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group_4_presentation_1_-_diabetes_mellitus [2018/09/28 17:08] markovif [Mechanisms] |
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| ===== Introduction ===== | ===== Introduction ===== | ||
| Diabetes mellitus (commonly referred to as diabetes) is a group of metabolic disorders caused by defects of insulin secretion. The prevalence of this disease has skyrocketed since the beginning of the 21st century, becoming the seventh most common global cause of death in 2016 (World Health Organization, 2018). This increase is most likely due to the lifestyle shift in North American and European countries. The domination of fast food chains and increased automation in the workplace and streets has lead to a decrease in physical activity and healthy eating habits. | Diabetes mellitus (commonly referred to as diabetes) is a group of metabolic disorders caused by defects of insulin secretion. The prevalence of this disease has skyrocketed since the beginning of the 21st century, becoming the seventh most common global cause of death in 2016 (World Health Organization, 2018). This increase is most likely due to the lifestyle shift in North American and European countries. The domination of fast food chains and increased automation in the workplace and streets has lead to a decrease in physical activity and healthy eating habits. | ||
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| There are four major categories of this disease: Type 1 diabetes, Type 2 diabetes, gestational diabetes, and specialized types of diabetes (Egan and Dinneen, 2014). Type 1 diabetes is caused by the destruction of pancreatic β-cells. The most common method of destruction being facilitated by the body’s inflammatory response. Type 2 diabetes is caused by insulin resistance, which is mediated by dysfunctional pancreatic β-cells. Gestational diabetes occurs when the onset of diabetes is during pregnancy. The final major category of diabetes (specialized types) encompasses a large variety of diseases that can be categorized as diabetes but have different onsets and mechanisms from the first three categories. The most common example is maturity-onset diabetes of the young (MODY), which is an inherited form of diabetes and associated with mutations in hepatic genes (Egan and Dinneen, 2014). | There are four major categories of this disease: Type 1 diabetes, Type 2 diabetes, gestational diabetes, and specialized types of diabetes (Egan and Dinneen, 2014). Type 1 diabetes is caused by the destruction of pancreatic β-cells. The most common method of destruction being facilitated by the body’s inflammatory response. Type 2 diabetes is caused by insulin resistance, which is mediated by dysfunctional pancreatic β-cells. Gestational diabetes occurs when the onset of diabetes is during pregnancy. The final major category of diabetes (specialized types) encompasses a large variety of diseases that can be categorized as diabetes but have different onsets and mechanisms from the first three categories. The most common example is maturity-onset diabetes of the young (MODY), which is an inherited form of diabetes and associated with mutations in hepatic genes (Egan and Dinneen, 2014). | ||
| - | The focus of this wiki page will be on Type 1 and Type 2 diabetes, where we will discuss the diseases’ risk factors, symptoms, diagnosis, epidemiology, etiology, pathophysiology, and treatment methods. | + | |
| + | The focus of this wiki page will be on Type 1 and Type 2 diabetes, where risk factors, symptoms, diagnosis, epidemiology, etiology, pathophysiology, and treatment methods will be discussed. | ||
| ===== Epidemiology ===== | ===== Epidemiology ===== | ||
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| ===== Mechanisms ===== | ===== Mechanisms ===== | ||
| - | The primary regulator of blood glucose uptake is the hormone Insulin. Insulin most commonly acts upon the IGF-1 receptor located across the cell membrane. A Deficiency of insulin or an issue with its receptors therefore plays a major role in the development of all types of diabetes. | + | The primary regulator of blood glucose uptake is the hormone Insulin. Insulin most commonly acts upon the IGF-1 receptor located across the cell membrane (Siddiqui, 2013). A Deficiency of insulin or an issue with its receptors therefore plays a major role in the development of all types of diabetes. |
