testing
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
2hPG, 2-hour plasma glucose; AlC, glycated hemoglobin; FPG, fasting plasma glucose; OGTT, oral glucose
tolerance test; PG, plasma glucose.
39. PERSONAL USE ONLY
Considerations when using A1C for
Diagnosis
• Need validated standardized assay
• Repeat confirmatory test on another day
• Recognize conditions leading to misleading A1C
• A1C is not used for diagnosis in children, adolescents (as the sole
diagnostic test), pregnant women as part of routine screening for GDM,
those with cystic fibrosis (CFRD) or those with suspected T1DM
• Ethnicity and age can affect A1C results
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
40. Pitfalls of
A1c
• Decrease RBCs turnover e.g., anemia, asplenia
• Laboratory interference e.g., hypertriglyceridemia,
hyperbilirubinemia, ETOH
• Blood transfusion
False Elevation of HbA1c
• Increase RBCs turnover e.g., acute blood loss,
hemolysis, splenomegaly
• CKD
• EPO and iron treatment
• Inhibition of glycosylation e.g. vitamin C and E
• Dilutional effect
False Reduction of HbA1c
Radin MS. Pitfalls in hemoglobin A1c measurement: when results may be misleading. J Gen Intern Med. 2014 Feb;29(2):388-94.
41. PERSONAL USE ONLY
Pros and Cons of Diagnostic Tests
Test Advantages Disadvantages
FPG Established standard
Fast and easy
Single Sample
Sample not stable
Day-to-day variability
Inconvenient to fast
Glucose homeostasis in single time point
2hPG in 75
g OGTT
Established standard Sample not stable
Day-to-day variability
Inconvenient, Unpalatable
Cost
A1C Convenient
Single sample
Low day-to-day variability
Reflects long term glucose
$$$
Affected by medical conditions, aging, ethnicity
Standardized, validated assay required
Not applicable to every patient type
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
42. PERSONAL USE ONLY
Dealing with discordance in results
Many people identified as having diabetes
using A1C will not be identified as having
diabetes by traditional glucose criteria,
and vice versa.
When results of more than one test are available (FPG, A1C, 2hPG in a 75-g
OGTT) and the results are discordant, the test whose result is above diagnostic
cut-point should be repeated, and the diagnosis made on basis of the repeat test.
FPG 2hPG
A1C
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
A1C, glycated hemoglobin; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; PG,
plasma glucose
43. Health Day A1c
• 2.1b Point-of-care A1C testing for
diabetes screening and diagnosis should
be restricted to U.S. Food and Drug
Administration–approved devices at
laboratories proficient in performing
testing of moderate complexity or higher
by trained personnel. B
44. Years from
diagnosis
0 5
-10 -5 10 15
Onset Diagnosis
Insulin secretion
Sources:
Ramlo-Halsted BA et al. Prim Care. 1999;26:771-789
Nathan DM et al. NEJM 2002;347:1342-1349
Fasting glucose
Insulin resistance
Microvascular complications
Macrovascular complications
Type II diabetes
Pre-diabetes
Postprandial
glucose
Natural History of Type II Diabetes Mellitus
46. | 46
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
47. | 47
Criteria for
screening for
diabetes or
prediabetes in
asymptomatic
adults
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
48. | 48
Prediabetes and Type 2 Diabetes
CLASSIFICATION AND DIAGNOSIS OF DIABETES
2.10 If tests are normal, repeat screening recommended at a
minimum of 3-year intervals is reasonable, sooner with symptoms or
change in risk (i.e., weight gain). C
2.11 To screen for prediabetes and type 2 diabetes, fasting plasma
glucose, 2-h plasma glucose during 75-g oral glucose tolerance test,
and A1C are each appropriate. B
2.12 When using oral glucose tolerance testing as a screen for
diabetes, adequate carbohydrate intake (at least 150 g/day) should
be assured for 3 days prior to testing. A
49. | 49
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
The vast majority of diabetic patients are classified into one of two broad categories: type 1 diabetes mellitus, which is caused by an absolute or near absolute deficiency of insulin, or type 2 diabetes mellitus, which is characterized by the presence of insulin resistance with an inadequate compensatory increase in insulin secretion.
Completely different
They meet only in hyperglycemia
Due to autoimmune ß-cell destruction, usually leading to absolute insulin deficiency, including latent autoimmune diabetes of adulthood
Pancreatic diabetes includes both structural and functional loss of glucosenormalizing insulin secretion in the context of exocrine pancreatic dysfunction and is commonly misdiagnosed as type 2 diabetes.
Hyperglycemia due to general pancreatic dysfunction has been called “type 3c diabetes,” and, more recently, diabetes in the context of disease of the exocrine pancreas has been termed pancreoprivic diabetes (1).
The diverse set of etiologies includes pancreatitis (acute and chronic), trauma or pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy, rare genetic disorders (193), and idiopathic forms (1); as such, pancreatic diabetes is the preferred umbrella terminology.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37(Suppl. 1):S81–S90
There is loss of both insulin and glucagon secretion and often higher-than-expected insulin requirements.
Risk for microvascular complications appears to be similar to that of other forms of diabetes.
In the context of pancreatectomy, islet autotransplantation can be done to retain insulin secretion (200,201).
In some cases, autotransplant can lead to insulin independence. In others, it may decrease insulin requirements (202).
CFRD is the most common comorbidity in people with cystic fibrosis, occurring in about 20% of adolescents and 40–50% of adults.
Diabetes in this population, compared with individuals with type 1 or type 2 diabetes, is associated with worse nutritional status, more severe inflammatory lung disease, and greater mortality.
Insulin insufficiency is the primary defect in CFRD.
Cystic fibrosis is a genetic condition. It's caused by a faulty gene that affects the movement of salt and water in and out of cells. This, along with recurrent infections, can result in a build-up of thick, sticky mucus in the body's tubes and passageways – particularly the lungs and digestive system.
The primary rationale for the use of insulin in people with CFRD isto induce an anabolic state while promoting macronutrient retention and weight gain.
2 shorter lists
African-Americans, American-Indians, Hispanics, and Asians have A1C values that are up to 0.4% higher at similar glycemic levels
Script:
While all 3 approaches predict microvascular disease and can be used for diagnosis, A1c may be a better predictor of macrovascular disease. The decision of which test to use for diabetes diagnosis is left to clinical judgment. Each diagnostic test has advantages and disadvantages
TT: Slide compares the advantages and disadvantages of the different tests.
While there is overall in these three tests, there also may be discordant results whereby one test is diagnostic of diabetes while another does not agree. If this does occur, the tests whose result is above diagnostic cut-point should be repeated, and the diagnosis made on the basis of the repeat test.
Type II diabetes mellitus increases the risk of microvascular and macrovascular complications. Improved glycemic control can help to minimize these complications over time.