Diabetes Mellitus- general

General Information

Description

  • Type 2 diabetes is characterized by hyperglycemia resulting from progressive loss of insulin secretion, often in the setting of insulin resistance1
  • The chronic hyperglycemia of diabetes can lead to multiorgan damage resulting in renal, neurologic, cardiovascular, and other serious complications2

Also Called

  • diabetes mellitus type II
  • type 2 diabetes
  • type II diabetes
  • non-insulin-dependent diabetes mellitus (NIDDM)
  • adult-onset diabetes

Types

  • American Diabetes Association (ADA) classifies type 2 diabetes as varying degrees of insulin resistance and insulin deficiency2
  • type 1 diabetes is defined as beta-cell destruction, usually leading to absolute insulin deficiency (can be immune-mediated or idiopathic)2
  • latent autoimmune diabetes of the adult (LADA)
    • a slowly progressive subtype of immune-mediated diabetes mellitus type 1 that occurs in adults
    • controversial but commonly used diagnostic criteria for LADA include all of
      • the onset of diabetes at age > 30 years
      • presence of circulating islet autoantibodies
      • insulin independence for ≥ 6 months after diagnosis
    • Reference – Front Med 2012 Sep;6(3):243
    • review of the management of LADA can be found in Curr Diabetes Rev 2019;15(3):188
  • brittle diabetes is a historic term used to refer to patients with insulin-dependent diabetes (usually type 1) who experience significant glucose variability resulting in disruption in activities of everyday life and recurrent and/or prolonged hospitalizations
    • reported in 3 per 1,000 patients with insulin-dependent diabetes, particularly in young women
    • can present with ≥1 of the following
      • frequent, severe, unpredictable episodes of hypoglycemia
      • recurrent diabetic ketoacidosis (DKA)
    • maybe caused by delayed gastric emptying as a result of autonomic neuropathy, malabsorption, certain drugs (such as alcohol or antipsychotics), defective insulin absorption or degradation, or a defect of hyperglycemic hormones (especially glucocorticoid and glucagon)
    • the term brittle diabetes is not commonly used in current literature, and most clinicians instead refer to the clinical presentation itself (severe hypoglycemia and/or recurrent DKA)
    • Reference – Ann Endocrinol (Paris) 2006 Sep;67(4):287
  • other types of diabetes
    • gestational diabetes mellitus
    • other less common types of diabetes, such as
      • genetic defects of beta-cell development and function, including
        • maturity-onset diabetes of the young
        • neonatal diabetes (can be transient or permanent)
      • diseases of the exocrine pancreas, including
        • chronic pancreatitis
        • pancreatectomy
        • pancreatic cancer
        • cystic fibrosis
        • hemochromatosis
      • endocrinopathies, including
        • acromegaly
        • Cushing syndrome
        • pheochromocytoma
        • hyperthyroidism
        • primary hyperaldosteronism
        • glucagonoma
        • somatostatinoma
      • infections, including
        • congenital rubella
        • hepatitis C virus
      • genetic defects in insulin action, including
        • type A insulin resistance
        • Donohue syndrome (leprechaunism)
        • Rabson-Mendenhall syndrome
        • lipoatrophic diabetes