Diabetes Mellitus 

Hamid reza Sadeghi

Shahid Beheshti University of Medical Sciences Saturday, July 11, 2015

Definition

a group of metabolic diseases characterised by elevated levels of glucose in the

blood : - defects in insulin secretion, - insulin action, - insulin receptors or any combination of conditions.

Classification of Diabetes

Type 1 diabetes : - β-cell destruction -“Juvenile Onset”

Type 2 diabetes ( NON-Insulin Dependent ) : -Decreased sensitivity of insulin receptor to insulin -“Adult Onset”

Gestational diabetes : - glucose intolerance

TYPE 1 DM

Due to B-cell destruction.

Require insulin for survival.

Presence of certain autoantibodies. Type 1A – presence of autoantibodies (anti-GAD, IA2, ICAA,

and anti-insulin antibodies). Type 1B – absence of autoantibodies (idiopathic)

Etiology

Genetic factors multiple genes involved : chromosome 6 ,HLA-DR4, HLA-DR3 or both (DR3/4 heterozygote) Environmental factors : - infections : include viruses (rubella, coxsackievirus) B4) -exposure to cow’s milk in infancy - Chemicals and drugs : pyrinuron, Zanosar

Pathophysiology

 destruction of beta cell in the pancreas - autoimmune response towards beta cells : CD4+ T helper cells and CD8+ T cells  autoantibody-producing B cells and activation of the innate immune system (GAD . ICA)

Prognosis

60% of patients : do not develop serious complications over the long term, 40% of patients : blindness, end-stage renal disease (ESRD) early death ESRD and proliferative retinopathy is twice as high in men as in

women

type2

Most common form of DM

Characterized by disorder in insulin action and insulin secretion or both.

Specific etiology unknown

Insulin resistance

Progressive B-cell failure.

They are obese.

Pathophysiology

 insufficient insulin production from beta cells increased glucose production in liver insulin resistance 1- acanthosis nigricans 2- metabolic syndrome 3- polycystic ovary syndrome

Ethiology

Lifestyle obesity and  overweight : - leptin - TNFa - IL6 Genetics   involve many genes ( unknown) Medical conditions   medications : - glucocorticoids  -thiazides -beta blockers and statins

Major risk factors

Age ˃45 Obesity Family history History of previous impaired glucose tolerance (IGT) Hypertension (>140/90 mm Hg) or dyslipidemia History of gestational diabetes mellitus pcos (which results in insulin resistance)

Prevention

weight loss exercise  Medication : 1- metformin 2- acarbose 3-orlistat

Prognosis

strongly influenced by the degree of control of disease

intensive therapy : decreased risk of microvascular complications

Gestational diabetes

Definition: Hyperglycemia with onset or first recognition during Pregnancy

Risk of developing GDM

Old women  (especially for women over 35 years of age)

Previous history of glucose intolerance

A previous pregnancy which resulted in a child with a macrosomia 

Diagnostic Criteria

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

DIAGNOSTIC CRITERIA FOR GDM

Acute complications

Diabetic ketoacidosis (DKA)

Hyperglyceamic hyperosmolar state(HHS)

Chronic Complications

Affects many organ systems.

Vascular : 1-Microvascular 2-Macrovascular

Non vascular: 1-Gastroparesis 2-Sexual dysfunction 3-Skin changes

Management

 1-Lifestyle 2-Insulin 3-Pancreas transplantation 4-Islet cell transplantation

Type 21 -Lifestyle2 -Medications3- Surgery

Type 1

Glycemic Recommendations

Blood Pressure and Lipid Goals

Blood pressure <130/80 mmHg

LDL cholesterol

TG

<100 mg/dL

<150 mg/dL

thankyou