Diabetes Mellitus,Definition, Epidemiology, Classification, Diagnostic criteria Etiology and pathogenesis Pathophysiology Clinical presentation Lab test Treatment DKA and NHDC,Stage I: description of the signs of diabetes recognition diabetes mellitus: polyuria, urine is sweet,Stage II: diabetes is associated with pancreas -find of insulin,Jan. 1922 Dr. Banting extract the insulin from pig pancreas and applied for the diabetic patients Father of insulin 14th November World Diabetes Day,Stage III: defects in insulin action -insulin resistance “a group of metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both . The chronic hyperglycemia is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidney, nerves, heart and blood vessels.”,Stage IV: diabetes can involve the eyes, kidneys, nerves and blood vessels,Diabetic retinopathy,Diabetic nephropathy,Diabetic foot,microangiopathy,macroangiopathy,Cerebral vessel,Coronal vessel,Peripheral vessel,World Health Organization/International Diabetes Federation, 1999. Diabetes Care 2001; 24 (Suppl 1):S5S20.,Definition Diabetes mellitus is a heterogeneous primary disorder of carbohydrate metabolism with multiple etiologic factors that generally involve absolute or relative insulin deficiency or both. All causes of diabetes ultimately lead to hyperglycemia, and it can causes the late complications involving the eyes, kidneys, nerves and blood vessels.,Environmental-Genetic interactions,Absolute or relative insulin deficiency,Disorder of carbohydrate, protein and fat metabolism,hyperglycemia,Complications involving the eyes,kidneys,nerves and blood vessels,病因,发病机制,病理生理,共同特征,最终结局,Epidemiology,Global prevalence of diabetes,1 2 3 4 5 6 7 8 9 10 Total,印度 中国 美国 俄联邦 日本 巴西 印度尼西亚 巴基斯坦 墨西哥 Ukraine 所有其他国家,19.4 16.0 13.9 8.9 6.3 4.9 4.5 4.3 3.8 3.6 49.7 135.3,印度 中国 美国 巴基斯坦 印度尼西亚 俄联邦 墨西哥 巴西 埃及 日本 所有其他国家,57.2 37.6 21.9 14.5 12.4 12.2 11.7 11.6 8.8 8.5 103.6 300.0,糖尿病患者前10位的国家,排名,国家,国家,1995 (百万),2025 (百万),King H, et al. Diabetes Care 1998;21:141431.,Epidemiology,新英格兰医学杂志2010;12;1090-101,IDF Diabetes Atlas. www.eatlas.idf.org.,中国正在面临糖尿病的巨大挑战,中国城市糖尿病患病率： 每10年翻倍,9200万糖尿病患者 1.48亿糖尿病前期患者,Classification,Etiologic classification of diabetes mellitus (1997 ADA 1999 WHO),Type 1 diabetes (T1DM),Other specific types,Type 2 diabetes(T2DM),Gestation diabetes mellitus(GDM),B cell destruction, usually leading to absolute insulin deficiency Two groups, three subgroups A. Immune mediated 1) being rapid, mainly in infants and children 2) being slow, mainly in adults-latent autoimmune diabetes in adults, LADA（成人晚发性自身免疫性糖尿病） B. Idiopathic,一 . Type 1 diabetes (T1DM),may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance The risk of developing this form of diabetes increases with age, obesity and lack of physical activity It is often associated with a strong genetic predisposition, more than is the type 1 diabetes higher prevalence,二. Type 2 diabetes (T2DM),三. Other specific types,Divided into 8 subgroups according to the etiology and pathogenesis, including all the secondary diabetes and specific etiologic diabetes,Genetic defects of B cell function Maturity-onset diabetes of the young (MODY) 青年发病的成年型糖尿病 1). Chromosome 20,HNF-4a (MODY1) 2). Chromosome 7p,glucokinase (MODY2) 3). Chromosome 12,HNF-1a (MODY3) 4). Insulinpromoter factor 1,IPF-1(MODY4) 5). HNF-1 (MODY5) 6). NEUROD4(MODY6) 7)Mitochondrial DNA 8). Others,Other specific types,四. Gestation diabetes mellitus(GDM),Diabetes and IGR be diagnosed during the gestation Screening the GDM during gestation 2428 weeks through OGTT 6 weeks after parturition, OGTT be given again,Diagnostic criteria (1999, WHO),The diagnostic criteria for diabetes mellitus,Etiology and pathogenesis,Type 1 DM,Prone to ketoacidosis,Absolute insulin deficiency(ID) (Low C-peptide level),B-cell destruction,idiopathy,Genetic susceptibility,Enviromental factors initiate,GAD, IAA, ICA IA2,HLA,autoimmune,Virus infection, chemical, diet,淋巴细胞介导的，以免疫性胰岛炎和选择性胰岛B细胞损伤为特征的自身免疫性疾病,Type 2 DM,Genetic susceptibility,Enviromental factors (Risk factors: obese , rich diet physical activity , old),Insulin deficiency(ID),Insulin resistance(IR),IGR (IGT, IFG),T2DM,Low born weight,Pathophysiology of DM,Insulin deficiency,IR,Characterized by hyperglycemia,Accompanied by disruption of protein , lipid , water and electrocytes metabolism,Glucogen synthesis Glucose oxidation Glucogen catabolism Hepatic glucose production,Adipocytes uptake TG Lipid synthesis Lipid mobilization -ketone ,Clinical feature of DM,Insulin deficiency,Insulin resistance,hyperglycemia,disruption of protein , lipid , water and electrolytes metabolism,Chronic impairment : Macrovascular (CHD, CVD, PVD) Microvascular (kidney, reticular, nerve),