Type 2 Diabetes

Question 1

What is type 1 diabetes?

Answer 1

Beta-cells which make insulin are destroyed, common in childhood

Question 2

What is type 2 diabetes?

Answer 2

Insulin resistance and beta cell dysfunction, most common in obesity

Question 3

What are the 2 hybrid forms of diabetes?

Answer 3

Slow evolving immune-mediated diabetes of adults

Ketosis-prone type 2

Question 4

What is slowly evolving immune mediated diabetes of adults?

Answer 4

Features of a metabolic syndrome

GAD autoantibody

Retains greater b-cell function

Question 5

What is ketosis prone diabetes?

Answer 5

Presents with ketosis and insulin deficiency

Not immune-mediated

Question 6

What are monogenic diabetes

Answer 6

Specific gene mutation

Determines chances of development and treatment

Question 7

What is the diagnostic criteria for diabetes?

Answer 7

Fasting plasma at more than 7.0mmol/L

Hba1c at more than 48mmol/mol

Question 8

What is Hba1c?

Answer 8

How much glucose is attached to the haemoglobin in the red blood cells

Question 9

How is type 2 disease a complete trait?

Answer 9

Involves both genetic predisposition and life style choices

Question 10

How many specific gene loci were associated with gene loci?

Answer 10

Over 600

Question 11

What is the function of FTO gene?

Answer 11

Increase weight and BMI

Question 12

What increases the genetic risk of type 2 diabetes?

Answer 12

Having multiple polymorphisms that are associated with disease risk.

Question 13

Recent studies have tried to put a number on the effect of diet compared to genetic risk of type 2 diabetes, how is this done?

Answer 13

Novel polygenic scores to evaluate the presence of additive or multiplicative gene or diet interactions on the development of T2D

Question 14

What was the result of the polygenic risk score study for type 2 diabetes?

Answer 14

For each Standard Deviation of the polygenic risk score your risk of T2D increased by 29%

Question 15

According to the polygenic risk score study how much do genetics which affect the beta cell dysfunction increase the risk of type 2 diabetes?

Answer 15

26%

Question 16

According to the polygenic risk score study how much do genetics which affect the impaired insulin synthesis increase the risk of type 2 diabetes?

Answer 16

14%

Question 17

According to the polygenic risk score study how much do genetics which affect the obesity mediated insulin resistance increase the risk of type 2 diabetes?

Answer 17

9%

Question 18

According to the polygenic risk score study how much do genetics which affect the body fat distribution increase the risk of type 2 diabetes?

Answer 18

23%

Question 19

According to the polygenic risk score study how much do genetics which affect the lipid or hepatic metabolism increase the risk of type 2 diabetes?

Answer 19

11%

Question 20

How to assess diet quality?

Answer 20

AHEI score

Alternative healthy eating index

Question 21

According to the polygenic risk score study how much does a lower diet quality increase?

Answer 21

Estimated at 30% for low, intermediate, high genetic factors.

Found to not significantly be connected

Question 22

Does healthy diet reduce the risk of type 2 diabetes?

Answer 22

Found to decrease the risk of diabetes by 30% for all genetic risk individuals.

Question 23

Is insulin resistance the same for the whole population?

Answer 23

No some individuals can have higher insulin resistance but their pancreas matches that of

Question 24

What is the function of insulin in the muscles?

Answer 24

Glucose uptake and storage increases

This is called glycogenolysis

Question 25

What is the function of insulin on the liver?

Answer 25

Increase glucose storage Decrease glucose production (glycogenesis)

Question 26

What is the function of insulin in adipose tissue?

Answer 26

Decrease fat breakdown (lipolysis)

Question 27

What is the single cause that links insulin resistance and impaired beta cell function

Answer 27

Dysregulation in storage of fat (in the liver)

Question 28

What is the twin cycle hypothesis?

Answer 28

An acute negative energy balance (surgery eg) will normalise insulin sensitivity and restore normal insulin response

Question 29

What is a normal amount of liver fat?

Answer 29

Less than 5%

Question 30

Where is the first place fat is moved from when an individual loses a significant amount of weight?

Answer 30

The liver

Question 31

Can weight loss surgery affect muscle insulin sensitivity?

Answer 31

No, only affected by genetics and physical activity.

Question 32

Why use a liquid diet for weight loss?

Answer 32

Safe and effective Complete nutrition Lack of hunger Complete break from food decision Motivation from rapid weight loss Break habits Triggers stand out Blank slate

Question 33

Does liquid diet work for diabetes remission

Answer 33

Yes due to high weight loss

Question 34

What does it mean for someone to be in diabetes remission?

Answer 34

Must be measured at least 3 months after stopping glucose lowering medications Hba1c below 48mmol/mol

Question 35

Main principles of remission.

Answer 35

Type 2 diabetes More likely in short duration Significant weight loss Not a cure Maintaining lower weight

Question 36

Why could some people not achieve remission?

Answer 36

Insufficient weight loss Damage to beta cells too high Going back to old habits

Question 37

How long does remission last after bariatric surgery?

Answer 37

5 years

Question 38

How long did the liquid low calorie diet offer remission?

Answer 38

2 years

Question 39

Why is temporary remission worth it?

Answer 39

People who achieved it even for short periods of time continued to benefit from lower exposure to hyperglycaemia lower the risk of cardiovascular disease Requires weight loss of 10%

Question 40

How many people with a BMI over 40 don’t have diabetes?

Answer 40

70%

Question 41

What percentage of T2D people have a normal BMI?

Answer 41

15%

Question 42

What is the personal fat threshold hypothesis?

Answer 42

Proposes that we all have a level of body fat that we can cope with and if we go above me increase our risk of type 2 diabetes even if not overweight.

Question 43

For normal BMI participants what was the level of remission for the weight loss study?

Answer 43

70%