英文糖尿病

DiabetesMellitusZhao-xiaojuanIntroductionDiabetesmellitusisaheterogeneousgroupofmetabolicdiseasescharacterizedbyhyperglycemiaresultingfromdefectsininsulinsecretion,insulinaction,orboth.IntroductionThechronichyperglycemiaofdiabetesisassociatedwithlong-termdamage,dysfunction,andfailureofvariousorgans,especiallytheeyes,kidneys,nerves,heart,andbloodvessels.SymptomsPolyuriaPolydipsia(thirst)WeightlossWeaknessPolyphagiaBlurredvisionRecurrentinfectionImpairmentofgrowthCriteriafordiagnosisofdiabetes(WHO1999)Symptomsofdiabetes+Casualplasmaglucose≥11.1mmol/l(200mg/dl)OrFPG≥7.0mmol/l(126mg/dl)Or2-hPG≥11.1mmol/lDiagnosticCriteriaWHO1999IGT-FPG7mmol/L-2-hPG≥7.8mmol/Land11.1mmol/LIFG-FPG≥6.1mmol/Land7.0mmol/LLaboratoryFindingsUrinaryglucoseUrinaryketoneBloodglucose(FPGand2-hPG)HbA1candFA(fructosamine)OGTTInsulin/CPreleasingtestClassification(1)Type1diabetesβ-celldestruction,usuallyleadingtoabsolutedeficiency1Immune-mediateddiabetes2IdiopathicdiabetesType2diabetesRangingfrompredominantlyinsulinresistancewithrelativeinsulindeficiencytopredominantlyaninsulinsecretorydefectwithinsulinresistanceClassification(2)OtherspecifictypesofdiabetesDuetoothercauses,e.g.,geneticdefectsininsulinaction,diseasesoftheexocrinepancreas,drugorchemicalinducedGestationaldiabetesmellitus(GDM)diagnosedduringpregnancyEtiologicclassificationofdiabetesmellitus(1)I.Type1diabetes(-celldestruction,usuallyleadingtoabsoluteinsulindeficiency)A.immunemediatedB.IdiopathicII.Type2diabetes(mayrangefrompredominantlyinsulinresistancewithrelativeinsulindeficiencytoapredominantlysecretorydefectwithinsulinresistance)III.OtherspecifictypesA.geneticdefectsof-cellfunction1.Chromosome12,HNF-1(MODY3)2.Chromosome7,glucokinase(MODY2)3.Chromosome20,HNF-4(MODY1)4.MitochondrialDNA5.OthersB.Geneticdefectsininsulinaction1.TypeAinsulinresistance2.Leprechaunism3.Rabson-Mendenhallsyndrome4.Lipoatrophicdisease5.OthersC.Diseasesoftheexocrinepancreas1.Pancreatitis2.Trauma/pancreatectomy3.Neoplasia4.Cysticfibrosis5.Hemochromatosis6.Fibrocalculouspancreatopathy7.OthersEtiologicclassificationofdiabetesmellitus(2)D.Endocrinopathies1.Acromegaly2.Cushing’ssyndrome3.Glucagonoma4.Pheochromocytoma5.Hyperthyroidism6.Somatostatinoma7.Aldosteronoma8.OthersE.Drud-orchemical-induced1.Vacor2.Pentamidine3.Nicotinicacid4.Glucocorticoid5.Thyroidhormone6.Diazoxide7.-adrenergicagonists8.Thiazides9.Dilantin10.-Interferon11.OthersF.Infections1.Congenitalrubella2.Cytomegalovirus3.OthersEtiologicclassificationofdiabetesmellitus(3)G.Uncommonformsofimmune-mediateddiabetes1.“Stiff-man”syndrome2.Anti-insulinreceptorantibodies3.OthersH.Othergeneticsyndromessometimesassociatedwithdiabetes1.Down’ssyndrome2.Klinefelter’ssyndrome3.Turner’ssyndrome4.Wolfram’ssyndrome5.Friedreich’sataxia6.Huntington’schorea7.Laurence-moon-Biedlsyndrome8.Myotonicdystrophy9.Porphyria10.Prader-Willisyndrome11.OthersIV.Gestationaldiabetesmellitus(GDM)Patientswithanyformofdiabetesmayrequireinsulintreatmentatsomestageoftheirdisease.Suchuseofinsulindosenot,ofitself,classifythepatient.Type1DMGenerally30yearsRapidonsetModeratetoseveresymptomsSignificantweightlossLeanKetonuriaorketo-acidosisLowfastingorpost-prandialC-peptideImmunemarkers(anti-GAD,ICA,IA-2)Type2DMGenerally＞40yearsSlowlyonsetNotseveresymptomsObesityKetoacidosisseldomoccurNonketotichyperosmolarsyndromeNormalorelevatedC-peptidelevelsGeneticpredispositionPathophysiologicalmodelfordevelopmentofobesityandT2DMBeta-celldefectIntra-uteringrowthretardationInsulinResistancegenesObesitygenesInsulinResistance+IntraabdominalobesityIGTT2DMWesternlifestyleGlucosetoxicityMetabolicInsulinResistance(FFA)080402060YearDisorderofglycemia:etiologicaltypesclinicalstagesStagesTypesNormoglycemiaHyperglycemiaDiabetesmellitusType1Type2OtherspecifictypesGestationaldiabetesNormalglucosetoleranceIGTand/orIFGNotinsulinrequiringInsulinrequiringforcontrolInsulinrequiringforsurvivalAcute,life-threateningconsequencesHyperglycemiawithketoacidosisNonketotichyperosmolarsyndromeMicrovascularcomplicationsRetinopathyNephropathyPeripheralneuropathyAutonomicneuropathyMacrovascularcomplicationsAtheroscleroticcardiovasculardiseasePeripheralvasculardiseasecerebrovasculardiseaseOthersHypertensionAbnormalitiesoflipoproteinmetabolismPeriodontaldiseasePotentialchroniccomplicationsofelevatedHbA1cgoodpoorcontrol•Microalbuminuria•MildRetinopathy•MildNeuropathy•Albuminuria•MacularEdema•ProliferativeRetinopathy•PeridontalDisease•Impotence•Gastroparesis•Depression•FootUlcers•Angina•HeartAttack•CoronaryBypass•Surgery•Stroke•Blindness•Amputation•Dialysis•KidneyTransplantTheAimsofTreatmentReliefofhyperglycemicsymptomsCorrectionofhyperglycemia,ketonuriaandhyperlipidemiaEstablishmentandmaintenanceofadesirablebodyweight,andinchildrennormalgrowthanddevelopmentAvoidanceofacutemetabolicdisturbancePreventordelaytheonsetofthelong-termcomplicationsTargetsforcontrolOptimalFairPoorPlasmaglucose(mmol/L)FPG2-hPG4.4-6.14.4-8.07.010.07.010.0HbA1c(%)6.26.2-8.08.0Bloodpressure(mmHg)130/80130/80-160/95160/95BMI(kg/m2)Malefemale2