Diabetes mellitus & Classification of Diabetes

1. Diabetes Mellitus
Hamid reza Sadeghi
Shahid Beheshti University of Medical Sciences
Saturday, July 11, 2015

2. Definition
 agroup of metabolic diseases
 characterised by elevated levelsof glucosein theblood :
- defectsin insulin secretion,
- insulin action,
- insulin receptorsor any combination of conditions.

3. Classification of Diabetes
 Type1 diabetes:
- β-cell destruction
– -“JuvenileOnset”
 Type2 diabetes( NON-Insulin Dependent ) :
-Decreased sensitivity of insulin receptor to insulin
-“Adult Onset”
Gestational diabetes:
- glucoseintolerance

4. TYPE 1 DM
 Dueto B-cell destruction.
 Requireinsulin for survival.
 Presenceof certain autoantibodies.
– Type1A – presenceof autoantibodies(anti-GAD, IA2, ICAA, and anti-insulin
antibodies).
– Type1B – absenceof autoantibodies(idiopathic)

5. Etiology
Genetic factors
multiplegenesinvolved : chromosome 6 ,HLA-DR4, HLA-DR3 or
both (DR3/4 heterozygote)
Environmental factors :
- infections: includeviruses(rubella, coxsackievirus) B4)
-exposureto cow’smilk in infancy
- Chemicalsand drugs: pyrinuron, Zanosar

6. Pathophysiology
 destruction of betacell in thepancreas
- autoimmuneresponse towards betacells:
CD4+ T helper cells and CD8+ T cells
autoantibody-producing B cells and activation of
the innate immunesystem
(GAD . ICA)

7. Prognosis
 60% of patients:
do not develop seriouscomplicationsover thelong term,
 40% of patients:
blindness,
end-stagerenal disease(ESRD)
early death
 ESRD and proliferativeretinopathy istwiceashigh in men asin women

8. type2
Most common form of DM
Characterized by disorder in insulin action and insulin secretion or both.
Specific etiology unknown
Insulin resistance
ProgressiveB-cell failure.
They areobese.

9. Pathophysiology
 insufficient insulin production from betacells
 increased glucoseproduction in liver
 insulin resistance
1- acanthosisnigricans
2- metabolic syndrome
3- polycystic ovary syndrome

10. Ethiology
 Lifestyle
obesity and overweight : - leptin
- TNFa
- IL6
 Genetics
involvemany genes( unknown)
 Medical conditions
medications: - glucocorticoids
-thiazides
-betablockersand statins

11. Majorrisk factors
 Age˃45
 Obesity
 Family history
 History of previousimpaired glucosetolerance(IGT)
 Hypertension (>140/90 mm Hg) or dyslipidemia
 History of gestational diabetesmellitus
 pcos(which resultsin insulin resistance)

12. Prevention
 weight loss
 exercise
 Medication : 1- metformin
2- acarbose
3-orlistat

13. Prognosis
 strongly influenced by thedegreeof control of disease
 intensive therapy :
decreased risk of microvascular complications

14. Gestational diabetes
 Definition:
Hyperglycemiawith
onset or first
recognition during
Pregnancy

15. Risk of developing GDM
 Old women (especially for women over 35 yearsof age)
 Previoushistory of glucoseintolerance
 A previouspregnancy which resulted in achild with amacrosomia

16. Diagnostic Criteria
Note: In the absence of unequivocal hyperglycemia, result(s) should be
confirmed by repeat testing.

17. DIAGNOSTIC CRITERIA FOR GDM

19. Acutecomplications
 Diabetic ketoacidosis(DKA)
 Hyperglyceamic hyperosmolar
state(HHS)

20. Chronic Complications
 Affectsmany organ systems.
 Vascular :
1-Microvascular
2-Macrovascular
 Non vascular:
1-Gastroparesis
2-Sexual dysfunction
3-Skin changes

21. Management
1-Lifestyle
2-Insulin
3-Pancreastransplantation
4-Islet cell transplantation
Type2
1 -Lifestyle
2 -Medications
3- Surgery
Type1

22. Glycemic Recommendations

23. Blood Pressureand Lipid Goals
Blood pressure <130/80 mmHg
LDL cholesterol
TG
<100 mg/dL
<150 mg/dL

24. thankyou