Frits Holleman Diabetes mellitus is a heterogeneous group of diseases characterized by chronic elevation of glucose in the blood. It arises because the body is unable to produce enough insulin for its own needs, either because of impaired insulin secretion, impaired insulin action, or both. Diabetes affects some million people world-wide, and is on the increase.
Gale Diabetes mellitus refers to a condition in which circulating blood glucose is chronically elevated. As with for example anaemia, there are many possible causes for a high blood glucose. Equally, there can be wide variety of possible consequences, such that a physician specializing in diabetes must have some familiarity with almost every system in the body.
Investigation of diabetes itself An introduction to the analysis of diabetes mellitus be divided into the study of its causes, natural history, epidemiology, genetic basis, pathophysiological mechanism and biochemical consequences, and each of its many complications requires investigating along similar lines.
This entry provides a brief introduction to the way in which research findings have over the years been translated into the clinical investigation of diabetes. Introduction Figure 1As shown in the Figure 1, understanding a disease involves an iterative cycle of learning and investigation.
This begins with careful clinical observation of the natural history of the condition, leading on to the ability to make predictions about its course and prognosis.
Clinical interventions are developed and tested, in modern times by randomized controlled trials RCTs. Aetiological research seeks to identify possible causes, to examine their genetic basis and mechanism in humans and as necessary in experimental animals, and thereby feeds into possible new approaches to intervention.
Functional studies examine the way in which disease mechanisms are mediated and translate into clinical outcomes. Epidemiological analysis considers disease at a a population level, allowing investigation of potential environmental causes and correlates, of the impact of the disease, of its association with other disease states, and of its wider consequences.
Investigation of the Newly Diagnosed Patient This follows a logical sequence: A single positive test is generally considered reliable in people with typical symptoms, but a confirmatory test is prudent in asymptomatic people to exclude the possibility of laboratory error.
The oral glucose tolerance test OGTT may be useful in special circumstances, but is not generally necessary. See Other types of diabetes mellitus for a full list of the possibilities. Consideration should be given to the possibility of Monogenic diabetesPancreatic disordersEndocrine disorders and Drug-induced diabetes.
The distinction between Type 1 diabetes mellitus and Type 2 diabetes mellitus is generally straightforward and can be made on clinical grounds, but the two conditions blur at the margins, especially as early onset type 2 diabetes becomes more common in children and adolescents.
Special tests including measurement of C-peptide and islet autoantibodies may be needed in case of doubt. Examination for possible early complications Microvascular disease is the direct cause of diabetic retinopathy or diabetic nephropathy, and contributes to diabetic neuropathy.
Young patients with acute onset of diabetes are unlikely to have evidence of tissue damage at diagnosis, although regular long-term monitoring is needed. Evidence of early microvascular complications is not however uncommon in older people with slower onset of diabetes and often exposure to subclinical hyperglycaemia over many years.
Screening for Diabetic Retinopathy is performed by ophthalmoscopy through dilated pupils or retinal photography. Nephropathy is tested for by urinary testing for proteinuria or microalbuminuria. Neuropathy is tested for by standard clinical tests.
Older patients with type 2 diabetes are at high risk of cardiovascular or peripheral arterial disease, and will, as indicated, be investigated with ECGs, treadmill tests, doppler studies and so forth.
Type 2 diabetes is associated with a disease complex, often known as the metabolic syndrome, which is characterized by central obesity, dylipidaemia, hypertension, and insulin resistance. Obese individuals are at increased risk of some types of cancer, and diabetes may sometimes be the presenting symptom of Pancreatic cancer.
Lipids and blood pressure are routinely measured in the new-onset patient with type 2 diabetes, and further investigation may be required according to the clinical findings.
Review of other aspects of health Evaluation of a newly diagnosed person with diabetes is incomplete without careful review of their general health.
In older patients, especially, it is not uncommon to find evidence of other unrelated or indirectly related illness. Thus, general systems review and physical examination is required, together with standard screening tests including a full blood count, renal and liver function tests, and other general screening tests including CXR, ECG, etc, according to local guidelines.
Summary Investigation of diabetes should always be undertaken in a directed fashion, rather than by the routine deployment of standard tests. The investigator should actively question the possibility of unusual causes for diabetes, should reflect upon the relative contribution of insulin deficiency and pathogenesis and thus the most appropriate approach to therapyand should carefully evaluate the future risk of vascular disease and the best means of mitigating this.Diabetes mellitus type 1, also known as type 1 diabetes, is a form of diabetes mellitus in which very little or no insulin is produced by the pancreas.
Before treatment this results in high blood sugar levels in the body. The classic symptoms are frequent urination, increased thirst, increased hunger, and weight loss. Additional symptoms may include blurry vision, feeling tired, and poor wound.
Introduction. Observational and randomized clinical trials and observational data show a strong association between raised systolic and diastolic blood pressures (BPs) and clinically important microvascular (e.g. retinopathy and nephropathy) and cardiovascular (CV) complications in people with hypertension who have diabetes mellitus.
Diabetes: An Introduction: Also called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes.
Results when the body’s immune system attacks and destroys its own insulin-producing beta cells in the pancreas. People with type 1 diabetes need daily injections of insulin to live. DIABETES MELLITUS 1.
Introduction Diabetes mellitus is a chronic endocrine disorder, characterized by hyperglycaemia resulting from absolute or relative insulin deficiency. There are a number of different causes of diabetes but by far the majority of cases are classified as either type 1 or type 2 diabetes.
Methods. We searched for randomized trials comparing SGLT-2i to DPP-4i as add-on therapy to metformin in Type 2 arteensevilla.com pooled trials reporting outcomes between 12 and 26 weeks together while trials reporting results ≥52 weeks were pooled together.
Introduction. Research has shown an increasingly clear relationship between diabetes and a variety of mental health issues. These include diagnosable psychiatric disorders, and other problems that are specific to the experience of living with diabetes.