DIABETES

DEFINITION

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from

defects in insulin secretion, insulin action, or both.

CLASSIFICATION

Diabetes can be classified into the following general categories:

1. Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin
deficiency)

2. Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the
background of insulin resistance)

3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of
pregnancy that was not clearly overt diabetes prior to gestation)

DIAGNOSTIC TESTS FOR DIABETES

Diabetes may be diagnosed based on plasma glucose criteria, either the fasting plasma glucose
(FPG) or the 2-h plasma glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT).

RISK FACTORS FOR DIABETES

• People with overweight or obese (BMI ≥25 kg/m2 )

• First-degree relative with diabetes
• High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American,
Pacific Islander)
• History of CVD
• Hypertension (≥140/90 mmHg or on therapy for hypertension)
• HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL
(2.82 mmol/L)
• Women with polycystic ovary syndrome
• Physical inactivity
• Other clinical conditions associated with insulin resistance (e.g., severe obesity,
acanthosis nigricans)
 • Women who were diagnosed with GDM

SYMPTOMS

Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with
polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may
also accompany chronic hyperglycemia.

COMPLICATIONS

Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy
leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot
joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular
symptoms and sexual dysfunction. Patients with diabetes have an increased incidence of
atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease or Hypertension.

TREATMENT

In some individuals with diabetes, adequate glycemic control can be achieved with weight
reduction, exercise, and/or oral glucose-lowering agents. These individuals therefore do not require
insulin. In change, other individuals who have diabetes type one, require insulin for survival because
these individuals have extensive β-cell destruction and therefore no residual insulin secretion.

There are different types, or classes, of drugs that work in different ways to lower blood glucose
levels:

• Alpha-glucosidase inhibitors
• Biguanides
• Bile Acid Sequestrants
• Dopamine-2 Agonists
• DPP-4 inhibitors
• Meglitinides
• SGLT2 Inhibitors
• Sulfonylureas
• TZDs
• Oral combination therapy