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Diabetes mellitus 

Diabetes mellitus
Chapter:
Diabetes mellitus
Author(s):

Gary Butler

and Jeremy Kirk

DOI:
10.1093/med/9780198786337.003.0005
Page of

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date: 31 July 2021

Diabetes mellitus is a chronic hyperglycaemia state, caused by defects in:

insulin secretion

insulin action

both.

Type 1 diabetes accounts for ~95% of cases.

Rising incidence in UK (25/100,000 children/year) now appears to be stabilizing.

Peaks at younger age (4–6 years of age) and also puberty.

Therapy:

With subcutaneous insulin (multiple daily injections, continuous subcutaneous insulin infusion (CSII) (less used now, twice- and thrice-daily mixtures)) to mimic physiological secretion, maintain euglycaemia, minimize hypoglycaemic episodes and diabetic ketoacidosis.

Monitoring:

Minimum of five self-monitored blood glucose measurements a day recommended. Continuous glucose monitoring increasingly utilized, especially with CSII.

Overall control assessed using glycated haemoglobin.

Outcome:

Clear evidence that good diabetic control associated with reduction in complications (micro- and macrovascular).

Screening recommended at an early stage to detect complications and prevent progression.

Type 2 diabetes:

Increasingly recognized in children/adolescents.

Increased incidence in:

females

ethnic minorities

overweight/obese

those with family history.

Part of metabolic syndrome: T2DM/insulin resistance, hypertension, hyperlipidaemia, cardiovascular disease, adrenarche/polycystic ovarian syndrome.

A combination of insulin resistance and (relative) insulin deficiency; oral hypoglycaemics may be appropriate (at least initially).

Other forms of diabetes (uncommon):

Maturity-onset diabetes of the young (MODY):

autosomal dominant inheritance; dependent on type, variable

response to oral hypoglycaemics

development of microvascular complications.

Association with syndromes, e.g. Wolfram, Walcott–Rallison, Prader–Willi syndrome.

Cystic fibrosis-related diabetes:

not autoimmune in origin, due to combination of insulin deficiency/resistance

increasing incidence with age

treatment is with insulin.

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