Friday, 20 December 2013

Diabetes

Etiological classification of DM

I. Type 1 diabetes (beta cell destruction, usually leading to absolute insulin deficiency)
A. Immune-mediated
B. Idiopathic

II. Type 2 diabetes (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance)

III. Other specific types of diabetes
A. Genetic defects of beta cell function characterized by mutations in:
1. Hepatocyte nuclear transcription factor (HNF) 4 (MODY 1)
2. Glucokinase (MODY 2)
3. HNF-1 (MODY 3)
4. Insulin promoter factor-1 (IPF-1; MODY 4)
5. HNF-1 (MODY 5)
6. NeuroD1 (MODY 6)
7. Mitochondrial DNA
8. Subunits of ATP-sensitive potassium channel
9. Proinsulin or insulin

B. Genetic defects in insulin action
1. Type A insulin resistance
2. Leprechaunism
3. Rabson-Mendenhall syndrome
4. Lipodystrophy syndromes

C. Diseases of the exocrine pancreas—pancreatitis, pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy, mutations in carboxyl ester lipase

D. Endocrinopathies—acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronoma

E. Drug- or chemical-induced—glucocorticoids, vacor (a rodenticide), pentamidine, nicotinic acid, diazoxide, -adrenergic agonists, thiazides, hydantoins, asparaginase, -interferon, protease inhibitors, antipsychotics (atypicals and others), epinephrine

F. Infections—congenital rubella, cytomegalovirus, coxsackievirus

G. Uncommon forms of immune-mediated diabetes— "stiff-person" syndrome, anti-insulin receptor antibodies
H. Other genetic syndromes sometimes associated with diabetes— Wolfram's syndrome, Down's syndrome, Klinefelter's syndrome, Turner's syndrome, Friedreich's ataxia, Huntington's chorea, Laurence-Moon-Biedl syndrome, myotonic dystrophy, porphyria, Prader-Willi syndrome.

IV. Gestational diabetes mellitus (GDM)

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