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Clinical Gems

Our clinical gems come from the top selling medical books, and text books because knowledge is everything when it comes to diabetes.

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #17: Development and Maintenance of the Islet Beta Cell Part 1 of 4

The discovery of insulin by Banting and Best in the early 1920s marked the beginning of a new era of diabetes research that focused on the study of insulin and the biology of the hormone-producing cells of the pancreas. In the ensuing decades, although much was learned regarding the synthesis, structure, and action of insulin, the developmental origins of insulin-producing β cells remained ambiguous.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #16: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 5 of 5

Obesity and weight gain have consistently been shown to be the one of the strongest modifiable risk factors for diabetes. The ratio of a person’s weight in kilograms divided by the square of their height in meters called the body mass index (BMI) has been used in numerous studies as a surrogate for obesity. In a representative sample of the US population, each unit increase in BMI was associated with a 12% increased risk of T2DM. Compared to people with BMI less than 22 kg/m2 those with BMI of 25–27 kg/m2 had 2.75 times the risk of diabetes, and each kilogram increase in body weight over 10 years was associated with a 4.5% increase in diabetes risk.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #15: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 4 of 5

Type 2 diabetes was historically a rare occurrence in children but recent studies have reported marked increases in the prevalence of T2DM in children. Type 2 diabetes was first reported in a population-based study in 1979 of American Indian children in Arizona. This American Indian community has one of the highest rates of T2DM in adults and obesity in both adults and children.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #13: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 2 of 5

Age- and sex-specific prevalence of diabetes: The prevalence of diabetes has been estimated by applying the WHO 1999 criteria for 13 European and 11 Asian cohorts participating in the DECODE and the DECODA studies. In Europe, the age-specific prevalence of diabetes rose with age up to 70s and 80s in both men and women.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #12: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 1 of 5

Age- and sex-specific prevalence of type 2 diabetes in different ethnic groups: Type 2 diabetes mellitus (T2DM) is now taking its place as one of the main threats to human health in the twenty-first century. In 1921, Dr Elliot Joslin was already concerned that according to his count there had been a doubling of diabetes in three decades. The impact of T2DM is increasingly felt around the world, with its prevalence rising dramatically over recent decades.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #11: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 5 of 5

In industrialized countries, 20–40% of T1DM patients younger than 20 years present with diabetic ketoacidosis. After adjusting for age, gender, ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education. Younger children present with more severe symptoms at diagnosis, because children younger than 7 years old have lost on average 80% of the islets, compared to 60% in those 7–14 years old and 40% in those older than 14 years.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #10: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 4 of 5

Twin and family studies indicate that genetic factors alone cannot explain the etiology of T1DM. Seasonality, increasing incidence and epidemics of T1DM as well as numerous ecological, cross-sectional and retrospective studies suggest a critical role of environmental factors, such as infections with certain viruses (especially enteric infections in early life) and effects of early childhood diet. Natural history studies that follow children at increased risk of T1DM provide the best opportunity to study environmental triggers.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #9: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 3 of 5

The first large-scale studies of the prediction of T1DM relied upon the detection of cytoplasmic islet cell autoantibodies (ICA) assays based on indirect immunofluorescence. High titer cytoplasmic ICA is most often associated with the presence of multiple islet autoantibodies and therefore a high risk of progression to diabetes.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #8: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 2 of 5

Type 1A diabetes results from a chronic autoimmune destruction of the pancreatic beta cells, probably initiated by exposure of a genetically susceptible individual to some environmental agent(s). This preclinical period is marked by the presence of autoantibodies to pancreatic beta-cell antigens such as insulin, GAD65 (Glutamic Acid Decarboxylase), ICA512 (called also IA-2) or ZnT8 (Zinc Transporter 8), and precedes the onset of hyperglycemia by a few years.

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