This document discusses diabetes mellitus (DM), including the main types of DM (type 1, type 2, gestational, monogenic), pathogenesis, clinical manifestations, complications, diagnosis, prediabetes, and metabolic syndrome. It defines the diagnostic criteria and thresholds for DM and prediabetes using fasting plasma glucose, oral glucose tolerance test, and A1C levels. Key recommendations are provided for diagnosing DM and prediabetes.
This document provides an overview of diabetes mellitus (DM), including its pathogenesis, signs and symptoms, diagnostic criteria, complications, and management. It discusses the two main types of DM (type 1 and type 2), their distinguishing characteristics, and the role of insulin in the body. The document outlines microvascular and macrovascular complications of long-term hyperglycemia, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. It also covers diabetic ketoacidosis, risk factors for type 2 DM, and the increased risk of coronary heart disease in diabetic patients.
This document discusses diabetes mellitus and its management. It provides information on:
1) The classification and prevalence of diabetes in Saudi Arabia, finding an overall prevalence of 23.7% with higher rates in males.
2) The diagnostic criteria and thresholds for diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests. Screening is recommended for those over 45 or with risk factors.
3) Treatment involves lifestyle modifications, metformin as first line therapy, and additional oral medications or insulin as needed to achieve glycemic targets. Managing associated cardiovascular risk factors is also emphasized.
Highlights of ADA guidelines 2015 in Diabetes managementAhmed Elmoughazy
This document summarizes guidelines from the American Diabetes Association for the management of diabetes in 2015. It covers classification of diabetes, criteria for testing and diagnosis, targets for glycemic control, recommendations for treatment including lifestyle changes and medications, and management of cardiovascular risk factors and kidney disease complications. The guidelines provide evidence-based standards to guide clinical decision making for diabetes care.
This document provides classifications, diagnostic criteria, screening recommendations, treatment targets, and management strategies for different types of diabetes and related complications. It discusses classifications of diabetes, criteria for diagnosing and staging pre-diabetes and diabetes, recommendations for vaccinations and medical evaluations. It also outlines lifestyle management approaches, guidelines for glycemic, blood pressure, and lipid control, and considerations for treating diabetes-related complications including diabetic kidney disease and retinopathy.
This document provides a summary of diabetes mellitus (DM), including its definition, presentation, classifications, complications, investigations, and management. DM results from lack of or diminished insulin effectiveness and is characterized by hyperglycemia. There are two main types: type 1 DM is insulin-dependent while type 2 DM is non-insulin dependent initially but may eventually require insulin. Complications can include infections, neuropathy, retinopathy, and vascular diseases. Management involves lifestyle changes like diet and exercise as well as medications and insulin to manage blood glucose levels and prevent complications.
Diabetes mellitus ; signs, symptoms and managementOseiTony
The document discusses the pathophysiology and treatment of diabetes mellitus, outlining the different types of diabetes, prevalence rates, diagnostic criteria, treatment goals, and classes of antidiabetic medications. Management involves both nonpharmacologic approaches like diet and exercise as well as pharmacologic therapies including insulin, metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors. The goal of treatment is to control blood glucose levels, lower HbA1c, prevent acute and chronic complications, and maintain
The document reviews criteria for diagnosing diabetes and pre-diabetes, treatment goals, and therapeutic options. It discusses classifying diabetes types 1 and 2, criteria for diagnosis including HbA1c, fasting plasma glucose and oral glucose tolerance tests. Goals for glycemic control include HbA1c less than 7% and fasting/post-prandial blood glucose targets. Treatment options include lifestyle changes, metformin, other oral medications, and insulin to lower blood glucose and achieve goals.
This document provides an overview of diabetes mellitus (DM), including its pathogenesis, signs and symptoms, diagnostic criteria, complications, and management. It discusses the two main types of DM (type 1 and type 2), their distinguishing characteristics, and the role of insulin in the body. The document outlines microvascular and macrovascular complications of long-term hyperglycemia, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. It also covers diabetic ketoacidosis, risk factors for type 2 DM, and the increased risk of coronary heart disease in diabetic patients.
This document discusses diabetes mellitus and its management. It provides information on:
1) The classification and prevalence of diabetes in Saudi Arabia, finding an overall prevalence of 23.7% with higher rates in males.
2) The diagnostic criteria and thresholds for diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests. Screening is recommended for those over 45 or with risk factors.
3) Treatment involves lifestyle modifications, metformin as first line therapy, and additional oral medications or insulin as needed to achieve glycemic targets. Managing associated cardiovascular risk factors is also emphasized.
Highlights of ADA guidelines 2015 in Diabetes managementAhmed Elmoughazy
This document summarizes guidelines from the American Diabetes Association for the management of diabetes in 2015. It covers classification of diabetes, criteria for testing and diagnosis, targets for glycemic control, recommendations for treatment including lifestyle changes and medications, and management of cardiovascular risk factors and kidney disease complications. The guidelines provide evidence-based standards to guide clinical decision making for diabetes care.
This document provides classifications, diagnostic criteria, screening recommendations, treatment targets, and management strategies for different types of diabetes and related complications. It discusses classifications of diabetes, criteria for diagnosing and staging pre-diabetes and diabetes, recommendations for vaccinations and medical evaluations. It also outlines lifestyle management approaches, guidelines for glycemic, blood pressure, and lipid control, and considerations for treating diabetes-related complications including diabetic kidney disease and retinopathy.
