T2DM + Obesity Flashcards
Adiponectin
- Synthesized by adipose tissue and serum concentration inversely correlated to body fat percentage
- Lower in diabetes
- Function:
–Increased insulin sensitivity
–Improved markers of insulin resistance
–Decreased gluconeogenesis
–Increased glucose uptake
–Increased beta oxidation of fatty acids
Leptin
Synthesized in white adipose and serum concentration directly correlated with total body fat (less in less weight)
senses energy stores
Inhibits appetite
Required for male and female reproductive function
stimulus: eating
Ghrelin
Synthesized from cells lining the fundus of the stomach and in epsilon cells of the pancreas
Rises before meals and falls after
Stimulates appetite
stimulus: fasting
Amylin
- Co-secreted from beta cells with insulin
- Contributes to glucose regulation
–Decreased appetite
–Slowed gastric emptying
–Reduction in gastric enzymes
–Suppression or glucagon
-Deficient in type 2 diabetes
GLP-1
- Secreted by L cells of the intestine in response to nutrients
- Rapidly metabolized by DPP-4
- Decreases serum glucose
–Pancreas
—Stimulates insulin secretion
—Inhibits glucagon secretion
—Increases beta cell mass
–GI tract
—Slows gastric emptying, leading to lower post-prandial glucose excursion
–CNS
—Decreases appetite through central actions on the hypothalamus
*GLP-1 analogues available as injected agents
*DPP-4 inhibitors decrease metabolism of endogenous GLP-1
IL-6
- Synthesized and secreted by adipose tissue
adipose contributes to up to 35% of circulating IL‐6 - stimulates recruitment and activation of macrophages in adipose
- in the liver, IL-6 promotes STAT3—SOCS‐3 pathway mediated impairment of insulin actions
- In muscle, IL‐6 promotes insulin‐regulated glucose metabolism
TNF-α
- secretion increased in adipose tissue from obese humans.
- induces insulin resistance by downregulating the tyrosine kinase activity of the insulin receptor and decreasing the expression of GLUT-4 - reduces lipoprotein lipase activity in white adipocytes,
- stimulates hepatic lipolysis
Prevention of T2DM
Breastfeeding
Lifestyle
- Improve sleep quality and quantity
- Decrease sedentary behaviours
- Increase both light and vigorous physical activity
- Reducing sugar-sweetened beverage consumption
- Limit screen time
In children with obesity, family-based healthy behaviour interventions
Risk factors of T2DM
- FHx T2DM in a 1st- or 2nd-degree relative
- High-risk population (e.g. people of African, Arab, Asian, Hispanic, Indigenous or South Asian descent)
- Obesity
- Impaired glucose tolerance (IGT)
- Polycystic ovary syndrome
- Exposure to diabetes in utero
- Acanthosis nigricans
- Hypertension and dyslipidemia
- Non-alcoholic fatty liver disease (NAFLD)
- Atypical antipsychotic medications
Target A1c T2DM
=7%
Health lifestyle for T2DM
60 minutes daily of moderate-to-vigorous physical activity
limiting recreational screen time to < 2 hours per day
Limiting sedentary (motorized) transport, extended sitting and time spent indoors throughout the day
When to start insulin on T2DM dx
DKA
A1C ≥9.0%
symptoms of severe hyperglycemia
Once-a-day basal insulin
Tx T2DM
- lifestyle = number 1
- metformin
- insulin
- other meds
Complications and comorbidities of T2DM
Neuropathy
Retinopathy
Nephopathy
Dyslipidemia
Hypertension
NAFLD
PCOS
OSA
Depression
Binge eating
Neuropathy screening in T2DM
- when and frequency
- screening test
yearly starting at dx
questions and exam
symptoms, vibration, touch, ankle reflex
retinopathy screening in T2DM
- when and frequency
- screening test
yearly starting at dx
7-standard field- stereoscopic-colour funds photography w interpretation by a trained reader
nephropathy screening in T2DM
- when and frequency
- screening test
yearly starting at dx
first AM ACR (or random)
dyslipidemia screening in T2DM
- when and frequency
- screening test
yearly starting at dx
fasting TC, HDL-C, TG, calculated LDL-C
hypertension screening in T2DM
- when and frequency
- screening test
at dx and every dm-related encounter
BP measurement with appropriate sized cuff
NAFLD screening in T2DM
- when and frequency
- screening test
yearly starting at dx
ALT and/or fatty liver on ultrasound
PCOS screening in T2DM
- when and frequency
- screening test
yearly clinical screening starting at dx for pubertal females
clinical assessment on hx and p/e for oligo/amenorrhea, acne, hirsutism
most common complication of T2DM
retinopathy
CVD prevention in T2DM
smoking cessation
inactivity
when to start statin in T2DM
In children with familial dyslipidemia and a positive family history of early CV events, a statin should be started if the LDL-C level remains >4.1 mmol/L after a 3- to 6-month trial of dietary intervention
Who should be screened for T2DM?
- ≥3 risk factors in nonpubertal children beginning at 8 years of age or ≥2 risk factors in pubertal children. Risk factors include:
1) Obesity (BMI ≥95th percentile for age and gender)
2) Member of a high-risk ethnic group (e.g. African, Arab, Asian, Hispanic, Indigenous or South Asian descent)
3) First-degree relative with type 2 diabetes and/or exposure to hyperglycemia in utero
-4) Signs or symptoms of insulin resistance (including acanthosis nigricans, hypertension, dyslipidemia, NAFLD [ALT >3X upper limit of normal or fatty liver on ultrasound]) - PCOS
- IFG and/or IGT
- Use of atypical antipsychotic medications
How to screen for T2DM?
an A1C and a FPG or random plasma glucose
What are high risk groups for T2DM
African,
Arab,
Asian,
Hispanic,
Indigenous
South Asian descent
What is recommended for physical activity for children
≥60 minutes of moderate-to-vigorous physical activity daily,
