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© 2005 by the American Diabetes Association, Inc.
POSITION STATEMENTS |
Diagnosis and Classification of Diabetes Mellitus
American Diabetes Association
Abbreviations: FPG, fasting plasma glucose • GAD, glutamic acid decarboxylase • GCT, glucose challenge test • GDM, gestational diabetes mellitus • HNF, hepatocyte nuclear factor • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • MODY, maturity-onset diabetes of the young • WHO, World Health Organization
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DEFINITION AND DESCRIPTION OF DIABETES MELLITUS |
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Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
Several pathogenic processes are involved in the development of diabetes. These range from autoimmune destruction of the ß-cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or more points in the complex pathways of hormone action. Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either alone, is the primary cause of the hyperglycemia.
Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.
Long-term complications of diabetes include retinopathy with potential loss of vision; nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction. Patients with diabetes have an increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease. Hypertension and abnormalities of lipoprotein metabolism are often found in people with diabetes.
The vast majority of cases of diabetes fall into two broad etiopathogenetic categories (discussed in greater detail below). In one category, type 1 diabetes, the cause is an absolute deficiency of
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CLASSIFICATION OF DIABETES MELLITUS AND OTHER CATEGORIES OF GLUCOSE REGULATION |
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Type 1 diabetes (ß-cell destruction, usually leading to absolute insulin deficiency)
Immune-mediated diabetes.
Idiopathic diabetes.
Type 2 diabetes (ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance)
Other specific types of diabetes
Genetic defects of the ß-cell.
Genetic defects in insulin action.
Diseases of the exocrine pancreas.
Endocrinopathies.
Drug- or chemical-induced diabetes.
Infections.
Uncommon forms of immune-mediated diabetes.
Other genetic syndromes sometimes associated with diabetes.
Gestational diabetes mellitus (GDM)
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)
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DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS |
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Diagnosis of GDM
Testing for gestational diabetes.
One-step approach.
Two-step approach.
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