This document provides a summary of diabetes mellitus (DM), including its definition, presentation, classifications, complications, investigations, and management. DM results from lack of or diminished insulin effectiveness and is characterized by hyperglycemia. There are two main types: type 1 DM is insulin-dependent while type 2 DM is non-insulin dependent initially but may eventually require insulin. Complications can include infections, neuropathy, retinopathy, and vascular diseases. Management involves lifestyle changes like diet and exercise as well as medications and insulin to manage blood glucose levels and prevent complications.
Diabetes mellitus ; signs, symptoms and managementOseiTony
The document discusses the pathophysiology and treatment of diabetes mellitus, outlining the different types of diabetes, prevalence rates, diagnostic criteria, treatment goals, and classes of antidiabetic medications. Management involves both nonpharmacologic approaches like diet and exercise as well as pharmacologic therapies including insulin, metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and SGLT2 inhibitors. The goal of treatment is to control blood glucose levels, lower HbA1c, prevent acute and chronic complications, and maintain
The document reviews criteria for diagnosing diabetes and pre-diabetes, treatment goals, and therapeutic options. It discusses classifying diabetes types 1 and 2, criteria for diagnosis including HbA1c, fasting plasma glucose and oral glucose tolerance tests. Goals for glycemic control include HbA1c less than 7% and fasting/post-prandial blood glucose targets. Treatment options include lifestyle changes, metformin, other oral medications, and insulin to lower blood glucose and achieve goals.
The document presents a case study of a 51-year-old Filipino woman diagnosed with type 2 diabetes mellitus and hypertension. Her lab results and physical exam are provided. She is currently taking medications including Glimeperide, Metformin, Pioglitazone, and Nifedepine to manage her conditions. The document also provides general information on diabetes mellitus, including diagnostic criteria, treatment goals, glucose-lowering therapies and nutritional recommendations.
This document provides a review of diabetes mellitus including its pathophysiology, diagnostic criteria, treatment goals, pharmacological treatment options, and monitoring parameters for type 2 diabetes. It discusses the epidemiology of diabetes and reviews the signs and symptoms of hypoglycemia and hyperglycemia. Treatment options are reviewed including their efficacy, risk of hypoglycemia, effects on weight, adverse effects, and costs.
1. Early detection of diabetes is important through testing asymptomatic individuals who are overweight or have additional risk factors. The A1C, fasting plasma glucose, and oral glucose tolerance tests can detect both diabetes and prediabetes.
2. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells and accounts for 5-10% of diabetes cases. It is defined by the presence of autoimmune markers against islet cells and insulin.
3. Screening relatives of type 1 diabetes patients allows for early identification through detection of autoimmune risk markers in research studies.
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
The document discusses diabetes mellitus (DM), including its classification, epidemiology, pathophysiology, symptoms, screening, treatment goals, and management. DM is a group of metabolic disorders characterized by hyperglycemia and defects in insulin secretion and action. It is classified into type 1, type 2, gestational, and other specific types. Treatment aims to achieve glycemic control through lifestyle modifications like diet, exercise, and medication including insulin therapy for type 1 DM.
This document discusses standards of care for diabetes mellitus according to guidelines from 2015. It addresses the importance of type 2 diabetes as a serious disease that can lead to many complications affecting eyes, kidneys, heart, blood vessels, and nerves if not properly managed. The goals of diabetes management are to improve quality of life, reduce acute symptoms, achieve normal blood sugar levels safely, and prevent both acute and chronic complications. Key recommendations include individualizing treatment based on patient preferences and comorbidities, addressing cultural barriers to care, and focusing on evidence-based guidelines. The document also provides guidelines on screening, diagnosing, and managing diabetes, prediabetes, comorbid conditions like hypertension and dyslipidemia, and special populations like
Diabetes mellitus-treatment and psychiatric effectsMegha Isac
This document provides information on the diagnosis and management of diabetes mellitus. It defines the diagnostic criteria for diabetes as either a random blood glucose of 200 mg/dL or higher, a fasting plasma glucose of 126 mg/dL or higher, an A1C of 6.5% or higher, or a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also outlines treatment goals and management strategies, including lifestyle modifications, oral medications, and insulin therapies.
The document discusses new trends in the management of diabetes in cardiac patients. It provides guidelines on glycemic targets and pharmacological therapy for type 2 diabetes. The recommended first-line treatment is metformin. Glycated hemoglobin (A1C) of less than 7% is a reasonable goal for many adults with diabetes, though some may require less or more stringent targets depending on individual factors. Combination therapy with oral medications and insulin is often needed to control blood sugar levels in type 2 diabetes.
Pediatric Type 2 Diabetes Mellitus. BY DR SAYED ISMAILSayed Ahmed
diabetes mellitus type 2 in children
pathophysiology of type 2 DM
manifestations of DM
Complications , investigation and management of type2 DM in children
Definition : Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from impaired insulin secretion, insulin action [ insulin resistance ] or both .
The chronic hyperglycemia in DM is associated with long term damage dysfunction and failure of various organs
Is based on etiology not on type of treatment or age of the patient.
