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University of Toronto St. George
Trinity College Courses
Caroline Barakat

HLTC07 - Patterns of Health, Disease, and Injury Lecture 8: Diabetes Lecture outline  Diabetes Mellitus o Types of Diabetes o Prevalence patterns o Causes/Risk factors o Strategies for prevention Types of Diabetes  Chronic progressive disorder characterized by abnormalities in carbohydrates, fat, and protein metabolism and hyperglycemia (=excess of glucose in the bloodstream; when glucose can’t be broken down and concentrates in blood – signifies diabetes) o Metabolism disorder o Accumulation of glucose  Chronic hyperglycemia is associated with damage to many areas o For example, small and large blood vessels in the eye  Most complications begin about 10-15 yrs after disease onset and include the following:  Common complications: o Heart disease o High blood pressure o Stroke o Kidney failure o Amputations o Blindness  4 clinical classes of diabetes: 1) Type 1 diabetes 2) Type 2 diabetes 3) Gestational diabetes 4) Other  Pre-diabetes – recognized clinical state that’s associated with elevated risk of diabetes – this person is now at high risk for developing diabetes and it is recognized by glucose levels (1) Type 1 Diabetes  Results from autoimmune beta cell destruction (occurs during childhood)  Leads to absolute insulin deficiency where there’s: o Abrupt onset of hyperglycemia (glucose accumulating in blood stream) o Ketoacidosis (chemical imbalance when the body becomes far too acidic b/c there’s an accumulation of ketone bodies in blood) ...cannot produce insulin  5-10% of all diabetes cases  Associated w/ genetic factors although there’s no known single gene factor that’s known to be the cause of Type 1 diabetes o Occurs at a young age o Very rare (2) Type 2 Diabetes – diff b/c has multi-hormonal pathophysiology  Usually occurs at a later time:  Insufficient amounts of insulin are produced or the cells are resistant to the biological effects of insulin (not enough insulin produced for the cell) o Hyperglycemia (=excess glucose in the blood)  Typically progresses from initially being insulin resistant (means it’s not producing as much as it needs to break down all the glucose) then it moves onto post-prandial hyperglycemia eventually to clinical diabetes – it is a slow progression which will require pharmacological intervention  Type 2 diabetes is as serious Type 1 if not properly controlled;  Insulin resistance – postprandial hyperglycemia – clinical diabetes  85% of diabetes cases – more common type worldwide (more adult onset)  There’s no ‘mild’ type of diabetes o Type 2 is just as serious as Type 1 if not properly controlled (3) Gestational Diabetes (GDM)  Diagnosed during pregnancy o Body makes hormones that may interfere with the insulin  Pregnancy hormones block the action of maternal insulin causing insulin resistance and hyperglycemia (due to increased glucose in blood)  Women with history of GDM – increased risk of developing Type 2 diabetes o Most of the time, when hormone levels go down/pregnancy over, the diabetes may go away but what is noticed is that there’s a link between people who developed GDM and those that develop type 2 diabetes in later age  Women who have GDM tend to have overweight babies (4) Other Types of Diabetes (uncommon)  5% of cases have other causes: o Mutation of a single gene that also causes situation where glucose is no longer broken down o Chromosomal abnormality o Chemically induced diabetes  Environmental chemicals that interfere with normal metabolism of proteins, carbohydrates, glucose  Pre-diabetes or IGT (impaired glucose tolerance) – raises the risk of developing type 2 diabetes, heart disease and stroke o This happens when blood glucose levels are between normal and diabetic range o At some instances, you’ll be beyond normal range but the person isn’t classified as diabetic o Anything in between the upper limit of the normal range and diabetic range – person classified as impaired glucose tolerance – clinically recognized state IGT/pre-diabetes o Obesity and physical inactivity are modifiable factors that may reduce risk of progression into Type 2 diabetes for those that are IGT  Physical activity and weight loss by 7% may bring them back to normal levels Film about diabetes  http://www.youtube.com/watch?v=jHRfDTqPzj4  Which type of diabetes is amenable to prevention? Type 2 diabetes World Prevalence – Developing Countries  In developing countries o Cultural changes (going