CDCES 2025
What is the current prevalence of preDM & DM in the US? -
✅"50% of people have preDM or DM
- 11%/37M c DM
- - 23% don't know it
- 38% c preDM
- 35% by 2050
- mostly non-white, uneducated, poor ppl"
What is the current prevalence of preDM in youth in the US? -
✅"- 23% black & hispanic
- 16% white
- 13% girls
- 23% boys"
What intervention is most likely to decrease DM in the US? -
✅Community health programs that address social inequities & improve access to care
What are the SDOH? -
✅"- healthcare access & quality
- neighborhood & built environment
- social & community context
- economic stability
- education access & quality"
What goes into our health? -
✅"- 40% socioeconomic factors
- 10% physical environment
- 30% health behaviors
- 20% healthcare"
What is the total cost of DM? -
✅"- $413B, 43% to hospital inpt care
- 32% of Medicare dollars
- PWD have 2-4x greater medical expenditures"
What does pancreatic insulin do? -
✅"- beta cells
- anabolic, stores glucose as glycogen in muscle & liver
- secreted in response to elevated glucose
- halts breakdown of glycogen in liver
- ^PRO synthesis & fat storage
- powerful hypoglycemic"
What does pancreatic amlyn do? -
✅"- beta cells
1
,- secreted 1:1 ratio c insulin
- causes satiety
- lowers post-prandial glucagon response
- slows gastric emptying
- T1 makes none
- T2 make less than normal"
What does pancreatic glucagon do? -
✅"- alpha cells
- opposes insulin active in the liver
- stimulated in response to low glucose levels
- stimulates liver to release glycogen to glucose
- inhibits liver glucose uptake
- causes hypergly
- ""party animal"" in T2D"
How long does exercise ^insulin sensitivity? -
✅25-48h
What are the s/s of DM? -
✅"- polyuria (H2O losses)
- polydipsia (dehydration)
- polyphasia (fuel depletion)
- wt loss and fatigue (poor energy utilization)
- skin and other infections (bacteria cafeteria)
- blurry vision (osmotic changes)
- erectile dysfunction (thick sticky blood)"
PreDM is defined as glucose of: -
✅"- FBG 100-125
- random 140-199
- A1C 5.7-6.4
* screen annually for DM
* refer to DPP
(50% working pancreas, 58% of ppl can revert back to healthy)"
What is the diagnostic criteria for DM? -
✅"- repeat all tests in the absence of clear hypergly
- if test abnormal, repeat same test on different day
- if one test normal & one abnormal, repeat the abnormal test
- Medicare uses FBG as criteria for DSMES reimbursement"
T1 autoimmune co-conditions: -
✅"- hashimoto thyroiditis
- Graves dz
- celiac dz
- vitiligo
- autoimmune hepatitis, gastritis
2
,- myasthenia gravis
- pernicious anemia
- dermatomyositis"
Why might T1D be increasing globally? -
✅"- changes in environmental exposure, ""better"" hygiene, ^childhood wt
- doubling every 20y
- autoimmune dz rising overall"
T1D considerations: -
✅"- 10% of all DM
- common between 10-14yo
- insulin sensitive
- doesn't respond to oral agents
- expression d/t combo of genes & environment (exposure to virus)"
How much insulin does a person need in a day? -
✅"- 0.5-1.0u/kg/d but individualized
- - 0.5u/kg most common
- - 0.3 if ^risk of hypo, thin, elderly, ^creat
- - 1.0 if heavy, steriods, infection
- 50% basal
- 50% bolus, divided into 3 meals, if odd number give more at lunch or dinner
- if ^risk of hypo, use basal + correction (no bolus)"
What lab markers are features of T1D? -
✅"- positive GAD (primary marker), IA2 or ZnT8 antibodies
- low C-peptide tested less often
* Misdiagnosing T1 for T2 is common, 40% of the time
* 25% of ppl c T1D also have T2/insulin resistance"
AABBCC of T1D: -
✅"- age, <35yo, 75% <18yo
- autoimmunity, personal or family hx
- body habitus, BMI <25
- background, family hx T1
- control, ^BG levels on noninsulin therapies
- comorbitiies, other autoimmune conditions or CA tx"
What are the most discriminating factors of T1D? -
✅"- <35yo
- BMI <25
- UWL
- ketoacidosis, low pH
- BG 360+
Other s/s:
- ^thirst & hunger
3
, - frequent urination or bedwetting
- fatigue, irritability"
What are characteristics stage 1 T1D? -
"- normoglycemia
- presymptomatic
- multiple autoantibodies"
What are characteristics stage 2 T1D? -
"- dysglycemia (preDM range)
- presymptomatic
- multiple autoantibodies
- screen A1C every 6m
- 75g OGTT annually
- may benefit from CGM to monitor progress
- may be able to slow progress two additional yrs with Teplizumab (Tzield), monoclonal antibody"
What are characteristics stage 3 T1D? -
"- overt hyperglycemia (DM levels)
- symptomatic
- autoantibodies may disappear over time"
What nonprofit studies T1D? -
trialnet.org
What ^B-cell demand and ^the progression of T1D? -
"- less physical activity
- high glycemic foods
- excess sugar intake"
What reduces the risk of T1D progression? -
- daily vigorous physical exercise
What is latent autoimmunity DM in adults (LATA)? -
"- positive antibodies, autoimmune destruction
- adult age at onset
- usually needs insulin w/i 6m of DX, early insulin therapy may preserve beta cell funtion"
What are the clinical features of LATA? -
"- age >50yo
- acute hypergly
- BMI <25
- hx autoimmune dz
- family hx autoimmune dz"
What are the BMI categories? -
"- <20, underwt
- 20-25, healthy
- 26-29 overwt
