CHAIR: Prof.Dr.B.Jayakumar . Diabetes Mellitus definition, classification & aetiopathogenesis. Introduction. The prevalence of Diabetes is increasing rapidly,particularly in children and young adults. One third of cases of Diabetes remain undiagnosed.
Second century understanding:
Greek Physician Aretaeus of Cappadocia
II. Type 2 diabetes
b)Insulin resistance Environmental & Immunological factors interact leading to destruction of beta cells and insulin deficiency.
Failure to supressgluconeogenesis
Free Fatty Acid flux from adipocytes Increased lipid synthesis in hepatocytes.
Point mutations in mitochondrial DNA have been found to beassociated with diabetes mellitus and deafness.
Genetic abnormalities that result in the inability to convertproinsulin to insulin and the resultant carbohydrate intolerance have been identified
and 3. Rabson-Mendenhall syndrome
are two paediatric syndromes that
have mutations in the insulin receptor gene with subsequentalterations in insulin receptor function and extreme insulinresistance.
epinephrine) antagonize insulin action.
(e.g. Acromegaly, Cushing’s Syndrome, Glucagonoma and Phaeochromocytoma).
typically resolve when the hormone excess is removed.
diabetes in persons with insulin resistance.
binding to the insulin receptor.
recognition during pregnancy.
Risk Factors for Type 2 Diabetes Mellitus pregnancy, and
glucose load) or both are appropriate.
Fasting > 7.0 (> 126)
Or2-h post glucose load > 11.1 (> 200)
Fasting (if measured) < 7.0 (< 126)
& 2-h post glucose load > 7.8 (> 140) & < 11.1(<200)
Fasting > 6.1 (> 110) & < 7.0 (< 126)and (if measured)
2-h post glucose load < 7.8 (< 140
risk factor analysis and, if appropriate,use of an OGTT.
screening by measuring the plasma orserum glucose concentration 1 h after a50-g oral glucose load (glucose challengetest) and perform a diagnostic100-g OGTT on that subset of womenexceeding the glucose threshold valueon the glucose challenge test.
When the two-step approach is used, a glucose as a diagnostic test for DM.threshold value _140 mg/dl identifies80% of women with GDM, and theyield is further increased to 90% by usinga cutoff of _130 mg/dl.