Diabetes Mellitus

Question 1

Diabetes Mellitus

Answer 1

Insulin resistance

Insufficient insulin secretion

Hyperglycemia (high sugar level in blood)

1/10 of SG residents with DM

1/4 with DM, unaware they had DM

1/4 aware they had DM, had poor DM control

Question 2

Type 1

Answer 2

Autoimmune pancreatic B cell destruction —> macrophages eat B cells tagged with Abs

Absent insulin —> cells do not absorb glucose —> remain at elevated levels

Onset during childhood

Frequent ketoacidosis —> need alternative energy sources like fats, broken down to fatty acids, keto acids and ketones

Question 3

Type 2

Answer 3

More prevalent

Insulin resistance / impaired insulin secretion / increased hepatic glucose production

Often >40 years, but becoming more prevalent among obese children and young adults

Less common ketoacidosis —> body can still use glucose as energy source

Frequently undiagnosed for many years as hyperglycemia develops gradually and at earlier stages

Question 4

Hyperglycemia

Answer 4

Extreme thirst —> polydipsia ; loss of fluid thru urine, too much sugar drinks

Dry skin

Hunger —> polyphagia; lack of nutrients entering cells

Frequent urination —> polyuria ; excess glucose in urine draws more fluid into urine

Drowsiness —> body unable to utilise sugar for energy

Question 5

Microvascular complications

Answer 5

Neuropathy (nerve damage) —> infections, amputations

Retinopathy —> blindness

Nephropathy —> large molecules can enter urine e.g. protein

Question 6

Macro vascular

Answer 6

Atherosclerosis —> build up of fatty deposits within inner lining of blood vessels —> restrict blood flow —> Ischemia

Peripheral vascular disease

Stroke

CVD

Question 7

HbA1c

Answer 7

Glycated Hemoglobin

Measures average amount of glucose in blood over past 3 months

Question 8

United Kingdom Prospective Diabetes Study (UKPDS)

Answer 8

Intensive glycemic control

Decreased risk of microvascular disease

Question 9

Diabetes Control and Complications Trial (DCCT)

Answer 9

Intensive glycemic control associated with decreased risk of retinopathy, nephropathy and neuropathy

Question 10

Epidemiology of Diabetes Interventions and Complications Study (EDIC)

Answer 10

Early intensive glucose control led to reduction in risk of non fatal myocardial infarction, stroke or CVD

Question 11

Diabetes Prevention Program (DPP)

Answer 11

Treatment with metformin and lifestyle modification

Lifestyle interventions more cost effective than medications

Question 12

Primary prevention

Answer 12

Lifestyle intervention

Diet —> less fat, limit alcohol intake, avoid sweetened beverages , 25% lean meat, soy and low fat dairy, 25% brown rice and whole meal bread , 50% fruits and veg

Physical activity —> >=150 mins per week moderate ; >=75 mins per week vigorous

Smoking cessation

Front-of-pack nutrition labels

Ban on unhealthy advertising

Reduce market consumption

Reformulation

Question 13

Healthy ecosystems

Answer 13

Primary care network —> engage GPs

ActiveSG —> give monetary credits to access pools, gyms

NurtureSG

Cycling friendly city

Question 14

Secondary prevention

Answer 14

Screening

Early detection and follow up

Community Health Post —> regular follow ups and advice in lifestyle changes —> weight management, BMI tracking, blood pressure monitoring

Question 15

Tertiary prevention

Answer 15

Delaying onset of complications , maximise quality of life

Question 16

Drug subsidy scheme

Answer 16

Standard Drug List (SDL) —> medication subsidised

Medication Assistance Fund (MAF)