Key Clinical Updates in Diabetes Mellitus
Teplizumab mzwv is approved for use in individuals 8 years and older who are at high risk for type 1 diabetes (two positive antibodies and impaired glucose tolerance). Common adverse reactions include transient decreases in white cell and lymphocyte counts, rash, and headache.
The TNF-alpha blocker infliximab has been reported to reverse beta cell dysfunction and induce remission of diabetes in patients with checkpoint inhibitor–induced diabetes.
LeFevre JD et al. Am J Health Syst Pharm. [PMID: 36056809]
ESSENTIALS OF DIAGNOSIS
Type 1 diabetes
Polyuria, polydipsia, and weight loss with random plasma glucose of ≥ 200 mg/dL (11.1 mmol/L).
Plasma glucose of ≥ 126 mg/dL (7.0 mmol/L) after an overnight fast, documented on more than one occasion.
Ketonemia, ketonuria, or both.
Islet autoantibodies are frequently present.
Type 2 diabetes
Many patients are over 40 years of age and have obesity.
Polyuria and polydipsia. Ketonuria and weight loss are uncommon at time of diagnosis. Candidal vaginitis may be an initial manifestation.
Plasma glucose of ≥ 126 mg/dL after an overnight fast on more than one occasion. Two hours after 75 g oral glucose, diagnostic values are ≥ 200 mg/dL (11.1 mmol).
HbA1c ≥ 6.5%.
Hypertension, dyslipidemia, and atherosclerosis are often associated.
An estimated 37.3 million people (10.5%) in the United States have diabetes mellitus, of whom approximately 5–10% have type 1 diabetes and most of the rest have type 2 diabetes. A third group designated as “other specific types” by the American Diabetes Association (ADA) (Table 29–1) number in the thousands. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html).
Table 29–1.Other specific types of diabetes mellitus. ||Download (.pdf) Table 29–1. Other specific types of diabetes mellitus.
Genetic defects of pancreatic B-cell function
MODY 1 (HNF-4alpha); rare
MODY 2 (glucokinase); less rare
MODY 3 (HNF-1alpha); accounts for two-thirds of all MODY
MODY 4 (PDX1); very rare
MODY 5 (HNF-1beta); very rare
MODY 6 (neuroD1); very rare
Genetic defects in insulin action
Type A insulin resistance
Diseases of the exocrine pancreas
Drug- or chemical-induced diabetes
Other genetic syndromes (Down, Klinefelter, Turner, others) sometimes associated with diabetes
CLASSIFICATION & PATHOGENESIS
Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate for the resistance.
A. Type 1 Diabetes Mellitus
This form of diabetes is due to autoimmune destruction of pancreatic islet B cell. The rate of pancreatic B cell destruction is variable, being rapid in some individuals and slow in others. It occurs at any age but most commonly arises in ...