4
What is the current prevalence of preDM & DM in the US? -
✅"50% of people have preDM or DM
- 11%/37M c DM
- - 23% don't know it
- 38% c preDM
- 35% by 2050
- mostly non-white, uneducated, poor ppl"
What is the current prevalence of preDM in youth in the US? -
✅"- 23% black & hispanic
- 16% white
- 13% girls
- 23% boys"
What intervention is most likely to decrease DM in the US? -
✅Community health programs that address social inequities & improve access to care
What are the SDOH? -
✅"- healthcare access & quality
- neighborhood & built environment
- social & community context
- economic stability
- education access & quality"
What goes into our health? -
✅"- 40% socioeconomic factors
- 10% physical environment
- 30% health behaviors
- 20% healthcare"
What is the total cost of DM? -
✅"- $413B, 43% to hospital inpt care
- 32% of Medicare dollars
- PWD have 2-4x greater medical expenditures"
What does pancreatic insulin do? -
✅"- beta cells
- anabolic, stores glucose as glycogen in muscle & liver
- secreted in response to elevated glucose
- halts breakdown of glycogen in liver
- ^PRO synthesis & fat storage
- powerful hypoglycemic"
What does pancreatic amlyn do? -
✅"- beta cells
1
,- secreted 1:1 ratio c insulin
- causes satiety
- lowers post-prandial glucagon response
- slows gastric emptying
- T1 makes none
- T2 make less than normal"
What does pancreatic glucagon do? -
✅"- alpha cells
- opposes insulin active in the liver
- stimulated in response to low glucose levels
- stimulates liver to release glycogen to glucose
- inhibits liver glucose uptake
- causes hypergly
- ""party animal"" in T2D"
How long does exercise ^insulin sensitivity? -
✅25-48h
What are the s/s of DM? -
✅"- polyuria (H2O losses)
- polydipsia (dehydration)
- polyphasia (fuel depletion)
- wt loss and fatigue (poor energy utilization)
- skin and other infections (bacteria cafeteria)
- blurry vision (osmotic changes)
- erectile dysfunction (thick sticky blood)"
PreDM is defined as glucose of: -
✅"- FBG 100-125
- random 140-199
- A1C 5.7-6.4
* screen annually for DM
* refer to DPP
(50% working pancreas, 58% of ppl can revert back to healthy)"
What is the diagnostic criteria for DM? -
✅"- repeat all tests in the absence of clear hypergly
- if test abnormal, repeat same test on different day
- if one test normal & one abnormal, repeat the abnormal test
- Medicare uses FBG as criteria for DSMES reimbursement"
T1 autoimmune co-conditions: -
✅"- hashimoto thyroiditis
- Graves dz
- celiac dz
- vitiligo
- autoimmune hepatitis, gastritis
2
,- myasthenia gravis
- pernicious anemia
- dermatomyositis"
Why might T1D be increasing globally? -
✅"- changes in environmental exposure, ""better"" hygiene, ^childhood wt
- doubling every 20y
- autoimmune dz rising overall"
T1D considerations: -
✅"- 10% of all DM
- common between 10-14yo
- insulin sensitive
- doesn't respond to oral agents
- expression d/t combo of genes & environment (exposure to virus)"
How much insulin does a person need in a day? -
✅"- 0.5-1.0u/kg/d but individualized
- - 0.5u/kg most common
- - 0.3 if ^risk of hypo, thin, elderly, ^creat
- - 1.0 if heavy, steriods, infection
- 50% basal
- 50% bolus, divided into 3 meals, if odd number give more at lunch or dinner
- if ^risk of hypo, use basal + correction (no bolus)"
What lab markers are features of T1D? -
✅"- positive GAD (primary marker), IA2 or ZnT8 antibodies
- low C-peptide tested less often
* Misdiagnosing T1 for T2 is common, 40% of the time
* 25% of ppl c T1D also have T2/insulin resistance"
AABBCC of T1D: -
✅"- age, <35yo, 75% <18yo
- autoimmunity, personal or family hx
- body habitus, BMI <25
- background, family hx T1
- control, ^BG levels on noninsulin therapies
- comorbitiies, other autoimmune conditions or CA tx"
What are the most discriminating factors of T1D? -
✅"- <35yo
- BMI <25
- UWL
- ketoacidosis, low pH
- BG 360+
Other s/s:
- ^thirst & hunger
3
, - frequent urination or bedwetting
- fatigue, irritability"
What are characteristics stage 1 T1D? -
"- normoglycemia
- presymptomatic
- multiple autoantibodies"
What are characteristics stage 2 T1D? -
"- dysglycemia (preDM range)
- presymptomatic
- multiple autoantibodies
- screen A1C every 6m
- 75g OGTT annually
- may benefit from CGM to monitor progress
- may be able to slow progress two additional yrs with Teplizumab (Tzield), monoclonal antibody"
What are characteristics stage 3 T1D? -
"- overt hyperglycemia (DM levels)
- symptomatic
- autoantibodies may disappear over time"
What nonprofit studies T1D? -
trialnet.org
What ^B-cell demand and ^the progression of T1D? -
"- less physical activity
- high glycemic foods
- excess sugar intake"
What reduces the risk of T1D progression? -
- daily vigorous physical exercise
What is latent autoimmunity DM in adults (LATA)? -
"- positive antibodies, autoimmune destruction
- adult age at onset
- usually needs insulin w/i 6m of DX, early insulin therapy may preserve beta cell funtion"
What are the clinical features of LATA? -
"- age >50yo
- acute hypergly
- BMI <25
- hx autoimmune dz
- family hx autoimmune dz"
What are the BMI categories? -
"- <20, underwt
- 20-25, healthy
- 26-29 overwt
4
