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Diabetes Mellitus – A Review

Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination),polydipsia (increased thirst) and polyphagia (increased hunger).

There are three main types of diabetes:

  • Type 1 diabetes: results from the body’s failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
  • Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)
  • Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery.

Diabetes without proper treatments can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, retinal damage.

Universal Blue logo of Diabetes :-


Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.

As of 2000 at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Type 2 diabetes is by far the most common, affecting 90 to 95% of the U.S. diabetes population.

Comparison of type 1 and 2 diabetes
Feature Type 1 diabetes Type 2 diabetes
Onset Sudden Gradual
Age at onset Any age
(mostly young)
Mostly in adults
Body habitus Thin or normal Often obese
Ketoacidosis Common Rare
Autoantibodies Usually present Absent
Endogenous insulin Low or absent Normal, decreased
or increased
Concordance
in
identical twins
50% 90%
Prevalence Less prevalent More prevalent
– 90 to 95% of
U.S. diabetics

Causes

The cause of diabetes depends on the type. Type 2 diabetes is due primarily to lifestyle factors and genetics.

Type 1 diabetes is also partly inherited and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes(i.e., the genetic “self” identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger.

Following is a comprehensive list of other causes of diabetes:

  • Genetic defects of ?-cell Function
    • Maturity onset diabetes of the young (MODY)
    • Mitochondrial DNA mutations
  • Genetic defects in insulin processing or insulin action
    • Defects in proinsulin conversion
    • Insulin gene mutations
    • Insulin receptor mutations
  • Exocrine Pancreatic Defects
    • Chronic pancreatitis
    • Pancreatectomy
    • Pancreatic neoplasia
    • Cystic fibrosis
    • Hemochromatosis
    • Fibrocalculous pancreatopathy
  • Endocrinopathies
    • Growth hormone excess (acromegaly)
    • Cushing syndrome
    • Hyperthyroidism
    • Pheochromocytoma
    • Glucagonoma
  • Infections
    • Cytomegalovirus infection
    • Coxsackievirus B
  • Drugs
    • Glucocorticoids
    • Thyroid hormone
    • ?-adrenergic agonists

 

Diagnosis

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:

  • Fasting plasma glucose level ? 7.0 mmol/L (126 mg/dL).
  • Plasma glucose ? 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
  • Symptoms of hyperglycemia and casual plasma glucose ? 11.1 mmol/L (200 mg/dL).
  • Glycated hemoglobin (Hb A1C) ? 6.5%.

A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above-listed methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.

1 responses on "Diabetes Mellitus - A Review"

  1. very nice article.

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