Type I(Beta cell destruction-absolute insulin deficiency)
Immune mediated Idiopathic
Type II
predominant insulin resistant with relative insulin deficiency
predominant secretory defect with insulin resistance
This document discusses the holistic approach to treatment of type 2 diabetes mellitus (T2DM). The objectives of T2DM treatment are to correct hyperglycemia, prevent acute complications, prevent chronic complications like retinopathy and nephropathy, and improve quality of life. Chronic complications are caused by microvascular and macrovascular damage. Intensive control of blood glucose, blood pressure, cholesterol and other risk factors can help prevent cardiovascular disease and mortality according to studies like STENO-2 and UKPDS. Treatment should be individualized based on factors like age, weight, comorbidities. Drugs like SGLT2 inhibitors and GLP-1 receptor agonists that provide cardiovascular protection are preferred. Metformin
Ueda2016 symposium - glimepiride journey in management of type 2 dm - megahe...ueda2015
This document discusses glimepiride and its use in managing type 2 diabetes mellitus (T2DM). It begins with background on the global prevalence of diabetes and challenges in achieving glycemic control. It then focuses on glimepiride, explaining that it has a higher binding affinity and faster dissociation from sulfonylurea receptors compared to other sulfonylureas. This allows glimepiride to stimulate both the first and second phase of insulin secretion, improving fasting and postprandial hyperglycemia. In conclusion, glimepiride is an effective oral sulfonylurea option for the treatment of T2DM.
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
1) The document discusses guidelines for initiating basal insulin therapy in patients with type 2 diabetes, including benefits such as lowering HbA1c and reducing cardiovascular risk.
2) It compares different basal insulin options like glargine, detemir, and NPH insulin, finding that the long-acting analogs glargine and detemir have advantages like lower rates of hypoglycemia and weight gain compared to NPH.
3) Studies show that early initiation of basal insulin can help preserve beta-cell function and provide better long-term glycemic control for patients with type 2 diabetes.
This document discusses the benefits of early initiation of basal insulin in managing type 2 diabetes. It recommends starting with low doses of long-acting basal insulin, which can help lower HbA1c and reduce complications by providing consistent insulin levels throughout the day. Basal insulin is preferred over premix insulins when first adding insulin. Clinical guidelines support initiating basal insulin when oral medications fail to control blood sugar levels. Studies show basal insulin improves beta-cell function and glycemic control long-term compared to late insulin initiation.
1. Diabetes mellitus results from inadequate insulin supply or inadequate tissue response to insulin, leading to hyperglycemia. There are three main types: type 1 is autoimmune and causes complete insulin deficiency; type 2 is more common and involves relative insulin deficiency and insulin resistance; type 1b is a rare form not caused by autoimmunity.
2. Symptoms of diabetes include fatigue, weight loss, polyuria, polydipsia, and blurry vision. Diagnosis involves blood glucose criteria and HbA1c levels. Treatment involves lifestyle changes, oral medications like metformin and sulfonylureas, and insulin for more severe cases.
3. Complications include diabetic ketoacidosis, characterized by
This document provides an overview of diabetes mellitus including definitions, classification, epidemiology, pathophysiology of type 1 and type 2 diabetes, and goals of treatment. Key points include:
- Type 1 diabetes results from autoimmune destruction of pancreatic beta cells in genetically predisposed individuals and requires lifelong insulin treatment.
- Type 2 diabetes involves both insulin resistance and impaired insulin secretion and is strongly associated with obesity and physical inactivity. It can often be managed through lifestyle modifications and oral medications.
- Medical nutrition therapy, physical activity, weight loss (if indicated), glucose monitoring, and pharmacologic therapy including insulin are important components of diabetes management and prevention of complications.
This document provides an overview of diabetes mellitus (DM), including its epidemiology, classification, etiology, clinical features, complications, oral manifestations, diagnostic criteria, investigations, management, and differences between type 1 and type 2 DM. DM is characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It is classified into type 1, type 2, gestational DM, and other types. Clinical features and complications are discussed, along with oral manifestations like periodontal disease and increased risk of infection. Diagnostic testing and treatment focus on glycemic control to prevent microvascular and macrovascular complications.
This document discusses immunization and the Uganda National Expanded Programme on Immunization (UNEPI). It defines key terms like immunity, vaccines, and immunization. It describes the innate and adaptive immune systems and how vaccines induce immunity. It outlines Uganda's vaccination schedule, which protects against diseases like polio, pertussis, measles, and more. It also notes common minor side effects of vaccines like fever and pain at the injection site. The overall goal of UNEPI is to ensure Ugandans are protected from vaccine-preventable diseases through both routine and supplemental immunization activities.
The document outlines key topics related to paediatric HIV including epidemiology, transmission, pathogenesis, clinical manifestations, diagnosis, and management. It discusses mother-to-child transmission, care for HIV-exposed infants, opportunistic infections, and use of antiretroviral therapy. The goal is to provide an overview of paediatric HIV and strategies to prevent transmission from mother to child and properly manage infected children.
The document presents a case study of a 51-year-old Filipino woman diagnosed with type 2 diabetes mellitus and hypertension. Her lab results and physical exam are provided. She is currently taking medications including Glimeperide, Metformin, Pioglitazone, and Nifedepine to manage her conditions. The document also provides general information on diabetes mellitus, including diagnostic criteria, treatment goals, glucose-lowering therapies and nutritional recommendations.
