Clinical Skills Pearl Vol 2 (#18): Diabetes

I have told the medical students that if you know nothing but diabetes and alcoholism you know more than most....this week is about diabetes....so here are the questions:

Is life expectancy altered by diabetes and by how much?
What is the prevelance of diabetes in the population?
Are all races at the same risk for diabetes?
What factors predispose for diabetes?

Diabetes Mellitus (DM) is a disease caused by deficiency or diminished effectiveness of endogenous insulin. It is characterized by hyperglycaemia, deranged metabolism and sequelae predominantly affecting the vasculature.

Life expectancy is reduced by 15 years in Type 1 diabetes; 5-7 years in Type 2 diabetes.

Prevalence models suggest the true prevalence is close to 5%. The incidence of diabetes is increasing in all age groups. Type 1 diabetes is increasing in children (especially <5 years), and type 2 diabetes is increasing particularly in black and minority ethnic groups.

People of South Asian, African and African-Caribbean and Middle-Eastern descent are at greater risk of type 2 diabetes, compared with the white population. People who are obese, are inactive or have a family history are also at increased risk of type 2 diabetes.

Other factors predisposing to DM, Gestational Diabetes and impaired glucose tolerance Drugs: steroids and thiazides
Pancreatic disease: acute and chronic pancreatitis (including surgery if 90% pancreas removed), haemochromatosis, cystic fibrosis. Endocrine disease: Cushing's, acromegaly, phaeochromocytoma, thyrotoxicosis.
Others: acanthosis nigricans, congenital lipodystrophy with insulin receptor antibodies, Wolfram syndrome (DIDMOAD),4 and glycogen storage diseases.

Reference:
http://www.patient.co.uk/showdoc/40000914/

Posted on behalf of Dr. M. Luterman