| == Insulin Signal Transduction Pathway == | == Insulin Signal Transduction Pathway == | ||
| - | Insulin is released into the bloodstream from β-cells located in islets of Langerhans, a region of the pancreas. When a rise in blood glucose occurs, glucose enters the β-cell through the GLUT-2 inter-membrane receptor. It is then through a signal transduction cascade that voltage-gated calcium ion channels open, allowing extracellular calcium ions to enter the cell. Ca2+ can then activate insulin-gene expression via CREB (Calcium Responsive Element Binding Protein). At the same time, Ca2+ binds to insulin storing vesicles, which causes exocytosis of the insulin in the bloodstream. | + | Insulin is released into the bloodstream from β-cells located in islets of Langerhans, a region of the pancreas. When a rise in blood glucose occurs, glucose enters the β-cell through the GLUT-2 inter-membrane receptor. It is then through a signal transduction cascade that voltage-gated calcium ion channels open, allowing extracellular calcium ions to enter the cell. Ca2+ can then activate insulin-gene expression via CREB (Calcium Responsive Element Binding Protein). At the same time, Ca2+ binds to insulin storing vesicles, which causes exocytosis of the insulin in the bloodstream (Siddiqui, 2013). |
| {{:465px-glucose-insulin-release.svg.png?300|}} | {{:465px-glucose-insulin-release.svg.png?300|}} | ||
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| **Figure 4** Insulin release pathway of pancreatic β-cells | **Figure 4** Insulin release pathway of pancreatic β-cells | ||
| - | Upon reaching the target cell, Insulin can then bind to the extracellular portion of the IGF-1 tyrosine receptor kinase. Through a signal transduction cascade, vesicles containing GLUT-4 inter-membrane transport proteins are secreted to the cell membrane, where glucose enters through passive diffusion. | + | Upon reaching the target cell, Insulin can then bind to the extracellular portion of the IGF-1 tyrosine receptor kinase. Through a signal transduction cascade, vesicles containing GLUT-4 inter-membrane transport proteins are secreted to the cell membrane, where glucose enters through passive diffusion (Siddiqui, 2013). |
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| == Relevance to Diabetes Type I and II == | == Relevance to Diabetes Type I and II == | ||
| - | It is at two places in the insulin signaling mechanisms that diabetes can occur. In the case of Diabetes Type 1, insulin is either being produced in minimal quantities or none at all. This could be caused by numerous issues, such as lack of insulin-gene expression, improper transcription, translation, or folding of the protein, and non-functioning β-cells to name only a few. | + | It is at two places in the insulin signaling mechanisms that issues can occur. Within the islets of Langerhans, insulin can either being produced in minimal quantities or none at all. This could be caused by numerous issues, such as lack of insulin-gene expression, improper transcription, translation, or folding of the protein, and non-functioning β-cells to name only a few. |
| - | In type II diabetes, there are minimal or complete absence of functioning insulin tyrosine receptor kinases. Like all proteins, there are numerous places in the protein biosynthesis pathway that can cause a malfunction in the proteins or an absence of protein production. | + | At the target cells. Insulin may be non-functioning when binding to IGF-1 receptors. Like all proteins, there are numerous places in the protein biosynthesis pathway that can cause a malfunction in the proteins or an absence of protein production. |
| ===== Treatment ===== | ===== Treatment ===== | ||
| == Management == | == Management == | ||
| - | Diabetes is a chronic disease, meaning that there is no known cure. However, there are ways to actively manage and control the disease through factors such as lifestyle choices and medication. The most frequent method of management is controlling blood sugar levels. The goal of management is to keep blood sugar within a range close to what would be considered normal, without causing low blood sugar. Once diagnosed, the patient must go through significant lifestyle changes, such as losing weight, increasing activity, switching diets, insulin injections as well as oral medications in the case of type II diabetes. | + | Diabetes is a chronic disease, meaning that there is no known cure. However, there are ways to actively manage and control the disease through factors such as lifestyle choices and medication. The most frequent method of management is controlling blood sugar levels. The goal of management is to keep blood sugar within a range close to what would be considered normal, without causing low blood sugar (National Institute for Health and Clinical Excellence, 2008). Once diagnosed, the patient must go through significant lifestyle changes, such as losing weight, increasing activity, switching diets, insulin injections as well as oral medications in the case of type II diabetes (Haw, 2017). |