This document provides a review of diabetes mellitus including its pathophysiology, diagnostic criteria, treatment goals, pharmacological treatment options, and monitoring parameters for type 2 diabetes. It discusses the epidemiology of diabetes and reviews the signs and symptoms of hypoglycemia and hyperglycemia. Treatment options are reviewed including their efficacy, risk of hypoglycemia, effects on weight, adverse effects, and costs.
1. Early detection of diabetes is important through testing asymptomatic individuals who are overweight or have additional risk factors. The A1C, fasting plasma glucose, and oral glucose tolerance tests can detect both diabetes and prediabetes.
2. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells and accounts for 5-10% of diabetes cases. It is defined by the presence of autoimmune markers against islet cells and insulin.
3. Screening relatives of type 1 diabetes patients allows for early identification through detection of autoimmune risk markers in research studies.
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
The document discusses diabetes mellitus (DM), including its classification, epidemiology, pathophysiology, symptoms, screening, treatment goals, and management. DM is a group of metabolic disorders characterized by hyperglycemia and defects in insulin secretion and action. It is classified into type 1, type 2, gestational, and other specific types. Treatment aims to achieve glycemic control through lifestyle modifications like diet, exercise, and medication including insulin therapy for type 1 DM.
This document discusses standards of care for diabetes mellitus according to guidelines from 2015. It addresses the importance of type 2 diabetes as a serious disease that can lead to many complications affecting eyes, kidneys, heart, blood vessels, and nerves if not properly managed. The goals of diabetes management are to improve quality of life, reduce acute symptoms, achieve normal blood sugar levels safely, and prevent both acute and chronic complications. Key recommendations include individualizing treatment based on patient preferences and comorbidities, addressing cultural barriers to care, and focusing on evidence-based guidelines. The document also provides guidelines on screening, diagnosing, and managing diabetes, prediabetes, comorbid conditions like hypertension and dyslipidemia, and special populations like
Diabetes mellitus-treatment and psychiatric effectsMegha Isac
This document provides information on the diagnosis and management of diabetes mellitus. It defines the diagnostic criteria for diabetes as either a random blood glucose of 200 mg/dL or higher, a fasting plasma glucose of 126 mg/dL or higher, an A1C of 6.5% or higher, or a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. It also outlines treatment goals and management strategies, including lifestyle modifications, oral medications, and insulin therapies.
The document discusses new trends in the management of diabetes in cardiac patients. It provides guidelines on glycemic targets and pharmacological therapy for type 2 diabetes. The recommended first-line treatment is metformin. Glycated hemoglobin (A1C) of less than 7% is a reasonable goal for many adults with diabetes, though some may require less or more stringent targets depending on individual factors. Combination therapy with oral medications and insulin is often needed to control blood sugar levels in type 2 diabetes.
Pediatric Type 2 Diabetes Mellitus. BY DR SAYED ISMAILSayed Ahmed
diabetes mellitus type 2 in children
pathophysiology of type 2 DM
manifestations of DM
Complications , investigation and management of type2 DM in children
Definition : Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from impaired insulin secretion, insulin action [ insulin resistance ] or both .
The chronic hyperglycemia in DM is associated with long term damage dysfunction and failure of various organs
Is based on etiology not on type of treatment or age of the patient.
Type I(Beta cell destruction-absolute insulin deficiency)
Immune mediated Idiopathic
Type II
predominant insulin resistant with relative insulin deficiency
predominant secretory defect with insulin resistance
This document discusses the holistic approach to treatment of type 2 diabetes mellitus (T2DM). The objectives of T2DM treatment are to correct hyperglycemia, prevent acute complications, prevent chronic complications like retinopathy and nephropathy, and improve quality of life. Chronic complications are caused by microvascular and macrovascular damage. Intensive control of blood glucose, blood pressure, cholesterol and other risk factors can help prevent cardiovascular disease and mortality according to studies like STENO-2 and UKPDS. Treatment should be individualized based on factors like age, weight, comorbidities. Drugs like SGLT2 inhibitors and GLP-1 receptor agonists that provide cardiovascular protection are preferred. Metformin
Ueda2016 symposium - glimepiride journey in management of type 2 dm - megahe...ueda2015
This document discusses glimepiride and its use in managing type 2 diabetes mellitus (T2DM). It begins with background on the global prevalence of diabetes and challenges in achieving glycemic control. It then focuses on glimepiride, explaining that it has a higher binding affinity and faster dissociation from sulfonylurea receptors compared to other sulfonylureas. This allows glimepiride to stimulate both the first and second phase of insulin secretion, improving fasting and postprandial hyperglycemia. In conclusion, glimepiride is an effective oral sulfonylurea option for the treatment of T2DM.
Determination of Blood Glucose Using Glusose Oxidase-Peroxidase MethodZoldylck
This document discusses blood glucose determination using the oxidase-peroxidase method. It begins by introducing diabetes and its prevalence worldwide. It then describes the materials and methodology used, which involves collecting a blood sample, separating the plasma, and adding an O-toluidine reagent before measuring absorbance. The results showed the patient's glucose level was within the normal range. It further discusses hyperglycemia and hypoglycemia, the different types of diabetes, diagnostic criteria, and gestational diabetes.
