HTHSCI 3BB3 - F2023 - 9A - Diabetes Guest Lecture

gestational diabetes

glucose intolerance with onset or first recognition during pregnancy.

prediabetes

term for impaired fasting glucose (IFG) & impaired glucose tolerance (IGT) place individuals at risk of developing diabetes and its complications.

impaired fasting glucose

6.1-6.9 mmol/L

impaired glucose tolerance

7.8-11 mmol/L

metabolic syndrome

3 of:

- Prediabetes/diabetes

- BP > 130/85 mm/Hg

- TG > 1.7 mmol/L

- HDL < 1.0 mmol/L (men); 1.3 (women)

- Abdominal obesity > 102 cm (men); 88 (women)

Perfect storm diabetes

- Population is aging

- Overweight and Obesity rates are increasing

- Sedentary lifestyles

diabetes + prediabetes population is what percent of population

33%

Pathophysiology of T2DM

- insulin resistance;

- an insulin secretory defect that is not autoimmune-mediated

- an increase in glucose production by the liver.

- Incretin hormones and the gut.

Nutrition recommendations to decrease diabetes

1. Nutrition counselling by a Registered Dietitian.

2. Encouraged to follow Eating Well with Canada's Food

Guide (aim for balance, timing/spacing of meals).

3. Choose low glycemic index carbohydrates.

4. Sucrose and sucrose-containing foods can be substituted for other carbohydrates (max. of 10% of total daily energy).

5.Consume < 7% of total daily energy from saturated fats and should limit intake of trans fatty acids to a minimum.

6. Other dietary patterns -Mediterranean & Vegan!

Protective factors associated with Mediterranean diet

higher intake of vegetables, legumes, fruits, nuts, whole grains,

cheese/yogurt, fish and monounsaturated fats

low calorie diets

improvements in weight loss, diabetes remission and lipid profiles

intermittent fasting

shows promise for treatment of obesity

Physical Activity recommendations according to CDA 2018 CPG

- Accumulate 150 minutes of aerobic exercise/week (spread over at least 3 days of the week).

- Resistance exercise at least 2 times per week (preferred 3 times/week). (Initial instruction /supervision is recommended).

- People with possible CVD or microvascular complications should be assessed (medical evaluation)

Smoking information according to CDA 2018 CPG

Increases risk of MI (3-fold), stroke (30%) and progression to end stage renal disease (chronic kidney disease).

Smoking cessation is recommended and supported.

Smoking in people with diabetes is

an independent risk factor for all cause mortality.

Individuals with diabetes should be screened routinely for:

subclinical psychological distress (depressive and anxious symptoms) and psychiatric disorders, interview or by standardized questionnaires.

Structured lifestyle modification that includes moderate weight loss (5%), regular physical activity =

risk reduction for T2DM was approximately 58% at 4 years. (DPP Trial Group, NEJM, 2001 & 2002).

Lifestyle interventions (exercise/diet) for those at risk =

= 7 studies showed a decreased risk for T2DM up to 10 years after the intervention (Schellenberg, 2013)

how to prevent diabetes:

a) healthy eating; & b) increasing physical activity.

What do incretin medications do?

can help to regulate metabolic hormones, help with weight loss.

Type 2 diabetes remission is:

- Achieving glycated hemoglobin (A1C between 6.0% and 6.4%)

- no medications for 3 months.

Which diabetes remission technique is used for achieving >15 kg body weight loss.?

Low-calorie (~800 to 850 kcal/day) diets with meal replacement products (3 to 5 months)

Which diabetes remission technique promotes modest weight loss (~5% to 7% of initial body weight),?

Exercise training (aiming for 240 to 420 min/week of structured physical activity spread over 5 days per week)

NCD perfect storm

tobacco use e

unhealthy diet

physical inactivity

alcohol use

NCD Prevention

healthy lifestyle: Smoking cessation, Stress management, Alcohol intake

physical activity: Weight loss, Cardio/wt training

healthy eating: Sodium restriction, High fibre

GWAS

Genome wide association studies (GWAS) are being led to determine cardiovascular and metabolic phenotypes in humans.

built environment

studying our environment geographically, such as urbanization, pollution, walkability, bike friendly cites, etc.

Chemical environment

studying the chemicals that are disrupting our endocrine system (mimic estrogens)...known as obesogens

how do obesogens affect the body

DNA is not mutated, but expressed differently.

Occurs as early as in utero.