Diabetes mellitus (DM) comprises a group of metabolic disorders that share the common feature of hyperglycemia. DM is currently classified on the basis of the pathogenic process that leads to hyperglycemia. Type 1 DM is characterized by insulin deficiency and a tendency to develop ketosis—it is most commonly caused by autoimmune destruction of the pancreatic islet beta cells. Type 2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and excessive hepatic glucose production—it is strongly associated with obesity. Other specific types include DM caused by genetic defects (maturity-onset diabetes of the young [MODY] and other rare monogenic disorders), diseases of the exocrine pancreas (chronic pancreatitis, cystic fibrosis, hemochromatosis), endocrinopathies (acromegaly, Cushing’s syndrome, glucagonoma, pheochromocytoma, hyperthyroidism), drugs (nicotinic acid, glucocorticoids, thiazides, protease inhibitors), and pregnancy (gestational DM). The phenotype of these monogenetic and secondary types of DM typically resembles type 2 DM; its severity depends on the degree of beta cell dysfunction and prevailing insulin resistance.
The worldwide prevalence of DM is increasing rapidly; type 2 DM frequency in particular is rising in parallel with the epidemic of obesity (Chap. 175). In the past two decades, the worldwide prevalence of DM has increased more than 10-fold, from as estimated 30 million to >400 million cases. In the United States, the adult prevalence of DM ranges from 7–11% of the population, increasing with age. A significant portion of persons with DM are undiagnosed.
DM is attended by serious morbidity and significant mortality; it is consistently a leading cause of death worldwide.
Criteria for the diagnosis of DM are summarized in Table 176-1.
TABLE 176-1Criteria for the Diagnosis of Diabetes Mellitus ||Download (.pdf) TABLE 176-1 Criteria for the Diagnosis of Diabetes Mellitus
Symptoms of diabetes plus random blood glucose concentration ≥11.1 mmol/L (200 mg/dL)a or
Fasting plasma glucose ≥7.0 mmol/L (126 mg/dL)b or
Hemoglobin A1c ≥ 6.5%c or
2-h plasma glucose ≥11.1 mmol/L (200 mg/dL) during an oral glucose tolerance testd