Diabetes Mellitus,Adapted from Zimmet P et al. Diabet Med. 2003;20:693-702.,Prevalence of Diabetes Mellitus,million,2007：246 000 000 2025：380 000 000,2003：189 000 000 2025：324 000 000 72%,2,Outline,Definition Diagnosis Classification Complications Management,1.Definition,Diabetes mellitus is characterized by chronic hyperglycemia with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both.,1.Definition,The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.,American Diabetes Association, 2003,Outline,Definition Diagnosis Classification Complications Management,2. Diagnosis,Diagnostic Criteria (WHO 1999) Symptoms of diabetes + Casual plasma glucose 11.1mmol/L（ 200mg/dl) or Fasting plasma glucose（FPG） 7.0mmol/L （ 126mg/dl ）or 2h-Post load plasma glucose(2h-PG) 11.1mmol/L（ 200mg/dl ） If positive, confirm diagnosis with 7days,Symptoms,thirst polyuria polyphagia unexplained weight loss weakness (fatigue),Criteria for the diagnosis of DM,Laboratory Findings,Blood glucose (FPG and 2-hPG) Urinary glucose Urinary ketone HbA1c and FA (fructosamine) OGTT Insulin / CP releasing test Others (Blood lipid/ UAER/ Immune markers (anti-GAD,ICA,IAA),Coates PA et al. Diabetes Res Clin Pract 1994;26:177,FPG 8-12 mmol/L,FPG 1215 mmol/L,FPG 8 mmol/L,FPG 18 mmol/L,normal,T2DM,0.40,1.00,0.80,0.60,insulin,0.20,0,30,0,30,60,90,120,150,180,210,240,time (min),nmol/L,Insulin releasing test,Outline,Definition Diagnosis Classification Complications Management,3. Classification (1999WHO),Type1 diabetes (T1DM) Immune mediated Idiopathic Type 2 diabetes (T2DM) Other specific types Genetic defects of -cell function Genetic defects of insulin action Disease of the exocrine pancreas Endocrinopathies Drug - or chemical-induced Infections Anti-insulin receptor antibodies Other genetic syndromes sometimes associated with diabetes Gestational diabetes mellitus (GDM),3.1 Type 1 diabetes,-cell destruction, usually leading to absolute deficiency 1. Immune-mediated diabetes (Type1A) Latent autoimmune diabetes in adults, LADA 2. Idiopathic diabetes (Type1B),Autoantibodies,islet cell autoantibody (ICA) autoantibody to insulin (IAA) autoantibody to glutamic acid decarboxylase (GADA) autoantibody to tyrosine phosphatases(IA-2 / IA-2) Which reflects the autoimmune processes that have led to -cell destruction,Type 1 DM,Generally 25 years Rapid onset Moderate to severe symptoms Significant weight loss or lean Ketonuria or keto-acidosis Low fasting or post-prandial C-peptide Immune markers (ICA,GADA, IA-2),3.2 Type 2 diabetes,Heterogeneous diseases The most common form of diabetes Disorders of insulin action and insulin secretion Specific etiology is not known,IR a reduced response of target tissues to circulating insulin,Glucose,Defective insulin secretion,Excessive fatty acid release,Reduced glucose uptake,Excessive glucose production,Carbohydrate,Resistance to the action of insulin,Insulin,3.2.2 -cell dysfunction,Reduced ability of -cells to secrete insulin Impaired ability of -cells to compensate for IR Genetic and environmental pathophysiology,Features of Type 2 DM,Generally 40 years Slowly onset Not severe symptoms Obese Ketoacidosis seldom occur Nonketotic hyperosmolar syndrome Normal or elevated C-peptide levels Genetic predisposition,3.3 Other specific types of diabetes,Due to other causes, e.g: genetic defects of -cell function (MODY) genetic defects of insulin action disease of the exocrine pancreas endocrinopathies drug or chemical induced others,3.4 Gestational diabetes mellitus (GDM),GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy 6 weeks or more after delivery the woman should be reclassified,Course of disease,Normal glucose tolerance (NGT) Impaired glucose homeostasis (IGH) 3. Diabetes mellitus (DM), Impaired fasting glucose (IFG) Impaired glucose tolerance (IGT),Clinical stages,Normal glucose tolerance,Hyperglycemia,Impaired glucose regulation IGT / IFG,Diabetes mellitus,Not insulin requiring,Insulin requiring for control,Insulin requiring for survival,Stages,Types,Type 1,Type 2,Other Specific Types,GDM,Diabetes Mellitus,Zhao XiaoJuan Department of Endocrinology The First Hospital of China Medical University 2007.11.1,Outline,Definition Diagnosis Classification Complications Management,4. Chronic Complications,Diabetic retinopathy,Diabetic nephropathy,Cardiovascular disease,Stroke,Diabetic neuropathy,Peripheral vascular disease,Diabetic foot,macrovascular,microvascular,DM: Impact on patient,Blindness 10% Loss of reading vision 1