Chapter Category: Autoimmunity

From the book Endocrine and Organ Specific Autoimmunity

Type I Diabetes Mellitus

Eiji Kawasaki, Ronald G. Gill and George S. Eisenbarth

Diabetes mellitus is a series of disorders characterized by absolute or relative insulin deficiency that leads to hyperglycemia and altered glucose metabolism. These disorders are associated pathologically with micro- and macrovascular disease leading to accelerated arteriosclerosis, and various other characteristic long-term complications, including retinopathy, nephropathy, and neuropathy. The relative risks for blindness, renal failure, or amputation for people with diabetes are 20 to 40 times greater than for people without diabetes. Disease heterogeneity has important implications for research and for the clinical management of diabetes: first different genetic and environmental etiologic factors can result in similar diabetic phenotypes; and second the distinct disorders grouped together under the rubric diabetes may differ markedly in pathogenesis, natural history, and the responses to therapy and prophylactic measures. The recommended criteria for the diagnosis of diabetes are a casual plasma glucose concentration 200 mg/dl or a fasting plasma glucose 126mg/dl or a two-hour glucose on 75 gram oral glucose tolerance (oral glucose tolerance testing is not recommended for routine clinical use) testing of 200 mg/dl. In the absence of unequivocal hyperglycemia with metabolic decompensation the criteria should be confirmed by testing on a different day. The diagnosis of gestational diabetes requires only two of four glucoses on a 100 gram glucose tolerance test fasting with glucose 105mg/dl, 1 hour 190 mg/dl, 2 hour 165 mg/dl or 3 hour 145 mg/dl. Most patients with gestational diabetes have a return to normal glucose values postpregnancy, but a significant percentage progress to type 2 diabetes, and a smaller percentage (approximately 5%) are anti-islet autoantibody positive and have autoimmune type 1 diabetes.

Taken from the book

Endocrine and Organ Specific Autoimmunity

Edited by: Eiji Kawasaki, Ronald G. Gill and George S. Eisenbarth

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