1 / 15

Diabetes mellitus

Diabetes mellitus. Zhang jin-an ( 张进安） Endocrinology Department of the First Affiliated Hospital, Medical College, Xi’an Jiaotong University. Diabetes mellitus. Diabetes mellitus (DM) : a syndrome Factors contributing to hyperglycemia may include

raymondgreene
Télécharger la présentation

Diabetes mellitus

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diabetes mellitus Zhang jin-an (张进安） Endocrinology Department of the First Affiliated Hospital, Medical College, Xi’an Jiaotong University

  2. Diabetes mellitus Diabetes mellitus (DM) : a syndrome Factors contributing to hyperglycemia may include DM causes secondary pathophysiologic changes

  3. Prevalence In China, 1980: 0.67% 1994: 2.51% 1996: 3.21% In the world, 1997: 135 million 2000: 175 million 2025: 300 million

  4. Diabetes mellitus result in • DM is the leading cause of blindness between the ages of 20 and 74 in the United States • Diabetic nephropathy is the leading cause of ESRD in the United States and a leading cause of DM-related morbidity and mortality • DM is the leading cause of nontraumatic lower extremity amputation in the United States. • coronary heart disease events and mortality are two to four times greater in patients with type 2 DM

  5. Severe economic load of diabetes mellitus Medical cost of DM in USA (100million USD per year)

  6. Etiologic Classification of Diabetes Mellitus • I. Type 1 diabetes (β-cell destruction, usually leading to absolute insulin deficiency)  A. Immune-mediated  B. IdiopathicII. Type 2 diabetes (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance)III. Other specific types of diabetesIV. Gestational diabetes mellitus (GDM)

  7. III. Other specific types of diabetes A. Genetic defects of β-cell function characterized by mutations in: • Hepatocyte nuclear transcription factor (HNF) 4α (MODY 1) • Glucokinase (MODY 2) • HNF-1α (MODY 3) • Insulin promoter factor (IPF) 1 (MODY 4) • HNF-1β (MODY 5) • NeuroD1 (MODV6) • Mitochondrial DNA • Proinsulin or insulin conversion •  B. Genetic defects in insulin action • Type A insulin resistance • Leprechaunism • Rabson-Mendenhall syndrome • Lipodystrophy syndromes • C.Diseases of the exocrine pancreas—pancreatitis, pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathyD.Endocrinopathies—acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronomaE.Drug- or chemical-induced—Vacor, pentamidine, nicotinic acid, glucocorticoids, thyroid hormone, diazoxide, β-adrenergic agonists, thiazides, phenytoin, α-    interferon, protease inhibitors, clozapine, beta blockersF.Infections—congenital rubella, cytomegalovirus, coxsackieG.Uncommon forms of immune-mediated diabetes—“stiff-man” syndrome, anti-insulin receptor antibodiesH.Other genetic syndromes sometimes associated with diabetes—Down's syndrome, Klinefelter's syndrome, Turner's syndrome,    Wolfram's syndrome, Friedreich's ataxia, Huntington's chorea, Laurence-Moon-Biedl syndrome, myotonic dystrophy, porphyria, Prader-    Willi syndrome

  8. Classification: (ADA 1997) 1. Type 1 diabetes: absolute INS deficiency (Immune mediated, Idiopathic) 2. Type 2 diabetes: INS resistance and relative INS deficiency 3. Other specific types: cause is clear 4. Gestational diabetes: during pregnancy determine if DM after 6 ws of delivery.

  9. Etiology and pathogenesis 1. Type 1 DM : (1) genetic factors: concordance in identical twins50% HLA-DR3,DR4 (+), DQA1*0102, DQB1*0602(-) at least 17 different geneticloci (2) autoimmune factors: insulitis: CD4+/CD8+, IL-1,TNF-α, IFN-γ ICAs(GAD, insulin, IA-2) (3) environment factors: virus infection: Coxsackie B, mumps chemicals: vacor, streptozotocinum; diet: bovine milk proteins

  10. H.E ICA(-) ICA(+)

  11. Type 2 DM: (1) genetic factors: ---concordance inidentical twins 70~90% --- Various genetic loci (2) Environment factors: obesity: high calorie diet, less exercise INSULIN RESISTANCE (a) result: impairs glucose utilization; increases hepatic glucose output (b) molecular mechanism: postreceptor defects (Polymorphisms in IRS-1;GLUT4 ) IMPAIRED INSULIN SECRETION (a) Heavy burden to islet cell (b) amyloid fibrillar deposit in islet (c) glucose toxicity (d) lipotoxicity

More Related