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Home > 20 The Endocrine System > ENDOCRINE PANCREAS > DIABETES MELLITUS |
DIABETES MELLITUS |
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Diabetes mellitus is not a single disease entity but rather a group of metabolic disorders sharing the common underlying feature of hyperglycemia. Hyperglycemia in diabetesresults from defects in insulin secretion, insulin action, or, most commonly, both. The chronic hyperglycemia and attendant metabolic dysregulation of diabetes mellitus may be associated with secondary damage in multiple organ systems, especially the kidneys, eyes, nerves, and blood vessels. Diabetes affects an estimated 21 million people in the United States (or nearly 7% of the population), asmany as a third of whom are undiagnosed. Diabetes is a leading cause of end-stage renal disease, adult-onset blindness, and nontraumatic lower extremity amputations in the United States, underscoring the impact of this disease on the burden of health care costs. It also greatly increases the risk of developing coronary artery disease and cerebrovascular disease. In concert with great technologicadvances, there have been pronounced changes in human behavior, with increasingly sedentary life styles and poor eating habits. This has contributed to the simultaneous escalation of diabetes and obesity worldwide, which some have termed the "diabesity" epidemic. |
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Diagnosis |
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Blood glucose levels are normally maintained in a very narrow range, usually70 to 120 mg/dL. The diagnosis of diabetes is established by elevation of blood glucose by any one of three criteria: 1. A random blood glucose concentration of 200 mg/dL or higher, with classical signs and symptoms (discussed below) 2. A fasting glucose concentration of 126 mg/dL or higher on more than one occasion, or 3. An abnormal oral glucose tolerance test (OGTT), in which theglucose concentration is 200 mg/dL or higher 2 hours after a standard carbohydrate load (75 gm of glucose). |
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Derangements in carbohydrate metabolism proceed along a continuum. Individuals with serum fasting glucose values less than 110 mg/dL, or less than 140 mg/dL following an OGTT, are considered to be euglycemic. However, those with serum fasting glucose greater than 110but less than 126 mg/dL, or OGTT values of greater than 140 but less than 200 mg/dL, are considered to have impaired glucose tolerance. Individuals with impaired glucose tolerance have a significant risk of progressing to overt diabetes over time, with as many as 5% to 10% advancing to full-fledged diabetes mellitus per year. In addition, those with impaired glucose tolerance are at risk forcardiovascular disease, due to abnormal carbohydrate metabolism and the coexistence of other risk factors (see Chapter 10). |
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Classification |
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Although all forms of diabetes mellitus share hyperglycemia as a common feature, the underlying causes of hyperglycemia vary widely. The vast majority of cases ofdiabetes fall into one of two broad classes: Type 1 diabetes is characterized by an absolute deficiency of insulin secretion caused by pancreatic β-cell destruction, usually resulting from an autoimmune attack. Type 1 diabetes accounts for approximately 10% of all cases.Type 2 diabetes is caused by a combination of peripheral resistance to insulin action and an inadequate compensatory response ofinsulin secretion by the pancreatic β cells ("relative insulin deficiency"). Approximately 80% to 90% of patients have type 2 diabetes. |
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A variety of monogenic and secondary causes make up the remaining cases of diabetes (Table 20-5). It should be stressed that while the major types of diabetes have different pathogenic mechanisms, the long-term complications in kidneys,...
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