from rural areas to cities): these are common to developing nations; will find that there are diff regional factors but in general there is a cultural change throughout the world and in developing countries, it tends to be more magnified because of globalization and because people are going from rural to city – means they are closer to work, closer to each other = less walking)  Less physical activity  Higher rates of obesity  Changes in food availability  Impact of globalization! o Changes in food chains and lifestyle are impacting those in developing countries o Lifestyle and dietary changes are brought about by globalization and diabetes pandemic/epidemic is due to globalization and changes in lifestyle – gives rise to obesity pandemic and sedentary, technology oriented lifestyles Worldwide prevalence – Developed countries – is a bit diff  GDM is the 4th or 5th leading cause of death in developed world o There are many reasons behind this o It affects the aging population more, older than 65  Inequities in disease prevalence – poverty limits access to fresh fruit and vegetables, exercise and healthcare o In developed world, see a bit diff trend – see that poverty appears to be related to diabetes – due to limits of accessing good nutritious food, not enough time for exercise and lack of adequate healthcare  Alterations in food production, prep and consumption o (I.e., invention of microwave ovens, therefore available frozen foods with excessive fats/sugars/sodium – may be related to chronic diseases)  So, in developed country, diabetes linked to low SES because of lifestyle  Link of age and diabetes in developed world, link of technology and diabetes in developed world and inequities in developed world. Slide 21: Fig 1. Prevalence of diabetes in diff world regions – prevalence in millions  Based on year 2000 and projected for year 2030 o Prevalence of diabetes in percent = color-coded; darkest orange = more than 8% - mostly Middle East and Egypt – highest rates in the world – due to changes in lifestyle o N. America – 6-8% o Some places don’t have high prevalence – sub-Saharan Africa o Projection in N. American from 33 million to 66 million = doubling o In Africa – more than 2 fold – from 7 to 18 million o In Europe – 33 and 48 million in 2030 o Potentially due to changes in demography o Middle East – tripled – going from 15 to 42 million o In Australia/Asia – from 82 million to 190 million - doubled o Huge increases projected for year 2030; demography Slide 22: Fig 2. Scale based on bubble size  Taken from 2 diff maps – try to magnify so that it can be proportionate  Prevalence worldwide based on bubble size  China = 90 million; India = 61.3 million; USA = 23.7 million; Russia = 12.6 million  Gives idea of burden of this disease throughout the world  These are the prevalence, not prevalence rates/percentages which can give you a diff picture  Colors indicate whether high income, middle or low income o This isn’t really a problem related to low income countries o It is a problem related to high income countries o Low income countries are getting there but it’s not quite there yet o It is an epidemic – 146 million cases of diabetes worldwide – we must control it Figure 3: Prevalence of Diabetes worldwide  Prevalence of diabetes among adults based on the income of the country  Prevalence percentages based on where they fall in terms of income – it is definitely a middle/high income problem  Problem related to low income – also on the rise  Projected numbers – 2030 – in every single category – projected to increase  Mortality rates related to diabetes tend to be very high o More people die in lower income countries because not enough money spent for healthcare for people with diabetes Risk Factors (1) Inactivity  People aren’t burning off what they eat as they should  Work-related physical activity reduced  Technology makes life easier but there’s less physical activity  Leisure-time physical activity also low  Time spent outdoors very low  Walking – most of the roads are paved, for cars – travelling in cars; urban planning, some places don’t even have sidewalks, safety, things are at a distance (2) Technology  Typical child watches 40,000 commercials on TV; many of them are food ads – exposes kids and adults to nutritionally poor foods  TV o Sit in front of TV; eating popcorn; tend to eat the same food that they see on TV o Sedentary lifestyle  Cars  Video games  Internet shopping o Has to
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