Diabetes

• Diabetes mellitus is a chronic condition caused by relative or absolute insulin deficiency
• Type 1 diabetes


  • Autoimmune destruction of beta cells
  • Honeymoon phase
  • LADA
  • Other autoimmune disease
  • Lifelong requirement for insulin
  • DKA risk
• Type 2 diabetes


  • Increasing loss of beta cell insulin production
  • Insulin resistance
• Diabetes in pregnancy


  • Affects approximately 10% of pregnancies
  • Preconception planning
  • 5mg folate
  • Up to 50% risk of T2D within 10 years
• Other types of diabetes


  • Secondary to pancreatic disorders
  • Monogenic diabetes
  • Drug induced
  • Endocrinopathies
  • Immune mediated
  • Associated with other genetic syndromes
• Who is at risk of Type 2 diabetes


  • Screen if >18years
  • Lifestyle interventions
  • Annual HbA1c review
  • For every 1kg weight loss relative risk reduction of type 2 diabetes of 16%
• Diabetes contributes to 10% of Australian deaths

  
• Retinopathy affects 1 in 3 people with diabetes
• People with diabetes have 2-3 times risk of cardiovascular disease
• 1 in 4 people with diabetes have peripheral sensory neuropathy
• 1 in 3 people with diabetes have kidney disease
• Diabetes is associated with psychological effects and increased risk of cognitive impairment
• 71% of people with diabetes have multi-morbidity
• Early onset diabetes


  • Careful diagnosis
  • Increased mortality
  • Greater burden of complications
  • Require aggressive risk factor management
  • Issues of engagement and adherence
• Diabetes - a progressive disease?


  • Optimal diabetes management is about success, not failure
  • Type 2 diabetes remission is defined as a sustained improvement in blood glucose where HbA1c levels remain below 6.5% (48mmol/mol) for at least 3 months in the absence of glucose-lowering medications
• Optimise quality of life, no substitute for healthy lifestyle!
• Diabetes is a high risk medicine