| A major part of the disease treatment is through education. Since the progress of the disease depends a lot on personal lifestyle choices, it is important that patients continue learning and actively taking part in their treatment program. | A major part of the disease treatment is through education. Since the progress of the disease depends a lot on personal lifestyle choices, it is important that patients continue learning and actively taking part in their treatment program. | ||
| == Medication == | == Medication == | ||
| - | Medications used to treat diabetes act on lowering blood sugar levels. There are different types of anti-diabetic medications. Oral medication, such as metformin, is commonly prescribed while others are administered by injections. Type 1 diabetes can only be treated with insulin, either through insulin injections or insulin analogs. | + | Medications used to treat diabetes act on lowering blood sugar levels. There are different types of anti-diabetic medications. Oral medication, such as metformin, is commonly prescribed while others are administered by injections. Type 1 diabetes can only be treated with insulin, either through insulin injections or insulin analogs (National Institute for Health and Clinical Excellence, 2008). |
| == Surgery == | == Surgery == | ||
| - | Weight loss surgery is usually recommended for obese patients to promote long term blood glucose control. Operations such as gastric bypass may be conducted in order for patients to gain more control over their weight. Post-operation, many patients are able to control their blood glucose without the use of any medication. Long term mortality and complications from both diabetes and obesity are also decreased. However, around 1% of patients have increased short term risks of mortality post surgery. Usually, this surgery is considered for patients that are unable to get both blood sugar and weight under control. | + | Weight loss surgery is usually recommended for obese patients to promote long term blood glucose control. Operations such as gastric bypass may be conducted in order for patients to gain more control over their weight (Mottalib, 2017). Post-operation, many patients are able to control their blood glucose without the use of any medication. Long term mortality and complications from both diabetes and obesity are also decreased. However, around 1% of patients have increased short term risks of mortality post surgery (Mottalib, 2017). Usually, this surgery is considered for patients that are unable to get both blood sugar and weight under control. |
| Under certain circumstances, a pancreas transplant may be considered for patients suffering from type I diabetes. However, transplants are usually reserved for cases where a person may be suffering from severe complications, such as organ failure. | Under certain circumstances, a pancreas transplant may be considered for patients suffering from type I diabetes. However, transplants are usually reserved for cases where a person may be suffering from severe complications, such as organ failure. | ||
| == Prevention == | == Prevention == | ||
| - | Type I diabetes has no known means of prevention, however Type II diabetes can either be prevented or delayed through healthy lifestyle choices such as exercise, healthy diets, and maintaining a healthy body weight. Decreasing sugar intake and increasing foods rich in fiber have been known to decrease risk factors. Consuming less saturated fats along with quitting smoking have also shown to decrease type II diabetes risk factors as well. | + | Type I diabetes has no known means of prevention, however Type II diabetes can either be prevented or delayed through healthy lifestyle choices such as exercise, healthy diets, and maintaining a healthy body weight. Decreasing sugar intake and increasing foods rich in fiber have been known to decrease risk factors. Consuming less saturated fats along with quitting smoking have also shown to decrease type II diabetes risk factors as well (Haw, 2017). |
