WHAT FACTORS CONTRIBUTE TO THE DEVELOPMENT OF DIABETES?

TYPES OF DIABETES

CONTRIBUTING FACTORS AND SCREENING RECOMMENDATIONS

Type 1 Diabetes

The cause of type 1 diabetes remains unknown. It seems to occur, primarily, as a result of an irreversible, immune-mediated destruction of beta cells in the pancreas. This process is likely brought on by environmental factors in genetically predisposed individuals.5 While it is possible to estimate a persons risk of developing type 1 diabetes by considering family history and profiling immunity and genetic markers, as it is currently not preventable, there is no advantage to such screening.6

Type 2 Diabetes

Being over 40 years of age Being overweight, especially if the weight is carried around the abdomen Being a member of a high-risk population: people of Aboriginal, African, Asian, Hispanic or South Asian descent Having a first degree relative (parent, brother or sister) with type 2 diabetes Having a history of prediabetes (see below) Having a history of gestational diabetes or having given birth to a high birth weight baby (over 4 kg or 9 lbs) Having a history of hypertension or dyslipidemia Being diagnosed with polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), or schizophrenia Showing signs of health complications associated with diabetes4,6 Screening for type 2 diabetes using a fasting plasma glucose (FPG) test should be performed every 3 years in individuals greater than 40 years of age. More frequent and/or earlier testing should be considered in people with additional risk factors for diabetes.6

 Gestational Diabetes

Being over 35 years of age Being obese (BMI of 30 kg/m2 or greater) Being a member of a high-risk population: people of Aboriginal, African, Asian, Hispanic or South Asian descent Having a history of gestational diabetes in a previous pregnancy or having given birth to a high birth weight baby (over 4 kg or 9 lbs) Being diagnosed with polycystic ovary syndrome or acanthosis nigricans Use of corticosteroids5,6

All pregnant women should be screened for gestational diabetes between 24 and 28 weeks gestation. Women with multiple risk factors should be screened during the first trimester.7

What is prediabetes?
Prediabetes is a state where blood glucose levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes.4 It is a practical way of describing a condition where a person has impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).8 While having prediabetes certainly places a person at risk for developing diabetes and its complications, it is important to note that not all individuals with prediabetes will necessarily progress to diabetes. Indeed, a significant proportion of people who are diagnosed with IFG or IGT will return to having normal blood glucose levels with proper lifestyle modification.8 People with prediabetes are at higher risk of developing diabetes and cardiovascular disease. Studies have shown that, for people with IGT, making lifestyle changes has been highly effective in delaying or preventing the onset of diabetes.8,9 Appropriate lifestyle changes included: increased physical activity (at least 150 minutes per week) eating low-calorie, low-fat meals some weight loss (even as little as 5-10% of total body weight)9

KEY POINT: Type 2 diabetes can be prevented in some people by

weight loss, healthy eating and adopting an active lifestyle.

PRACTICE TIP-HOW YOU CAN HELP

Flag patients that are 40 years of age and older or those less than 40 years of age with at least one risk factor so that the pharmacist can recommend they are screened for type 2 diabetes at least every 3 years.

What is metabolic syndrome?

Metabolic syndrome is a complex condition characterized by several abnormalities, including abdominal obesity, hypertension, dyslipidemia, insulin resistance, impaired kidney function and dysglycemia. Individuals with metabolic syndrome are at significant risk of developing diabetes and cardiovascular disease. Evidence supports an aggressive approach to identifying those with metabolic syndrome and treating both the hyperglycemia and cardiovasular risk factors. However, there is currently no consensus regarding an operational definition of metabolic syndrome.8