Diabetes Mellitus - Wikipedia, The Free Encyclopedia

10/8/2016
DiabetesmellitusWikipedia,thefreeencyclopedia
Diabetesmellitus
FromWikipedia,thefreeencyclopedia
Diabetesmellitus(DM),commonlyreferredtoasdiabetes,isagroupofmetabolicdiseasesinwhichthereare
highbloodsugarlevelsoveraprolongedperiod.[2]Symptomsofhighbloodsugarincludefrequenturination,
increasedthirst,andincreasedhunger.Ifleftuntreated,diabetescancausemanycomplications.[3]Acute
complicationscanincludediabeticketoacidosis,nonketotichyperosmolarcoma,ordeath.[4]Seriouslongterm
complicationsincludeheartdisease,stroke,chronickidneyfailure,footulcers,anddamagetotheeyes.[3]
Diabetesmellitus
Diabetesisduetoeitherthepancreasnotproducingenoughinsulinorthecellsofthebodynotresponding
properlytotheinsulinproduced.[5]Therearethreemaintypesofdiabetesmellitus:
Type1DMresultsfromthepancreas'sfailuretoproduceenoughinsulin.Thisformwaspreviously
referredtoas"insulindependentdiabetesmellitus"(IDDM)or"juvenilediabetes".Thecauseis
unknown.[3]
Type2DMbeginswithinsulinresistance,aconditioninwhichcellsfailtorespondtoinsulinproperly.[3]
Asthediseaseprogressesalackofinsulinmayalsodevelop.[6]Thisformwaspreviouslyreferredtoas
"noninsulindependentdiabetesmellitus"(NIDDM)or"adultonsetdiabetes".Theprimarycauseis
excessivebodyweightandnotenoughexercise.[3]
Gestationaldiabetesisthethirdmainformandoccurswhenpregnantwomenwithoutaprevioushistory
ofdiabetesdevelophighbloodsugarlevels.[3]
Preventionandtreatmentinvolvemaintainingahealthydiet,regularphysicalexercise,anormalbodyweight,
andavoidinguseoftobacco.Controlofbloodpressureandmaintainingproperfootcareareimportantfor
peoplewiththedisease.Type1DMmustbemanagedwithinsulininjections.[3]Type2DMmaybetreatedwith
medicationswithorwithoutinsulin.[7]Insulinandsomeoralmedicationscancauselowbloodsugar.[8]Weight
losssurgeryinthosewithobesityissometimesaneffectivemeasureinthosewithtype2DM.[9]Gestational
diabetesusuallyresolvesafterthebirthofthebaby.[10]
Asof2015,anestimated415millionpeoplehaddiabetesworldwide,[11]withtype2DMmakingupabout90%
ofthecases.[12][13]Thisrepresents8.3%oftheadultpopulation,[13]withequalratesinbothwomenandmen.[14]
Asof2014,trendssuggestedtheratewouldcontinuetorise.[15]Diabetesatleastdoublesaperson'sriskofearly
https://en.wikipedia.org/wiki/Diabetes_mellitus
Universalbluecirclesymbolfordiabetes. [1]
Classificationandexternalresources
Specialty
Endocrinology
ICD10
E10(http://apps.who.int/classification
s/icd10/browse/2016/en#/E10)E14
(http://apps.who.int/classifications/icd
10/browse/2016/en#/E14)
ICD9CM
250(http://www.icd9data.com/getIC
D9Code.ashx?icd9=250)
MedlinePlus 001214(http://www.nlm.nih.gov/me
dlineplus/ency/article/001214.htm)
eMedicine
med/546(http://www.emedicine.com/
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death.[3]From2012to2015,approximately1.5to5.0milliondeathseachyearresultedfromdiabetes.[7][11]The
globaleconomiccostofdiabetesin2014wasestimatedtobeUS$612billion.[16]IntheUnitedStates,diabetes
cost$245billionin2012.[17]
Contents
med/topic546.htm)emerg/134(http://
www.emedicine.com/emerg/topic134.