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| - | {{:past.jpg?400}} | + | |
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| - | **Figure 7**: The bihormonal bionic endocrine pancreas used in the clinical trial. (Russell, 2012) | + | |
| == Future Treatment == | == Future Treatment == | ||
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| - | ===== Conclusion ===== | + | ===== Final Remarks ===== |
| - | In conclusion, Type 1 and Type 2 diabetes are both prevalent global diseases with long term consequences. Although there is still much we do not understand about the diseases, we have come a long way and are advancing at a remarkable rate. The rate that the disease has been diagnosed should alarm all health organizations and encourage everyone to implement more preventative programs encouraging active, healthy lifestyles. This is especially true for North America, with the current culture of fast food and sedentary lifestyle. By maintaining diligence in our research, we can continue to find ways to make the disease more manageable for day-to-day living. | + | Type 1 and Type 2 diabetes are both prevalent global diseases with long term consequences. Although there is still much that is not understood, researchers have come a long way and are advancing at a remarkable rate. The rate that the disease has been diagnosed should alarm all health organizations and encourage everyone to implement more preventative programs encouraging active, healthy lifestyles. This is especially true for North America, with the current culture of fast food and sedentary lifestyle. However, current research will continue to find ways to make the disease more manageable for day-to-day living. |
| ===== References ===== | ===== References ===== | ||
| - | American Diabetes Association. (2017, August 28). Diabetes Symptoms. Retrieved September 25, 2018, from http://www.diabetes.org/diabetes-basics/symptoms/ | + | American Diabetes Association. (2017). Diabetes Symptoms. Retrieved from: http://www.diabetes.org/diabetes-basics/symptoms/ |
| - | “Are You at Risk?” Canadian Diabetes Association, Canadian Diabetes Association, 1 Jan. 2018, www.diabetes.ca/about-diabetes/risk-factors/are-you-at-risk. | + | Are You at Risk?. (2018). Canadian Diabetes Association. Retrieved from: www.diabetes.ca/about-diabetes/risk-factors/are-you-at-risk. |
| - | Baynest, H. W. (2015). Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. Journal of Diabetes & Metabolism, 06(05). doi:10.4172/2155-6156.1000541 | + | Baynest W. (2015). Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus. Journal of Diabetes & Metabolism, 06(05). doi:10.4172/2155-6156.1000541 |
| - | Centers for Disease Control and Prevention. (2017). National diabetes statistics report, 2017. Atlanta, GA: Centers for Disease Control and Prevention. | + | Centers for Disease Control and Prevention. (2017). National diabetes statistics report. Atlanta, GA: Centers for Disease Control and Prevention. |
| Classification and Diagnosis of Diabetes. (2014). Diabetes Care, 38(Supplement_1), S8-S16. doi: 10.2337/dc15-s005 | Classification and Diagnosis of Diabetes. (2014). Diabetes Care, 38(Supplement_1), S8-S16. doi: 10.2337/dc15-s005 | ||
| - | Dean L, McEntyre J. (2004). The Genetic Landscape of Diabetes. Retrieved April 5, 2011 from NCBI. | + | Dean L., McEntyre J. (2004). The Genetic Landscape of Diabetes. Retrieved April 5, 2011 from NCBI. |
| Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33(Supplement_1), S62-S69. doi: 10.2337/dc10-s062 | Diagnosis and Classification of Diabetes Mellitus. (2009). Diabetes Care, 33(Supplement_1), S62-S69. doi: 10.2337/dc10-s062 | ||
| - | Eckel RH. Metabolic syndrome. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrisons Principles of Internal Medicine. 17th ed. New York, | + | Eckel RH. Metabolic syndrome. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, eds. Harrisons Principles of Internal Medicine. 17th ed. New York, New York. McGraw-Hill;2008:1509-1514. |
| - | New York. McGraw-Hill;2008:1509-1514. | + | |
| - | Egan, A. M., & Dinneen, S. F. (2014). What is diabetes?. Medicine, 42(12), 679-681. | + | Ega, M., & Dinneen F. (2014). What is diabetes?. Medicine, 42(12), 679-681. |
