Diagnostic Criteria and Classification of Diabetes

  • Jocelyn Myers
  • Joel Zonszein

Abstract

Diabetes mellitus is a heterogeneous group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Chronic hyperglycemia is associated with pathognomonic changes and failure of various organs, especially the eyes, kidneys, and nerves. Individuals with hyperglycemia are also subject to the accelerated cardiovascular disease that causes premature morbidity and mortality. Pathogenic processes involved in the development of diabetes range from autoimmune destruction of the β-cells of the pancreas with consequent insulin deficiency, to abnormalities in insulin signaling that result in resistance to insulin action. The vast majority of cases of diabetes fall into two broad etiopathogenetic groups. In one group (type 1 diabetes), the cause is an absolute deficiency of insulin secretion. Individuals at increased risk of developing this type of diabetes can often be identified by serological evidence of an autoimmune process of the pancreatic islets and by genetic markers. In the second and more prevalent group (type 2 diabetes), the cause is a combination of resistance to insulin action with inadequate compensatory insulin secretory response.

Keywords

Insulin Secretion Gestational Diabetes Mellitus Oral Glucose Tolerance Test Impaired Glucose Tolerance Impair Fasting Glucose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28: 1039 1057, 1979.Google Scholar
  2. 2.
    The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care 24 (Suppl. 1): S5 - S20, 2001.CrossRefGoogle Scholar
  3. 3.
    Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in the U.S. population aged 20–74 yr. Diabetes 36: 523–534, 1987.PubMedCrossRefGoogle Scholar
  4. 4.
    Charles MA, Fontboune A, Thibult N, Warnet JM, Rosselin GE, Eschwege E. Risk factors for NIDDM in white population: Paris Prospective Study. Diabetes 40: 796–799, 1991.Google Scholar
  5. 5.
    Brunzell JD, Robertson RP, Lerner RL, Hazzard WR, Ensink JW, Bierman EL, Porte D Jr. Relationships between fasting plasma glucose levels and insulin secretion during intravenous glucose tolerance tests. J Clin Endocrinol Metab 42: 222–229, 1976.PubMedCrossRefGoogle Scholar
  6. 6.
    Klein, R, Comor EB, Blount BA, Wingard DL. Visual impairment and retinopathy in people with normal glucose tolerance, impaired glucose tolerance and newly diagnosed NIDDM. Diabetes Care 14:914— 918, 1991.Google Scholar
  7. 7.
    Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary-heart disease risk and impaired glucose tolerance: the Whitehall Study. Lancet i: 1373–1376, 1980.Google Scholar
  8. 8.
    Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 18: 258–268, 1995.PubMedCrossRefGoogle Scholar
  9. 9.
    McCance DR, Hanson RL, Charles MA, Jacobsson LTH, Pettitt DJ, Bennett PH, Knowler WC. Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes. Brit Med J 308: 1323–1328, 1994.PubMedCrossRefGoogle Scholar
  10. 10.
    American Diabetes Association. Tests of glycemia in diabetes (Position Statement). Diabetes Care 24 (Suppl. 1): S80 — S82, 2001.CrossRefGoogle Scholar
  11. 11.
    Engelgau MM, Thompson TJ, Herman WH, Boyle JP, Aubert RE, Kenny SJ, Badran A, Sous ES, Ali MA. Comparison of fasting and 2-hour glucose and HbAic levels for diagnosing diabetes: diagnostic criteria and performance revisited. Diabetes Care 20: 785–791, 1997.PubMedCrossRefGoogle Scholar
  12. 12.
    Barrett-Connor E, Wingard DL. HbAlc levels predict mortality across population ranges. Brit Med J 322: 5–6, 2001.PubMedCrossRefGoogle Scholar
  13. 13.
    Metzger BE. Organizing committee summary and recommendations of the Third International Workshop-Conference on gestational diabetes mellitus. Diabetes 40: 197–201, 1991.PubMedCrossRefGoogle Scholar
  14. 14.
    Harris MI, Hadden WC, Knowler WC, Bennett PH: Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in the U.S. population aged 20–74 yr. Diabetes 36: 523–534, 1987.PubMedCrossRefGoogle Scholar
  15. 15.
    Atkinson MA, Maclaren NK. The pathogenesis of insulin dependent diabetes. N Engl J Med 331: 1428–1436, 1994.PubMedCrossRefGoogle Scholar
  16. 16.
    Kaufman D, Erlander M, Clare-Salzler M, Atkinson M, Maclaren N, Tobin A. Autoimmunity to two forms of glutamate decarboxylase in insulin-dependent mellitus. J Clin Invest 89: 283–292, 1992.PubMedCrossRefGoogle Scholar
  17. 17.
    Myers MA, Rabin DU, Rowley MJ. Pancreatic islet cell cytoplasmic antibody in diabetes is represented by antibodies to islet cell antigen 512 and glutamic acid decarboxylase. Diabetes 44: 1290–1295, 1995.PubMedCrossRefGoogle Scholar
  18. 18.
    Lan MS, Wasserfall C, Maclaren NK, Notkins AL. IA-2, a transmembrane protein of the protein tyrosine phosphatase family, is a major autoantigen in insulin-dependent diabetes mellitus. Proc Natl Acad Sci USA 93: 6367–6370, 1996.PubMedCrossRefGoogle Scholar
