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PSBEDM Review > 36 Type 1 Diabetes Mellitus > Flashcards

36 Type 1 Diabetes Mellitus Flashcards

(96 cards)

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1
Q

Randomized clinical trial that laid the foundation of intensive insulin therapy as the standard of care

A

DCCT

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2
Q

Interventions in DCCT

A

Intensive vs conventional insulin therapy

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3
Q

Number of participants in DCCT

A

1,441 persons

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4
Q

Age range of participants in DCCT

A

13-39 years old

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5
Q

Diabetes type of participants in DCCT

A

T1DM

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6
Q

Median HbA1c levels of the groups compared in DCCT (2)

A

Intensive: 7%
Conventional: 9%

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7
Q

DCCT: Decrease in microvascular complications in intensive therapy group

A

35-76%

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8
Q

DCCT: Microvascular complications (3) that were decreased in intensive therapy group

A

Retinopathy
Nephropathy
Neuropathy

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9
Q

EDIC: Years of follow-up from DCCT

A

20-25 years

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10
Q

Outcomes in intensive therapy group in EDIC (3)

A

Reduced microvascular complications
Reduced macrovascular complications
Reduced overall mortality

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11
Q

Standard composition of macronutrients in nutritional therapy for T1DM (3)

A

50% carbohydrates
30% fat
20% protein

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12
Q

Breakdown of fat intake targets in T1DM (3)

A

<10% saturated fat
<10% polyunsaturated fat
>10% monounsaturated fat

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13
Q

Recommended daily fruit and vegetable portions in T1DM

A

5 portions

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14
Q

Risk factors (3) for ketosis during intake of very low carbohydrate diet in T1DM

A

Insulin dose reductions
Disordered eating behaviors
Use of SGLT2Is

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15
Q

Recommended duration of physical activity in youth with T1DM

A

≥60 mins daily

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16
Q

How many days/week should muscle and bone strengthening exercises be done in youth with T1DM

A

≥3 days/week

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17
Q

Recommended duration of physical activity in adults with T1DM

A

≥150 mins/week of moderate intensity aerobic activity
≥75 mins/week of vigorous aerobic activity

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18
Q

How many days/week should muscle strengthening exercises be done in adults with T1DM

A

≥2 days/week

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19
Q

Definition of significant ketosis prior to exercise in T1DM

A

More than small urinary ketones
Blood betahydroxybutyrate ≥1.5 mmol/L

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20
Q

In individuals with T1DM, intense exercise should be postponed in the setting of significant hyperglycemia, defined as glucose levels:

A

≥350 mg/dL or 19.4 mmol/L

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21
Q

Frequency of blood glucose and ketone monitoring in T1DM during sick days

A

Every 1-3 hours

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22
Q

Correction doses or __% of TDD with rapid acting insulin every 2-3 hours while ketones persist is recommended in T1DM patients during sick days

A

5-20% of TDD

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23
Q

Preferred method of monitoring ketones in T1DM during sick days

A

Blood beta hydroxybutyrate

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24
Q

In the lag effect of exercise in T1DM, hypoglycemia occurs how many hours after exercise

