中国医科大学附属第一医院：《内科学》课程教学资源（PPT课件讲稿，双语版）Diabetes Mellitus

Diabetes mellitus Zhao-xiaojuan

Diabetes Mellitus Zhao-xiaojuan

Introduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion insulin action or both

Introduction Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Introduction 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

Introduction 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

Symptoms Polyuria Polydipsia( thirst) Weight loss Weakness Polyphagia Blurred vision Recurrent infection Impairment of growth

Symptoms Polyuria Polydipsia (thirst) Weight loss Weakness Polyphagia Blurred vision Recurrent infection Impairment of growth

Criteria for diagnosis of diabetes (HO1999 Symptoms of diabetes Casual plasma glucose 1.mmo/(200mg/dl) Or FPG≥70mmoM(126mg/d) Or 2-hPG≥11.1mmo

Criteria for diagnosis of diabetes (WHO1999) Symptoms of diabetes + Casual plasma glucose ≥ 1.1mmol/l(200mg/dl) Or FPG ≥ 7.0mmol/l (126mg/dl) Or 2-hPG ≥ 11.1mmol/l

Diagnostic Criteria WHO1999 IGT FPG<7mmol/L -2-h PG278mmol/ and <11.1 mmol/L IFG -FPG26. 1 mmol/L and <7.0mmol/L

Diagnostic Criteria WHO1999 IGT -FPG<7mmol/L -2-h PG≥7.8mmol/L and <11.1mmol/L IFG -FPG≥6.1mmol/L and <7.0mmol/L

Laboratory Findings Urinary glucose Urinary ketone Blood glucose(FPG and 2-hPG) HbAlc and FA(fructosamine) OGTT Insulin/cp releasing test

Laboratory Findings Urinary glucose Urinary ketone Blood glucose (FPG and 2-hPG) HbA1c and FA(fructosamine) OGTT Insulin / CP releasing test

classification (1) Type 1 diabetes B-cell destruction, usually leading to absolute deficiency Immune-mediated diabetes ldiopathic diabetes Type 2 diabetes Ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance

Classification (1) Type 1 diabetes β-cell destruction, usually leading to absolute deficiency Immune-mediated diabetes Idiopathic diabetes Type 2 diabetes Ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance

Classification(2) Other specific types of diabetes Due to other causes, e.g. genetic defects in insulin action diseases of the exocrine pancreas, drug or chemical induced Gestational diabetes mellitus(GDM) diagnosed during pregnancy

Classification (2) Other specific types of diabetes Due to other causes, e.g.,genetic defects in insulin action, diseases of the exocrine pancreas, drug or chemical induced Gestational diabetes mellitus(GDM) diagnosed during pregnancy

Etiologic classification of diabetes mellitus(1) IType 1 diabetes( B-cell destruction, usually leading to absolute insulin deficiency A immune mediated B Idiopathic Il Type 2diabetes( may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defectwith insulin resistance) lll.Other specific types A genetic defects of B-cell function 1. Chromosome 12, HNF-1a MODY3 2. Chromosome 7, glucokinase(MODY2) 3. Chromosome 20, HNF-4a(MODY1) 4. Mitochondrial dNA 5. others B. Genetic defects in insulin action 1. Type A insulin resistance 2. Leprechaunism 3. Rabson-Mendenhall syndrome 4. Lipoatrophic disease 5. Others C Diseases of the exocrine pancreas 1. Pancreatitis 2. Trauma/ pancreatectomy 3. Neoplasia Cystic fibrosis 5. Hemochromatosis 6. Fibrocalculous pancreatopathy 7. Others

Etiologic classification of diabetes mellitus(1) I.Type 1diabetes (  -cell destruction, usually leading to absolute insulin deficiency ) A. immune mediated B. Idiopathic II.Type 2diabetes ( may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance ) III.Other specific types A. genetic defects of  -cell function 1. Chromosome 12, HNF-1 (MODY3) 2. Chromosome 7, glucokinase (MODY2) 3. Chromosome 20, HNF-4 (MODY1) 4. Mitochondrial DNA 5. Others B. Genetic defects in insulin action 1. Type A insulin resistance 2. Leprechaunism 3. Rabson- Mendenhall syndrome 4. Lipoatrophic disease 5. Others C. Diseases of the exocrine pancreas 1. Pancreatitis 2. Trauma / pancreatectomy 3. Neoplasia 4. Cystic fibrosis 5. Hemochromatosis 6. Fibrocalculous pancreatopathy 7. Others