This document provides an overview of diabetes mellitus (DM), including the different types of DM, pathophysiology, clinical presentation, diagnosis, treatment goals, and pharmacotherapy options. It discusses type 1 DM, type 2 DM, and gestational diabetes. For type 2 DM, it outlines non-pharmacologic treatment including lifestyle changes and describes pharmacologic options including metformin, sulfonylureas, and insulin therapy. The goals of treatment for type 2 DM are also summarized.
1) The document discusses guidelines for initiating basal insulin therapy in patients with type 2 diabetes, including benefits such as lowering HbA1c and reducing cardiovascular risk.
2) It compares different basal insulin options like glargine, detemir, and NPH insulin, finding that the long-acting analogs glargine and detemir have advantages like lower rates of hypoglycemia and weight gain compared to NPH.
3) Studies show that early initiation of basal insulin can help preserve beta-cell function and provide better long-term glycemic control for patients with type 2 diabetes.
This document discusses the benefits of early initiation of basal insulin in managing type 2 diabetes. It recommends starting with low doses of long-acting basal insulin, which can help lower HbA1c and reduce complications by providing consistent insulin levels throughout the day. Basal insulin is preferred over premix insulins when first adding insulin. Clinical guidelines support initiating basal insulin when oral medications fail to control blood sugar levels. Studies show basal insulin improves beta-cell function and glycemic control long-term compared to late insulin initiation.
1. Diabetes mellitus results from inadequate insulin supply or inadequate tissue response to insulin, leading to hyperglycemia. There are three main types: type 1 is autoimmune and causes complete insulin deficiency; type 2 is more common and involves relative insulin deficiency and insulin resistance; type 1b is a rare form not caused by autoimmunity.
2. Symptoms of diabetes include fatigue, weight loss, polyuria, polydipsia, and blurry vision. Diagnosis involves blood glucose criteria and HbA1c levels. Treatment involves lifestyle changes, oral medications like metformin and sulfonylureas, and insulin for more severe cases.
3. Complications include diabetic ketoacidosis, characterized by
This document provides an overview of diabetes mellitus including definitions, classification, epidemiology, pathophysiology of type 1 and type 2 diabetes, and goals of treatment. Key points include:
- Type 1 diabetes results from autoimmune destruction of pancreatic beta cells in genetically predisposed individuals and requires lifelong insulin treatment.
- Type 2 diabetes involves both insulin resistance and impaired insulin secretion and is strongly associated with obesity and physical inactivity. It can often be managed through lifestyle modifications and oral medications.
- Medical nutrition therapy, physical activity, weight loss (if indicated), glucose monitoring, and pharmacologic therapy including insulin are important components of diabetes management and prevention of complications.
This document provides an overview of diabetes mellitus (DM), including its epidemiology, classification, etiology, clinical features, complications, oral manifestations, diagnostic criteria, investigations, management, and differences between type 1 and type 2 DM. DM is characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It is classified into type 1, type 2, gestational DM, and other types. Clinical features and complications are discussed, along with oral manifestations like periodontal disease and increased risk of infection. Diagnostic testing and treatment focus on glycemic control to prevent microvascular and macrovascular complications.
This document discusses immunization and the Uganda National Expanded Programme on Immunization (UNEPI). It defines key terms like immunity, vaccines, and immunization. It describes the innate and adaptive immune systems and how vaccines induce immunity. It outlines Uganda's vaccination schedule, which protects against diseases like polio, pertussis, measles, and more. It also notes common minor side effects of vaccines like fever and pain at the injection site. The overall goal of UNEPI is to ensure Ugandans are protected from vaccine-preventable diseases through both routine and supplemental immunization activities.
The document outlines key topics related to paediatric HIV including epidemiology, transmission, pathogenesis, clinical manifestations, diagnosis, and management. It discusses mother-to-child transmission, care for HIV-exposed infants, opportunistic infections, and use of antiretroviral therapy. The goal is to provide an overview of paediatric HIV and strategies to prevent transmission from mother to child and properly manage infected children.
Nephrotic syndrome is a kidney disorder characterized by heavy proteinuria, low albumin levels, edema, and high cholesterol. The most common type in children is minimal change nephrotic syndrome, which is idiopathic and affects boys more than girls aged 2-6 years. Treatment involves high-dose steroids to induce remission, followed by lower alternate-day doses for maintenance. Complications include edema, dyslipidemia, and increased infection risk. With treatment, 80-90% of children experience remission of symptoms.
This document provides an overview of common vitamin deficiencies, including vitamins A, B complex, C, D, and E. It discusses the roles of each vitamin, sources of each vitamin, clinical features of deficiencies, diagnosis, and treatment. Some key points include:
- Vitamin A deficiency can cause vision problems and increase susceptibility to infections. It is highly prevalent in Uganda.
- Thiamine (B1) deficiency can cause beriberi with symptoms like edema, heart failure, and neurological issues.
- Pellagra results from niacin (B3) deficiency and presents as dermatitis, diarrhea, and dementia.