| - | Forouhi, N., & Wareham, N. (2014). Epidemiology of diabetes. Medicine, 42(12), 698-702. doi: 10.1016/j.mpmed.2014.09.007 | + | Forouhi N., & Wareham N. (2014). Epidemiology of diabetes. Medicine, 42(12), 698-702. doi: 10.1016/j.mpmed.2014.09.007 |
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| + | Haw S., Galaviz I., Straus N., Kowalski J., Magee J., Weber B., Wei J., Narayan M., Ali K. (2017). Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Internal Medicine. 177 (12): 1808–1817 | ||
| McCarthy MI. (2010). Genomics, type 2 diabetes, and obesity. New England Journal of Medicine, 363(24), 2339-2350. | McCarthy MI. (2010). Genomics, type 2 diabetes, and obesity. New England Journal of Medicine, 363(24), 2339-2350. | ||
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| MNT Editorial, T. (2016, January 05). Diabetes Symptoms: Common Symptoms of Diabetes. Retrieved September 25, 2018, from | MNT Editorial, T. (2016, January 05). Diabetes Symptoms: Common Symptoms of Diabetes. Retrieved September 25, 2018, from | ||
| https://www.medicalnewstoday.com/info/diabetes/diabetessymptoms.php | https://www.medicalnewstoday.com/info/diabetes/diabetessymptoms.php | ||
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| + | Mottalib A., Kasetty M., Mar Y., Elseaidy T., Ashrafzadeh S., Hamdy O. (2017). Weight Management in Patients with Type 1 Diabetes and Obesity. Current Diabetes Reports. 17 (10): 92. doi:10.1007/s11892-017-0918-8 | ||
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| + | National Institute for Health and Clinical Excellence. (2008). Clinical guideline 66: Type 2 diabetes. London. | ||
| Pathophysiology Research. (2017). Retrieved September 25, 2018, from https://www.diabetes.ca/research/research-funding/pathophysiology-research | Pathophysiology Research. (2017). Retrieved September 25, 2018, from https://www.diabetes.ca/research/research-funding/pathophysiology-research | ||
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| Shechter, Y., & Shisheva, A. (1993). Vanadium salts and the future treatment of diabetes. Endeavour, 17(1), 27-31. | Shechter, Y., & Shisheva, A. (1993). Vanadium salts and the future treatment of diabetes. Endeavour, 17(1), 27-31. | ||
| - | Siddiqui, A. A., Siddiqui, S. A., Ahmad, S., Siddiqui, S., Ahsan, I., & Sahu, K. (2004). Diabetes: Mechanism, Pathophysiology and Management. International Journal of Drug | + | Siddiqui A., Siddiqui S., Ahmad S., Siddiqui S., Ahsan I., Sahu K. (2004). Diabetes: Mechanism, Pathophysiology and Management. International Journal of Drug Development and Research, 21-43. doi:10.1016/b978-012732350-3/50003-x |
| - | Development and Research, 21-43. doi:10.1016/b978-012732350-3/50003-x | + | |
| - | Siddiqui A, Siddiqui S, Ahmad S, Siddiqui S, Ahsan I, Sahu k. “Diabetes: Mechanism, Pathophysiology and Management-A Review” Int. J. Drug Dev. & Res., April-June 2013, 5(2): 1-23. | + | Siddiqui A., Siddiqui S., Ahmad S., Siddiqui S., Ahsan I., Sahu k. (2013). Diabetes: Mechanism, Pathophysiology and Management-A Review. Int. J. Drug Dev. & Res., 5(2): 1-23. |
| - | Symptoms & Causes of Diabetes. (2016, November 01). Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes | + | Symptoms & Causes of Diabetes. (2016). Retrieved from: https://www.niddk.nih.gov/healthinformation/diabetes/overview/symptoms-causes |
| TEDDY Study Group. (2008). The environmental determinants of diabetes in the young (TEDDY) study. Annals of the New York Academy of Science, 1150, 1-13. | TEDDY Study Group. (2008). The environmental determinants of diabetes in the young (TEDDY) study. Annals of the New York Academy of Science, 1150, 1-13. | ||
| - | "The top 10 causes of death Fact sheet N°310". World Health Organization. May 24, 2018. | + | The top 10 causes of death Fact sheet N°310. World Health Organization. May 24, 2018. |
| World Health Organization. Global report on diabetes. World Health Organization, 2016. | World Health Organization. Global report on diabetes. World Health Organization, 2016. | ||
| - | Yeung WC, Rawlinson WD, Craid ME. (2011). Enterovirus infection and type1 diabetes mellitus: systematic review and meta-analysis of observational studies. BMJ, 3, 342, d35. | + | Yeung C., Rawlinson D., Craid E. (2011). Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational studies. BMJ, 3, 342, d35. |