  19. 19.
    Lu J, Li Q, Xie H, Chen Z, Borovitskaya AE, Maclaren NK, Notkins AL, Lan MS. Identification of a second transmembrane protein tyrosine phosphatase, IA-2a, as an autoantigen in insulin-dependent diabetes mellitus: precursor of the 37-kDa tryptic fragment. Proc Natl Acad Sci USA 93: 2307–2311, 1996.PubMedCrossRefGoogle Scholar
  20. 20.
    Huang W, Connor E, DelaRosa T, Muir A, Schatz D, Silverstein J, Crockett S, She JX, Maclaren NK. Although DR3-DQB 1 * may be associated with multiple component diseases of the autoimmune polyglandular syndromes, the human leukocyte antigen DR4DQB 1I0302 haplotype is implicated only in beta cell autoimmunity. J Clin Endocrinol Metab 81: 1–5, 1996.CrossRefGoogle Scholar
  21. 21.
    Zimmet PZ, Tuomi T, Mackay R, Rowley MJ, Knowles W, Cohen M, Lang DA. Latent autoimmune diabetes mellitus in adults (LADA): the role of antibodies to glutamic acid decarboxylase in diagnosis and prediction of insulin dependency. Diabet Med 11: 299–303, 1994.PubMedCrossRefGoogle Scholar
  22. 22.
    Banerji M, Lebovitz H. Insulin sensitive and insulin resistant variants in IDDM. Diabetes 38: 784–792, 1989.PubMedCrossRefGoogle Scholar
  23. 23.
    Yamagata K, Oda N, Kaisaki PJ, Menzel S, Furuta H, Vaxillaire M, Southam L, Cox RD, Lathrop GM, Boriraj VV, Chen X, Cox NJ, Oda Y, Yano H, Le Beau MM, Yamada S, Nishigori H, Takeda J, Fajans SS, Hattersley AT, Iwasaki N, Hansen T, Pedersen O, Polonsky KS, Bell GI. Mutations in the hepatocyte nuclear factor- gene in maturity-onset diabetes of the young (MODY 3). Nature 384: 455–458, 1996.PubMedCrossRefGoogle Scholar
  24. 24.
    Froguel P, Vaxillaire M, Sun F, Velho G, Zouali H, Butel MO, Lesage S, Vionnet N, Clement K, Fougerousse F, et al. Close linkage of glucokinase locus on chromosome 7p to early-onset non-insulindependent diabetes mellitus. Nature 356: 162–164, 1992.PubMedCrossRefGoogle Scholar
  25. 25.
    Vionnet N, Stoffel M, Takeda J, Yasuda K, Bell GI, Zouali H, Lesage S, Velho G, Iris F, Passa P, et al. Nonsense mutation in the glucokinase gene causes early-onset non-insulin-dependent diabetes mellitus. Nature 356: 721–1488, 1992.PubMedCrossRefGoogle Scholar
  26. 26.
    Yamagata K, Furuta H, Oda N, Kaisaki PJ, Menzel S, Cox NJ, Fajans SS, Signorini S, Stoffel M, Bell GI. Mutations in the hepatocyte factor4a gene in maturity-onset diabetes of the young (MODY 1). Nature 384: 458–460, 1996.PubMedCrossRefGoogle Scholar
  27. 27.
    Kadowaki T, Kadowaki H, Mori Y, Tobe K, Sakuta R, Suzuki Y, Tanabe Y, Sakura H, Awata T, Goto Y, et al. A subtype of diabetes mellitus associated with a mutation of mitochondrial DNA. N Engl J Med 330: 962–968, 1994.PubMedCrossRefGoogle Scholar
  28. 28.
    Gruppuso PA, Gorden P, Kahn CR, Cornblath M, Zeller WP, Schwartz R. Familial hyperproinsulinemia due to a proposed defect in conversion of proinsulin to insulin. N Engl J Med 311: 629–634, 1984.PubMedCrossRefGoogle Scholar
  29. 29.
    Given BD, Mako ME, Tager HS, Baldwin D, Markese J, Rubenstein AH, Olefsky J, Kobayashi M, Kolterman O, Poucher R. Diabetes due to secretion of an abnormal insulin. N Engl J Med 302: 129–135, 1980.PubMedCrossRefGoogle Scholar
  30. 30.
    Taylor SI. Lilly Lecture: molecular mechanisms of insulin resistance: lessons from patients with mutations in the insulin-receptor gene. Diabetes 41: 1473–1490, 1992.PubMedCrossRefGoogle Scholar
  31. 31.
    Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, Roth J. The syndromes of insulin resistance and acanthosis nigricans. N Engl J Med 294: 739–745, 1976.PubMedCrossRefGoogle Scholar
  32. 32.
    Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 41: 1257–1266, 1992.PubMedCrossRefGoogle Scholar
  33. 33.
    Karjalainen J, Knip M, Hyoty H, Linikki P, Ilonen J, Kaar M-L, Akerblom HK. Relationship between serum insulin antibodies, islet cell antibodies and Coxsackie-B4 and mumps virus—specific antibodies at the clinical manifestation of type I (insulin-dependent) diabetes. Diabetologia 31: 146–152, 1988.PubMedCrossRefGoogle Scholar
  34. 34.
    Pak CY, Eun H, McArthur RG, Yoon J. Association of cytomegalovirus infection with autoimmune type 1 diabetes. Lancet ii: 1–4, 1988.Google Scholar
  35. 35.
    Engelgau MM, Herman WH, Smith PJ, German RR, Aubert RE. The epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care 18: 1029–1033, 1995.PubMedCrossRefGoogle Scholar
  36. 36.
    Magee MS, Walden CE, Benedetti TJ. Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity. JAMA 269: 609–615, 1993.PubMedCrossRefGoogle Scholar
  37. 37.
    Langer O, Rodriguez DA, Xenakis EMJ, McFarland MB, Berkus MD, Arrendondo F. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol 170: 1036–1047, 1994.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Jocelyn Myers
  • Joel Zonszein

There are no affiliations available

Personalised recommendations