- Vitamin D deficiency in children causes rickets, resulting in bone
Urinary tract infections are common bacterial infections in children that can affect any part of the urinary tract. While the prognosis is generally good with early treatment, UTIs are associated with risks such as renal scarring and long-term complications if not properly treated. The presentation outlines the definition, epidemiology, etiology, clinical manifestations, diagnosis, and management of UTIs in children. Treatment involves antibiotics to eliminate the infection and relieve symptoms, with longer courses used to treat pyelonephritis in the kidneys compared to cystitis of the bladder alone.
This document provides an overview of meningitis, including its definition, causes, clinical presentation, diagnosis, treatment, and prevention. Meningitis is an inflammation of the meninges that surround the brain and spinal cord. It can be caused by bacteria, viruses, or other factors. Bacterial meningitis is the most serious form and can be life-threatening if not treated promptly with antibiotics. Common symptoms vary by age but may include fever, headache, nausea, stiff neck, and altered mental status. Diagnosis involves lumbar puncture and analysis of cerebrospinal fluid. Treatment aims to eliminate the infecting organism with antibiotics and reduce inflammation. Complications can include hearing loss, seizures, and developmental delays. Vaccination
Burns are an injury to the skin or tissues caused by heat, electricity, chemicals, or other energy transfers. They are a global public health problem, especially in low and middle income countries. Children and women are particularly vulnerable. Common causes of burns include hot liquids, flames, and chemicals. Burns are classified based on depth, severity, and etiology. Local and systemic responses to burns involve inflammation, increased metabolism, and organ dysfunction. Accurately estimating the total body surface area burned guides management, which focuses on resuscitation, infection control, nutrition, and wound healing. Complications can include shock, renal failure, and contractures if not properly treated.
An abscess is a collection of pus caused by a bacterial infection. It is characterized by inflammation, swelling, pain, and the presence of dead and live bacteria, white blood cells, and tissue debris. Abscesses are usually caused by Staphylococcus aureus infections and can occur anywhere in the body. They are diagnosed based on symptoms, physical exam, and imaging tests. Treatment involves antibiotics, analgesics, and sometimes surgical drainage of the pus. Complications can include sepsis, organ damage, and tissue destruction if not properly treated.
This document discusses shock and its classifications and pathophysiology. It defines shock as an imbalance between oxygen delivery and demand. There are four main classifications of shock: cardiogenic, hypovolemic, distributive, and obstructive. The pathophysiology involves a progression from compensated shock to end organ dysfunction as the body's compensatory mechanisms become insufficient to maintain adequate tissue perfusion and oxygen delivery. Treatment involves initial stabilization and assessment followed by definitive care, which may include fluid resuscitation, vasopressor therapy, treating the underlying cause, and monitoring for complications.
This document discusses the management of asthma exacerbations in children. It begins with a case scenario of a 3-year-old boy presenting with cough, difficulty breathing, wheezing, and fever. It then provides definitions and descriptions of asthma, exacerbations, signs and symptoms. It classifies exacerbation severity and outlines initial treatment including inhaled short-acting beta-agonists, oral corticosteroids, and oxygen. It discusses reassessing the child's response and adding additional medications if needed. The goal is relief of symptoms and planning follow-up care.
Rheumatic fever is a non-suppurative systemic disease that occurs as a delayed complication of untreated or ineffectively treated streptococcal pharyngitis. It primarily affects children between 5-15 years of age and is characterized by migratory polyarthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. If not properly treated, it can lead to rheumatic heart disease, which involves permanent damage to the heart valves and is the most serious complication. Treatment involves bed rest, anti-inflammatory medications, antibiotics to prevent recurrent infections, and possibly cardiac surgery for severe valve damage.
This document discusses pulmonary tuberculosis (TB). It provides background information on TB epidemiology globally and in Uganda. It describes the pathophysiology and phases of TB infection and disease. It defines TB cases and classifications. It discusses investigations for diagnosing TB including imaging, microscopy, culture and tuberculin skin testing. It also outlines TB treatment regimens and definitions of treatment outcomes.
Micronutrient deficiencies are widespread globally and affect approximately 2 billion people. The most common deficiencies are caused by lack of iron, iodine, and zinc. Micronutrient deficiencies can cause a variety of clinical issues depending on the deficient nutrient, but often include poor growth, cognitive impairments, increased infection risk, and sometimes even death if deficiencies go untreated. Public health efforts focus on prevention through diet, supplementation, and food fortification programs.
This document provides information on different types of diarrhoea including acute diarrhoea, persistent diarrhoea, and dysentery. It defines each type and discusses their causes, pathogenesis, clinical features, risk factors, management, and treatment. The main points covered are that acute diarrhoea is usually viral in children and lasts less than 14 days, persistent diarrhoea lasts more than 14 days and is related to malnutrition, and dysentery involves bloody stools which is commonly caused by Shigella bacteria.
The document discusses acute malnutrition in Uganda. It defines malnutrition and its two broad categories: undernutrition and overnutrition. Undernutrition, which results from not getting enough nutrients, affects 6% of Ugandan children, with 2% having severe acute malnutrition (SAM). Malnutrition can be assessed through anthropometric measurements, clinical signs, and biochemical tests. Its management involves 3 phases: initial stabilization, transition to intensive feeding, and rehabilitation. The 10 key points of managing SAM are addressed.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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2. Introduction
◦Diabetes mellitus (DM) is a chronic, metabolic disease characterized
by elevated levels of blood sugar, which leads over time to serious
damage to the heart, blood vessels, eyes, kidneys and nerves.
