DM1

• Diabetes mellitus

  Chronic hyperglycemia due to relative insulin deficiency, resistance or both
• Diabetes is generally irreversible and although the patient can lead a reasonably normal lifestyle, its late complications result in reduced life expectancy and major health costs
• Type 1 diabetes mellitus

  • Accounts for approximately 5 to 10 percent of diabetes in adults and 96% of diabetes in children
  • Autoimmune destruction of the insulin-producing pancreatic beta cells, leading to absolute insulin deficiency
  • Occurs in genetically susceptible individuals and is probably triggered by one or more environmental antigens
  • Autoantibodies directed against insulin and islet cell antigens predate the onset of clinical disease by several years
  • Typically presents during childhood and peaks around puberty, but can present at any age
  • Could be associated with other organ-specific autoimmune disease
  • Patients must be treated with insulin replacement
• Type 2 diabetes mellitus

  • Non-insulin-dependent
  • Most common type of diabetes in adults (>90 percent)
  • Most are over 40 years, but teenagers are now getting T2DM
  • Environmental factors, notably central obesity, lack of exercise, calorie and alcohol excess, trigger the disease in genetically susceptible individuals (polygenic)
  • Four major determinants are increasing age, obesity, ethnicity and family history
  • Established diabetes is associated with insulin hypersecretion although still inadequate to restore glucose homeostasis
  • Glucose intolerance or frank diabetes may be present in a subclinical or undiagnosed form for years before diagnosis, and 25-50% of patients already have some evidence of vascular complications at the time of diagnosis
  • The β-cell mass is reduced to about 50% of normal at the time of diagnosis
  • Patients with T2DM almost all show islet amyloid deposition due to co-secretion of peptides (amylin or IAPP) with insulin
  • Typically progresses from a preliminary phase of impaired glucose tolerance or impaired fasting glucose (IFG)
  • T2DM is associated with central obesity, HTN, hypertriglyceridemia, a decrease in HDL and an increase in pro-inflammatory markers, all of which cause insulin resistance and contribute to increased cardiovascular risk, referred to as the "metabolic syndrome"