Diabetes diagnosis and classification

With the recent years diabetic epidemiology, etiology, pathogenesis and clinical research in-depth and continuous progress in 1996, December 9-13 held in the United Kingdom WHO criteria for diagnosis of diabetes and its complications and sub-advisory member of the Meeting to consider carefully the 1979 NDDG [1], 1980 and 1985, WHO made the diagnosis and classification of the reasonableness of the law, combined with in the past 17 years, the study found that diabetes diagnosis and typing out a preliminary proposal. The new classification based on the cause of diabetes, rather than according to their clinical performance, more scientific and reasonable. Be divided into four types as follows: Type 1 diabetes [3, 7, 8] islet β cells led to the destruction of an absolute lack of insulin. Into autoimmune (including the acute onset and slow onset) and idiopathic (idiopathic type 1 diabetes, a minority, the cause is unknown, the lack of pancreatic islet β cells in the body's own immune evidence of a strong genetic tendency). Further sure, "LADA diabetes (latent autoimmune diabetes in adults, LADA)" should belong to the subtype of type 1 diabetes, characterized as: ① age of onset is greater than any of the 15-year-old age group, the incidence of six months is not Insulin-dependent, non-ketosis occurred; ② when the incidence of non-obese; ③ islet β cells in the body antibodies (ICA, GAD and insulin autoantibodies, etc.) often continued positive; ④ with type 1 diabetes susceptibility gene (for example, HLA-DR3 , HLA-DR4, BW54 and DQ-131-57-Non-Asp, etc.); ⑤ are often accompanied by thyroid and stomach wall cells, such as organ-specific antibody-positive. LADA one should be diagnosed early adoption of insulin treatment in order to protect the remnants of β cells. LADA Europe and the United States who report information about type 2 diabetes by 10% -15% in non-obese patients with type 2 diabetes have reported that up to 50%; cents States have reported type -2 diabetes GAD-Ab positive rate of 14.2% Type 2 diabetes [3,9,10] insulin resistance mainly with lack of insulin secretion, or lack of insulin secretion mainly with or without insulin resistance. All patients with diabetes account for about 90%, its cause is unknown, it is considered by many genetic and environmental factors (mainly for the lack of movement and the relative surplus of energy) common trigger, race, family history, obesity (especially abdominal obesity) , Hyperlipidemia, and impaired glucose tolerance is a risk factor for these groups should step up monitoring of blood glucose. It includes a series of specific causes of diabetes compared with the explicit or secondary diabetes, mainly in the following categories [3]: 1. Islet abnormal gene β-cell function: mainly young adult onset diabetes mellitus (MODY) and mitochondrial diabetes. ① MODY: According to the abnormal gene in three different subtypes [3,5,11]: chromosome 12, HNF12 (MODY3); chromosome 7, glucokinase (MODY2); chromosome 20, HNF-4α (MODY1). MODY characteristics: onset diabetes often <25 years old; early application of insulin without correct Hyperglycemia, a history of at least 2 years; nonketotic tendencies; dominant, the occurrence of high blood sugar mechanism is not yet entirely clear, common features for the islet β cell of glucose to stimulate insulin secretion barriers islet β cells function as the regular course of gradually extending the recession-resistant pancreatic bird is not its cause. ② mitochondrial diabetes and other [3, 12]: 1992 ven den Ouweland and Ballinger were confirmed by the mitochondrial diabetes caused by mutations in mitochondrial DNA. For clinical diabetes and deafness families. Its general characteristics: the number of onset before the age of 45, the first 11 years of age, but also as late onset before the age of 81; more patients with no tendency to ketosis, fat-free, the majority of patients in the course of disease onset or insulin when needed Treatment; often have mild to moderate hearing loss, deafness and diabetes onset time can be inconsistent, 20-year interval; showed maternal inheritance. Mitochondrial DNA mutations caused by diabetes may be the mechanism for the Department of pancreatic islet β cells, glucose oxidative phosphorylation obstacles, ATP produce enough insulin secretion induced obstacles, insulin resistance is not the major cause of morbidity. 2. Abnormal insulin receptor gene: insulin receptor mutation or deletion, which can range from mild hyperinsulinemia and glucose to serious diabetes, may be acanthosis nigricans disease, including type A insulin resistance syndrome goblin, Rabson - Mendenhall syndrome, atrophy of fat, such as diabetes. 3. Endocrine diseases: Cushing's disease, acromegaly, pheochromocytoma, Glucagonoma, somatostatin tumor, tumor aldosterone, such as hyperthyroidism. 4. Pancreatic disease: any damage caused by diffuse islet of the disease can cause high blood sugar, which include fiber calcified lesions of the pancreas disease, pancreatitis, pancreatic resection or trauma, tumor or tumor-infiltrating, cystic fibrosis, hemochromatosis And so on. 5. Drug-induced or chemical agents: nicotinic acid, corticosteroids, thyroid hormone, α-adrenergic antagonists, β-adrenergic antagonists, thiazide-type diuretics, calcium channel blockers (mainly Such as nifedipine), phenytoin, double-blind E, rodenticides Vacor (N-3-pyridine p-NP urea) and α-interferon, and so on. 6. Infection: congenital rubella and cytomegalovirus infection, and so on, but most of these patients have type 1 diabetes and autoimmune features of HLA markers. 