◦The most common is type 2 diabetes mellitus (T2DM), usually it
occurs in adults, and develops when the body becomes resistant to
insulin or doesn't make enough insulin.
◦In the past 3 decades the prevalence of type 2 diabetes has risen
dramatically in countries of all income levels.
◦Type 1 diabetes mellitus (T1DM), once known as juvenile diabetes
or insulin-dependent diabetes, is a chronic condition in which the
pancreas produces little or no insulin by itself.
11. Pathogenesis of DM
Absolute insulin deficiency (Type 1 DM) occurs with autoimmune destruction of insulin
secreting β-cells (Type 1A DM) and other congenital (genetic defects in the formation or
function of the endocrine pancreas), or acquired (relapsing pancreatitis and pancreatectomy)
conditions.
Absolute deficiency of insulin action also can occur in the total absence of insulin receptors, a
rare event.
12.
13. T2DM related metabolic
Progressive insulin deficiency thus induces a starvation like state
which is associated with the following metabolic processes:
Excessive hepatic and renal gluconeogenesis
Decreased peripheral utilization of glucose
Hyperglycemia with resultant glycosuria
Loss of water and sodium salts
Proteolysis in muscle liberating amino acids such as alanine and
glutamine as substrates for gluconeogenesis
Uncontrolled lipolysis leads to the rapid mobilization of fatty acids
from adipose tissue and the increased delivery of fatty acids to the
liver leading to the increased synthesis of triglycerides and secretion
of very low-density lipoprotein (VLDL).
14. Pathogenesis of DM
◦Relative insulin deficiency occurs with genetic or acquired
defects in insulin synthesis or secretion that are
inadequate to overcome the resistance caused by fewer
functioning insulin receptors, or resistance to insulin
action induced by stress, drugs, and most commonly
obesity (Type 2 DM)
15.
16.
17. Acute clinical Manifestation/Acute Complications
◦Most of them are a result of hyperglycemia which
exceeds renal threshold to result in polyuria, increased
thirst, dehydration, electrolyte disturbances, weight loss,
and metabolic decompensation, in extreme degree
known as diabetic ketoacidosis and non-ketotic
hyperosmolar coma
18. Chronic Complications
◦The chronic complications include macrovascular
(CAD, CVD, amputations) and microvascular
(retinopathy, nephropathy, neuropathy) lesions
19. Diagnosis of Diabetes
FPG ≥7.0 mmol/L
Fasting = no caloric intake for at least 8 hours
or
A1C ≥6.5% (in adults)
Using a standardized, validated assay in the absence of factors that
affect the accuracy of the A1C and not for suspected type 1 diabetes
or
2hPG in a 75 g OGTT ≥11.1 mmol/L
or
Random PG ≥11.1 mmol/L
Random = any time of the day, without regard to the interval since the
last meal
A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
20.
21. Confirmatory test required
• In the absence of symptomatic hyperglycemia, if a
single lab test result is in the diabetes range, a repeat
confirmatory lab test (FPG, A1C, 2hPG in a 75 g OGTT)
must be done on another day
• Repeat the same test (in a timely fashion) to confirm
• But a random PG in the diabetes range in an
asymptomatic individual should be confirmed with an
alternate test
• If results of two different tests are available and both
are above the diagnostic thresholds, the diagnosis of
diabetes is confirmed
2hPG, 2-hour plasma glucose; AlC, glycated hemoglobin; FPG, fasting plasma glucose;
OGTT, oral glucose tolerance test; PG, plasma glucose.
22. 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
2hPG, 2-hour plasma glucose; AlC, glycated hemoglobin; FPG, fasting plasma glucose;
OGTT, oral glucose tolerance test; PG, plasma glucose.
23. 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
A1C, glycated hemoglobin; FPG, fasting plasma glucose; PG, plasma glucose
24. 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
A1C, glycated hemoglobin; FPG, fasting plasma glucose; OGTT, oral glucose tolerance
test; PG, plasma glucose
26. A1C Level and Future Risk of Diabetes:
Systematic Review
A1C Category (%)
5-year incidence of
diabetes
5.0-5.5 <5 to 9%
5.5-6.0 9 to 25%
6.0-6.5 25 to 50%
Zhang X et al. Diabetes Care. 2010;33:1665-1673.
