Which of the following is a risk factor for developing Type 1 Diabetes mellitus?
Correct Answer: HLA DR3
Description: Ref: Nelson's Textbook of Pediatrics. 19th EditionExplanation:Pathophysiology and Risk factors for Type I Diabetes mellitusType l DM is the culmination of lymphocytic infiltration and destruction of insulin -secreting beta cells of the islets of Langerhans in the pancreas.As beta-cell mass declines, insulin secretion decreases until the available insulin no longer is adequate to maintain normal blood glucose levels.After 80-90% of the beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed.Autoimmunity - Major determinantViral infection may stimulate the production of antibodies against a viral protein that trigger an autoimmune response against antigenically similar beta cell molecules.Approx 85% of type 1 DM patients have circulating islet cell antibodies, and the majority also has detectable anti-insulin antibodies before receiving insulin therapy.The most commonly found islet cell antibodies are directed against glutamic acid decarboxylase (GAD). an enzyme found within pancreatic beta cells.The prevalence is increased in other autoimmune diseases, such as:Graves diseaseHashimoto thyroiditisAddison diseasePolymorphisms of the class II human leukocyte antigen (HIA) genes that encode DR and I)Q are the major genetic determinants.Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4.HLA-DQs are also considered specific markers of type 1 DM susceptibility.Some haplotypes (eg, HLA-DR2) confer strong protection against type 1 DMRisk Factors for Type 2 Diabetes MellitusFamily history of diabetes (i.e., parent or sibling with type 2 diabetes)Obesity (BMI >25 kg/m2)Physical inactivityRace/ethnicity (e.g.. African American. Latino, Native American. Asian American. Pacific Islander)Previously identified with IFG, IGT, or an A1C of 5.7-6.4%History of GDM or delivery of baby >4 kg (9 lb)Hypertension (blood pressure >140/90 mmHg)HDL cholesterol ievel <35 mg/dL {0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)Polycystic ovary syndrome or acanthosis nigricansHistory of cardiovascular disease
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