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Diabetes mellitus 

Diabetes mellitus
Diabetes mellitus

Gary Butler

and Jeremy Kirk

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date: 31 July 2021

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

insulin secretion

insulin action


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.


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.


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.


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:


ethnic minorities


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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