A1C, glycated hemoglobin
27. Definition of Metabolic Syndrome
Measure Categorical thresholds
Elevated waist circumference (population/country specific)
Canada, United States of America
Middle Eastern, Sub-Saharan African, Mediterranean,
Europids
Asians, Japanese, South and Central Americans
Men Women
≥102 cm
≥94 cm
≥90 cm
≥88 cm
≥80 cm
≥80 cm
Elevated TG (drug treatment for elevated TG is an alternate
indicator†)
≥1.7 mmol/L
Reduced HDL-C (drug treatment for reduced HDL-C is an
alternate indicator†)
<1.0 mmol/L in males;
<1.3 mmol/L in females
Elevated BP (antihypertensive drug treatment in a person with
a history of hypertension is an alternate indicator)
systolic ≥130 mmHg or
diastolic ≥85 mmHg
Elevated FPG (drug treatment of elevated glucose is an
alternate indicator)
≥5.6 mmol/L
Adapted from: Alberti KG, et al. Circulation 2009;120:1640
† Commonly used drugs for elevated TG and reduced HDL-C are fibrates and nicotinic acid. A person taking one of these
drugs can be presumed to have high TG and reduced HDL-C. High-dose omega-3 fatty acids presumes high TG
28. Definition of Metabolic Syndrome
Measure Categorical thresholds
Elevated waist circumference (population/country specific)
Canada, United States of America
Middle Eastern, Sub-Saharan African, Mediterranean,
Europids
Asians, Japanese, South and Central Americans
Men Women
≥102 cm
≥94 cm
≥90 cm
≥88 cm
≥80 cm
≥80 cm
Elevated TG (drug treatment for elevated TG is an alternate
indicator†)
≥1.7 mmol/L
Reduced HDL-C (drug treatment for reduced HDL-C is an
alternate indicator†)
<1.0 mmol/L in males;
<1.3 mmol/L in females
Elevated BP (antihypertensive drug treatment in a person with
a history of hypertension is an alternate indicator)
systolic ≥130 mmHg or
diastolic ≥85 mmHg
Elevated FPG (drug treatment of elevated glucose is an
alternate indicator)
≥5.6 mmol/L
Adapted from: Alberti KG, et al. Circulation 2009;120:1640
† Commonly used drugs for elevated TG and reduced HDL-C are fibrates and nicotinic acid. A person taking one of these
drugs can be presumed to have high TG and reduced HDL-C. High-dose omega-3 fatty acids presumes high TG
29. Recommendation 1
1.Diabetes should be diagnosed by any of the following
criteria:
◦ FPG ≥7.0 mmol/L [Grade B, Level 2]
◦ A1C ≥6.5% (for use in adults in the absence of factors that
affect the accuracy of A1C and not for use in those with
suspected type 1 diabetes) [Grade B, Level 2]
◦ 2hPG in a 75 g OGTT ≥11.1 mmol/L [Grade B, Level 2]
◦ Random PG ≥11.1 mmol/L [Grade D, Consensus]
30. Recommendation 1 cont’d
◦ In the presence of symptoms of hyperglycemia, a
single test result in the diabetes range is sufficient to
make the diagnosis of diabetes.
◦ In the absence of symptoms of hyperglycemia, if a
single laboratory test result is in the diabetes range, a
repeat confirmatory laboratory test (FPG, A1C, 2hPG
in a 75 g OGTT) must be done on another day
31. Recommendation 1 cont’d
◦ It is preferable that the same test be repeated (in a
timely fashion) for confirmation, but a random PG in
the diabetes range in an asymptomatic individual
should be confirmed with an alternate test.
◦ If results of two different tests are available and both
are above the diagnostic cut-points, the diagnosis of
diabetes is confirmed [Grade D, Consensus]
32. ◦ 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 [Grade
D, Consensus]
Recommendation 1 cont’d
33. Recommendation 2
2. Prediabetes (defined as a state which places
individuals at high risk of developing diabetes and its
complications) is diagnosed by any of the following
criteria:
◦ IFG (FPG 6.1-6.9 mmol/L) [Grade A, Level 1]
◦ IGT (2hPG in a 75 g OGTT 7.8-11.0 mmol/L) [Grade A, Level
1]
◦ A1C 6.0%-6.4% (for use in adults in the absence of factors
that affect the accuracy of A1C and not for use in suspected
type 1 diabetes) [Grade B, Level 2]
34. Key Messages
◦ The chronic hyperglycemia of diabetes is associated with
significant long-term microvascular and CV complications
◦ A FPG of ≥7.0 mmol/L, a 2hPG value in a 75 g OGTT of
≥11.1 mmol/L or an A1C of ≥6.5% can predict the
development of retinopathy. This permits the diagnosis of
diabetes to be made on the basis of each of these
parameters
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
35. Key Messages
◦ The term "prediabetes" refers to impaired fasting glucose,
impaired glucose tolerance or an A1C of 6.0% to 6.4%,
each of which places individuals at increased risk of
developing diabetes and its complications
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
36. Key Messages for People with
Diabetes
◦ There are two main types of diabetes. Type 1 diabetes
occurs when the pancreas is unable to produce insulin.
Type 2 diabetes occurs when the pancreas does not
produce enough insulin or when the body does not
effectively use the insulin that is produced
◦ Gestational diabetes is a type of diabetes that is first
recognized or begins during pregnancy
◦ Monogenic diabetes is a rare disorder caused by genetic
defects of beta cell function
2018 Diabetes Canada CPG – Chapter 3. Definition, Diagnosis & Classification of Diabetes, Prediabetes, Metabolic Syndrome
37. Key Messages for People with Diabetes
◦ Prediabetes refers to blood glucose levels that are higher
than normal, but not yet high enough to be diagnosed as
type 2 diabetes. Although not everyone with prediabetes
will develop type 2 diabetes, many people will
◦ You should discuss the type of diabetes you have with
your diabetes health-care team
◦ There are several types of blood tests that can be done to
determine if a person has diabetes and, in most cases, a
confirmatory blood test is required to be sure
Editor's Notes
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.
Script: Zhang et al did a systematic review on A1c level and future risk of diabetes and you as the A1C increased from 6.0 to 6.5%, this covereted to a 5-year incidence of diabetes across 25% -50%.