A

7-11 hours

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25
To prevent hypoglycemia during exercise in T1DM, one should begin exercise with a glucose of:
≥100 mg/dL or ≥5.6 mmol/L
26
When physical activity lasts ≥40 mins in T1DM, consider providing how much carbohydrates per min?
0.25-1 g per min
27
Consider providing 0.25-1 g of carbohydrates per minute of exercise when the activity lasts how long?
≥40 mins
28
For any meal or snack within 2 hours of planned activity in T1DM, one should decrease bolus insulin doses by how much?
50%
29
For T1DM patients on CSII, basal rates should be decreased by how much during exercise to prevent hypoglycemia?
50%
30
For T1DM patients on CSII, basal rates can be suspended for how long during exercise to prevent hypoglycemia?
1-2 hours
31
To manage lag effect of exercise in T1DM patients on CSII, basal rates should be decreased by how much for up to 6 hours at bedtime?
~20%
32
To manage lag effect of exercise in T1DM patients on CSII, basal rates should be decreased by 20% for up to __ at bedtime
6 hours
33
To manage lag effect of exercise in T1DM patients, long-acting insulin doses should be decreased by how much at bedtime?
~20%
34
Two peaks of T1DM presentation in terms of age
Small peak between 5 and 7 years Larger peak at or near puberty
35
Drug that is directly toxic to beta cells used to induced diabetes in mice
Streptozotocin
36
Standardized definition of insulitis
At least 3 islets containing >15 CD45+ cells in a pancreas
37
Symptoms of diabetes were thought to appear when how much of pancreatic beta cells had met their demise
85-90%
38
10 year risk of T1DM in an individual with 2 or more anti-islet autoantibodies who seroconvert before 3 years old
75%
39
10 year risk of T1DM in an individual with 2 or more anti-islet autoantibodies who seroconvert after 3 years old
60%
40
Proportion of T1DM patients without a first degree relative with the disease
>85%
41
Highest known incidence of T1DM (2)
Finland Sardinia
42
T1DM is uncommon in these countries (~0.1 per 100,000 per year) (3)
China India Venezuela
43
Risk of type 1 diabetes: General population
0.3% (15-25/100,000)
44
Risk of type 1 diabetes: Offspring
1%
45
Risk of type 1 diabetes: Sibling
3.2% through adolescence 6% lifetime
46
Risk of type 1 diabetes: Dizygotic twin
6%
47
Risk of type 1 diabetes: Mother
2%
48
Risk of type 1 diabetes: Father
4.6%
49
Risk of type 1 diabetes: Both parents
~10%
50
Risk of type 1 diabetes: Monozygotic twin
50% 70% before age 5 <10% after age 25
51
Most important loci determining risk of T1DM
HLA class II molecules (DR, DQ, DP)
52
Major HLA determinants of T1DM susceptibility
DR and DQ molecules
53
HLA molecule that provides dominant protection from T1DM
DQ6
54
Highest risk HLA-DR-DQ genotype
DR3/4-DQ2/8 heterozygotes
55
Best single marker for T1DM development in young children
IAA
56
Mutation in this gene can result in permanent neonatal DM but does not cause IUGR
ABCC8
57
Mutations in these genes (2) may result in either transient or permanent forms of neonatal DM
KCNJ11 ABCC8
58
Most common form of neonatal DM
ZAC/HYMAI
59
Gene mutated in Wolcott-Rallison syndrome
EIF2AK3
60
Mutation in EIF2AK3 results in this syndrome with transient neonatal DM
Wolcott-Rallison syndrome
61
Gene mutated in X-linked permanent neonatal DM
FOXP3
62
X-linked syndrome that results in permanent neonatal DM
IPEX syndrome
63
Most common form of MODY
MODY 3
64
Second most common form of MODY
MODY 2
65
Gene affected in MODY1
HNF4A
66
Gene affected in MODY2
GCK
67
Gene affected in MODY3
TCF1
68
Gene affected in MODY4
IPF1
69
Gene affected in MODY5
TCF2
70
Gene affected in MODY6
NeuroD1 or BETA2
71
Typical age of onset of MODY6
4th decade of life
72
Treatment of IPEX/XPID syndrome
Bone marrow transplantation
73
In this prospective study, a genetic risk score model was able to identify infants with high risk of developing anti-insulin autoantibodies by 6 years of age
TEDDY study
74
US study that showed the most rapid rise of T1DM is in teenagers
SEARCH
75
These hypotheses suggest that childhood obesity increases insulin demand, overloading the islet cells and accelerating beta-cell autoimmune damage
Accelerator and overload hypotheses
76
This hypothesis implicates dietary exposure as a possible direct regulator of the immune system and of self-tolerance by altering gut microbiota and intestinal permeability
Old friends hypothesis
77
This hypothesis proposes that microbial infection induces a temporary state in which other antigens can easily react to yield autoreactive T cells
Fertile field hypothesis
78
Best evidence for a specific environmental agent to contribute to T1DM pathogenesis
Congenital rubella infection
79
Anti-CD3 antibody that delayed progression to clinical T1DM in high risk patients
Teplizumab
80
This protocol used meticulous islet isolation techniques, transplantation of islets from multiple pancreata, avoided the use of steroids, and utilized an immunosuppressive regimen involving rapamycin, that improved outcomes for patients with T1DM
Edmonton protocol
81
Insulin autoimmune syndrome or Hirata syndrome is associated with treatment of the following medications (2)
Sulfhydryl-containing medications, particularly methimazole Alpha-lipoic acid
82
ADA target HbA1c for (1) adults (2) younger children
7% for adults 7.5% for children
83
Most common form of permanent neonatal DM involves a mutation in what gene?
KCNJ11
84
IFG or IGT is usually present within how many months before the onset of overt DM?
6 months
85
Stage of pre-T1DM where dysglycemia develops
Stage 2
86
Most common strategy of implementing feedback control of automated insulin delivery
Proportional integral derivative
87
Two peaks of T1DM diagnosis
Small peak between 5 and 7 years of age Larger peak at or near puberty
88
Sex predilection of T1DM
Males > Females
89
Standard definition of insulitis
Three islets containing >15 CD45* cells in a pancreas
90
In this hypothesis, beta cell destruction is proposed to result from interactions between the environment, immune system, and the beta cells themselves in genetically susceptible individuals.
Copenhagen model
91
This finding in gut microbiota has been associated with anti-islet autoimmunity
High Bacteroides to Firmicutes ratio
92
These bacteria may protect against T1DM by promoting synthesis of mucin and reducing intestinal leakiness
Butyrate-producing bacteria
93
Use of these medications are associated with insulin autoimmune syndrome or Hirata syndrome
Sulfhydryl-containing medications (methimazole, alpha-lipoic acid)
94
Carbohydrate ratio is roughly computed as:
450 divided by TDD
95
Correction factor (sensitivity factor/index) can be approximated as:
1650 divided by TDD
96
Most common strategy of implementing feedback control of AID
PID controller

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