复旦大学临床医学专业：《内科学》课程教学资源（课件讲义，双语版）糖尿病（胡仁明）

Diabetes mellitus Renming Hu M D, PhD Department of Endocrinology Huashan Hospital Institute of Endocrinology and Diabetes at Fudan University

Diabetes Mellitus Renming Hu M.D,PhD Department of Endocrinology Huashan Hospital Institute of Endocrinology and Diabetes at Fudan University

Classification of diabetes(ADA-1997 pe (beta-cell destruction, usually leading to absolute insulin deficiency Autoimmune Idiopathic Type 2 (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without nsulin resistance ● Other specific types e Gestational diabetes * x

Classification of diabetes(ADA-1997) Type 1 ⚫ (beta-cell destruction, usually leading to absolute insulin deficiency) • Autoimmune • Idiopathic ⚫ Type 2 – (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance) ⚫ Other specific types ⚫ Gestational diabetes**

Other specific types o Genetic defects of beta-cell function o Genetic defects in insulin action Diseases of the exocrine pancreas ● Endocrinopathies o Drug- or chemical-induced ● Infections o Uncommon forms of immune-mediated diabetes o Other genetic syndromes sometimes associated with diabetes

Other specific types ⚫ Genetic defects of beta-cell function ⚫ Genetic defects in insulin action ⚫ Diseases of the exocrine pancreas ⚫ Endocrinopathies ⚫ Drug- or chemical-induced ⚫ Infections ⚫ Uncommon forms of immune-mediated diabetes ⚫ Other genetic syndromes sometimes associated with diabetes

Pathogenesis

Pathogenesis

Pathology e Type I DM: inflammation of pancreas e Type 2 DM: amyloidosis of pancreas e Large vessel: atherosclerosis e Kidney diffuse or nodular glomerular 目east erosIs 口 north ● Retina: arteriolar sclerosis、 microaneurysm、 exudates、 new vessel seasonseason season S ormation Nerve: axon degeneration myelinolysis

Pathology ⚫ Type 1 DM：inflammation of pancreas ⚫ Type 2 DM：amyloidosis of pancreas ⚫ Large vessel ：atherosclerosis ⚫ Kidney ：diffuse or nodular glomerular sclerosis ⚫ Retina：arteriolar sclerosis、 microaneurysm、exudates、new vessel formation ⚫ Nerve：axon degeneration 、 myelinolysis 0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 season 1 season 2 season 3 season 4 east west north

Pathophysiology

Pathophysiology

Abnormalities in metabolism ● Carbohydrate: anabolism, catabolism个 utilization ● Lipid: anabolism, catabolic↑, ketoplasia ● protein: anabolism, catabolism↑, yconeogenesis

Abnormalities in metabolism ⚫ Carbohydrate ：anabolism ，catabolism、 utilization ⚫ Lipid ： anabolism ，catabolism ， ketoplasia ⚫ protein： anabolism ，catabolism ， glyconeogenesis

Insulin secretion curve normal and diabetics 1600 1400 Hhtype2 1200 占1000 -normal 800 obese 600 400 200 0 30 60 90 120 clock time(hours)

Insulin secretion curve :normal and diabetics 0 200 400 600 800 1000 1200 1400 1600 0 3 0 6 0 9 0 120 clock time(hours) insulin(μU/ml） type2 normal obese type 1

Clinical presentation

Clinical Presentation

Natural history of type 2 DM After the diagnosis of type 2 diabetes IR constantly exists Insulin secretion ability gradually declines: When fPg reachs the diagnostic criteria, insulin secretion ability has already declined by 50% When FPG≌7.0mmo/L,阝- ellinsulin secretion ability When fPg≥10~11.0mmol/L,β- Insulin secretion ability has already neared absolute deficiency

Natural history of type 2 DM After the diagnosis of type 2 diabetes: IR constantly exists Insulin secretion ability gradually declines: When FPG reachs the diagnostic criteria，insulin secretion ability has already declined by 50% When FPG≥7.0mmol/L，-cell insulin secretion ability When FPG≥1011.0mmol/L，-C insulin secretion ability has already neared absolute deficiency