7. Immunomodulatory very see-diabetes: insulin autoimmune syndrome (insulin resistance), acanthosis nigricans Ⅱ (insulin receptor antibodies have been referred to as type B insulin resistance), "Stiff Man" syndrome, the body is usually higher The islet cell antibody (ICA) and glutamic acid decarboxylase (CAD) of the antibody titration degrees, α interferon treatment (more than accompanied by the emergence of islet cell antibodies). 8. Other genetic diseases associated with diabetes: many of the genetic syndrome associated with increased incidence of diabetes: Down syndrome, Friedreich ataxia, Huntington disease, Klinefelter syndrome, Lawrence Moon Beidel syndrome, myotonic muscular atrophy, Porphyria, Prader Willin syndrome, Turner syndrome, Wolfram syndrome, and so on. Gestational diabetes mellitus (GDM [3,5,13]) occurred during pregnancy or the first time, found diabetes, pre-pregnancy may be normal or abnormal glucose metabolism but has not found its recommendations with other diagnostic criteria for diabetes, but not yet widely accepted . Screening time normally choose to 24-48 weeks of pregnancy, the current application of screening and diagnostic methods for: a state of non-fasting oral glucose 50g, such as the 1 hour blood glucose ≥ 7.8mmol / L, a further 100g OGTT [fasting 5.8mmol / L (105 mg / dl), 1 hours 10.mmol / L (190 mg / dl), 2 hours 9.2mmol / L (165 mg / dl) and 3 hours 8.1mmol / L (145mg/dl)]. All of the following conditions for those who do not have the screening: ① age <25 years old and with normal body weight; ② no family history of diabetes; ③ high incidence of non-diabetic race. Of gestational diabetes mellitus (GDM) in patients with post-6 weeks or longer period of time re-tolerance test, the majority of patients with normal blood sugar may be, may be a small part of the performance for IGT or IFG or diabetes (type 1 or type 2 diabetes ), GDM, even in patients with post-natal blood sugar returned to normal in time after a number of sugar increased opportunities for disease, care should be taken to strengthen the monitoring. Old and new types of comparative law The new type of diabetes the law broadly divided into four groups: sub-type, compared with the past, has the following characteristics: 1. Abolish the "insulin-dependent diabetes mellitus (IDDM) and" non-insulin-dependent diabetes mellitus (NIDDM) "the two terms, as a result of the classification on the basis of clinical treatment, often to the clinical diagnosis of diabetes and understanding of the source of confusion. Retain type Ⅰ Ⅱ and type 2 diabetes formulation, but the proposal to rewrite 1 and type 2 diabetes, as a result of the Roman alphabet and 11 Ⅱ may cause confusion. 2. IGT to retain the diagnosis, but it is not as a sub-type, but the development of diabetes in the course of a stage at the same time increase the "IFG". IGT and IFG are as important as the clinical significance of the view that the current clinical onset of type 2 diabetes have been almost 100% stage of IGT, the patients often accompanied by high blood pressure, hypertension and hyperlipidemia, and so on, the cardiovascular disease and Premature death rates were significantly increased, and progress to overt diabetes at the same time opportunities has also been a significant increase in the need to strengthen their management and intervention, and on a regular basis (six months to one year) follow-up. At home and abroad in recent years, with particular emphasis on the detection of patients with IGT and treatment interventions [3,14-16], IGT's intervention in the treatment of major acts, including the way (to strengthen the movement and control diet) and drugs (drug Shuanggua Lei, sugar al peaceful insulin Min, etc.), may reverse or slow down its progress to clinical diabetes, and will help to reduce the size of vascular complications. 3. An increase of "specific" names of the diagnosis: the specific type 2 diabetes, according to the etiology and pathogenesis of 8 are divided into subtypes, including the 1985-year of secondary diabetes, at the same time and cause of the pathogenesis To understand and compare the newly discovered diabetes is also one of ownership, such as MODY and mitochondrial diabetes and so on. 4. Malnutrition related diabetes (malnutrition-related diabetes mellitus, MRDM): The sub-type has been proposed to delete the [3,5]. Because: ① MRDM so far no epidemiological reports; ② MRDM in the diagnosis of non-specific characteristics, body mass index <18, replaced after 19, while the rural per capita in developing countries is 18.5 body mass index, lack of medical treatment to control diabetes Poor, the weight is also a diabetic; ③ MRDM two subtypes: First, the lack of protein due to diabetes, there is no convincing evidence that the lack of protein can cause diabetes; Second, the calcification of the pancreas fiber diabetes, such patients are often Chronic pancreatitis also can occur in its report of the normal human nutrition; ④ MRDM can affect other types of expression.