Diabetes mellitus classification

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS.
Arquivos brasileiros de cardiologia (Impact Factor: 1.02). 08/2010; 95(2):e40-6. DOI: 10.1590/S0066-782X2010001200025
Source: PubMed


The right classification for diabetes mellitus (DM) allows a more adequate treatment and comprises four categories: type 1 DM, type 2 DM, other types, and gestational diabetes. In some cases, there might be a superposition of situations, especially with regard to the DM that initiates in the young adult or is initially presented with diabetic ketoacidosis intermediately to type 1 and 2 DM. Thus, additions to the classic classification system have been proposed as assessing the presence of autoimmunity (antibody) and b cell function (C-peptide) to precisely define the subtypes. The aim of this literature review was to analyze these diagnostic indexes` performance in the DM classification and to describe subtypes with details. The antibodies against pancreas confirm autoimmunity, and the antibody against insulin is more accurate before 5 years old, while the anti-glutamic acid decarboxylase is more accurate after 20 years old, a test which remains positive for a longer period. The measurement of C-peptide evaluates the pancreatic insulin reserve, and the most largely used methods of stimulation are the measurement after meals or after intravenous glucagon. C-peptide values < 1.5 ng/ml define a patient with absent pancreatic function and, above this value, patients with preserved function. When the presence of antibodies (A+) directed to the pancreas is combined to its insulin secretion capability (β+), it is possible to subdivide DM`s classification in type 1A (A+β-) and 1B (A+β-); and type 2A (A+β+) and 2B (A-β+), which allows a more precise classification and treatment besides opening horizons for the understanding of DM pathogenesis.

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Available from: Sandra Pinho Silveiro, Feb 26, 2014
    • "Type 1 diabetes accounts for only 5-10% of those with diabetes, and includes cases resulting from the autoimmune destruction of pancreatic -cells, usually leading to absolute deficiency of insulin secretion, and those with diabetes due to unknown causes (idiopathic diabetes) [1] [3]. On the other hand, type 2 diabetes accounts for approximately 90-95% of cases, has no autoimmune component, and involves the combination of resistance to insulin action and an inadequate compensatory insulin secretory response [1] [3]. "
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    ABSTRACT: Diabetes mellitus is a common and growing problem worldwide, especially in the elderly population imposing a huge economic burden for individuals and healthcare services. The purpose of this narrative review was to summarize the current state of knowledge about the relationship between diabetes and important geriatric syndromes, physical function measures, and gait variables. Studies pertaining to the topics were identified through on-line search of databases. Seniors with diabetes are more likely to experience falls, depression, and frailty. Furthermore, in older patients, diabetes has been associated with disability, including basic and instrumental activities of daily living, and with poorer performance on objective measures of physical function, such as sit-to-stand test, handgrip strength, Timed Up and Go (TUG) test, and Short Physical Performance Battery (SPPB). Diabetic seniors also have an altered gait pattern characterized by lower velocity and stride length, and higher step width, stance time, double support time, and stride length variability compared to non-diabetic seniors. Little is known about fear of falling in older adults with diabetes. The relationship between these outcomes and diabetes in older people is still outstanding and merits further investigation.
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    ABSTRACT: Diabetes mellitus (DM) represents a heterogeneous group of conditions that share certain characteristics with hyperglycemia as a common feature. The first worldwide accepted classification scheme for DM was published in 1979 by the National Diabetes Data Group (NDDG) and classified DM based on the pharmacologic therapy applied into two major groups: Insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The terms coined by the NDDG became popular during the 1980s and 1990s, but with time, the misclassification of patients became evident. Since the correct classification of DM allows a more adequate treatment, the new classification proposed by the American Diabetes Association in 1997 was based in the pathogenesis of the disease and comprises four categories: Type 1 DM, Type 2 DM, other types and gestational diabetes. Despite significant advances in diabetes understanding, some gray areas still remain and new studies are necessary to further improve diabetes classification.
    No preview · Article · Jan 2012 · Advances in Experimental Medicine and Biology
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    ABSTRACT: BACKGROUND: The etiology of type 1 diabetes (T1D) is heterogeneous and is according to presence or absence of pancreatic autoantibodies divided into two subtypes: type 1A (autoimmune-mediated) and type 1B (non-autoimmune-mediated). Although several genes have been linked to type 1A diabetes, the genetic cause of type 1B diabetes in Japanese individuals is far from understood. OBJECTIVE: The aim of this study was to test for monogenic forms of diabetes in auto antibody-negative Japanese children with T1D. METHODS: Thirty four (19 males and 15 female) unrelated Japanese children with glutamate decarboxylase (GAD) 65 antibodies and/or IA-2A-negative T1D and diabetes diagnosed at < 5 yr of age were recruited from 17 unrelated hospitals participating in the Japanese Study Group of Insulin Therapy for children and adolescent diabetes (JSGIT). We screened the INS gene and the KCNJ11 gene which encode the ATP-sensitive potassium cannel by direct sequencing in 34 Japanese children with T1D. RESULTS: We identified three novel (C31Y, C96R, and C109F) mutations and one previously reported mutation (R89C) in the INS gene in five children, in addition to one mutation in the KCNJ11 gene (H46R) in one child. These mutations are most likely pathogenic and therefore the cause of diabetes in carriers. CONCLUSION: Our results suggest that monogenic forms of diabetes, particularly INS gene mutations, can be detected in Japanese patients classified with type 1B. Mutation screening, at least of the INS gene, is recommended for Japanese patients diagnosed as autoantibody negative at <5 yr of age.
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