htm#)
PatientUK Diabetesmellitus(http://patient.info/
doctor/managementoftype1diabete
s)
MeSH
1 Signsandsymptoms
1.1 Diabeticemergencies
1.2 Complications
2 Causes
2.1 Type1
2.2 Type2
2.3 Gestationaldiabetes
2.4 Othertypes
3 Pathophysiology
4 Diagnosis
5 Prevention
6 Management
6.1 Lifestyle
6.2 Medications
6.3 Surgery
6.4 Support
7 Epidemiology
8 History
8.1 Etymology
9 Societyandculture
9.1 Naming
10 Otheranimals
11 Research
12 References
13 Furtherreading
14 Externallinks
C18.452.394.750(https://www.nlm.ni
h.gov/cgi/mesh/2016/MB_cgi?mode=
&term=Diabetes&field=entry#TreeC
18.452.394.750)
Videoexplanation
Signsandsymptoms
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Theclassicsymptomsofuntreateddiabetesareweightloss,polyuria(increasedurination),polydipsia
(increasedthirst),andpolyphagia(increasedhunger).[18]Symptomsmaydeveloprapidly(weeksor
months)intype1DM,whiletheyusuallydevelopmuchmoreslowlyandmaybesubtleorabsentin
type2DM.
Severalothersignsandsymptomscanmarktheonsetofdiabetesalthoughtheyarenotspecifictothe
disease.Inadditiontotheknownonesabove,theyincludeblurryvision,headache,fatigue,slow
healingofcuts,anditchyskin.Prolongedhighbloodglucosecancauseglucoseabsorptioninthelens
oftheeye,whichleadstochangesinitsshape,resultinginvisionchanges.Anumberofskinrashes
thatcanoccurindiabetesarecollectivelyknownasdiabeticdermadromes.
Diabeticemergencies
Lowbloodsugariscommoninpersonswithtype1andtype2DM.Mostcasesaremildandarenot
consideredmedicalemergencies.Effectscanrangefromfeelingsofunease,sweating,trembling,and
increasedappetiteinmildcasestomoreseriousissuessuchasconfusion,changesinbehaviorsuchas
aggressiveness,seizures,unconsciousness,and(rarely)permanentbraindamageordeathinsevere
cases.[19][20]Moderatehypoglycemiamayeasilybemistakenfordrunkenness[21]rapidbreathingand
sweating,cold,paleskinarecharacteristicofhypoglycemiabutnotdefinitive.[22]Mildtomoderate
casesareselftreatedbyeatingordrinkingsomethinghighinsugar.Severecasescanleadto
unconsciousnessandmustbetreatedwithintravenousglucoseorinjectionswithglucagon.
Overviewofthemostsignificantsymptomsofdiabetes
People(usuallywithtype1DM)mayalsoexperienceepisodesofdiabeticketoacidosis,ametabolicdisturbancecharacterizedbynausea,vomitingandabdominal
pain,thesmellofacetoneonthebreath,deepbreathingknownasKussmaulbreathing,andinseverecasesadecreasedlevelofconsciousness.[23]
Ararebutequallyseverepossibilityishyperosmolarnonketoticstate,whichismorecommonintype2DMandismainlytheresultofdehydration.[23]
Complications
Allformsofdiabetesincreasetheriskoflongtermcomplications.Thesetypicallydevelopaftermanyyears(1020),butmaybethefirstsymptominthosewho
haveotherwisenotreceivedadiagnosisbeforethattime.
Themajorlongtermcomplicationsrelatetodamagetobloodvessels.Diabetesdoublestheriskofcardiovasculardisease[24]andabout75%ofdeathsindiabetics
areduetocoronaryarterydisease.[25]Other"macrovascular"diseasesarestroke,andperipheralvasculardisease.
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Theprimarycomplicationsofdiabetesduetodamageinsmallbloodvesselsincludedamagetotheeyes,kidneys,andnerves.[26]Damagetotheeyes,knownas
diabeticretinopathy,iscausedbydamagetothebloodvesselsintheretinaoftheeye,andcanresultingradualvisionlossandblindness.[26]Damagetothe
kidneys,knownasdiabeticnephropathy,canleadtotissuescarring,urineproteinloss,andeventuallychronickidneydisease,sometimesrequiringdialysisor
kidneytransplant.[26]Damagetothenervesofthebody,knownasdiabeticneuropathy,isthemostcommoncomplicationofdiabetes.[26]Thesymptomscan
includenumbness,tingling,pain,andalteredpainsensation,whichcanleadtodamagetotheskin.Diabetesrelatedfootproblems(suchasdiabeticfootulcers)
mayoccur,andcanbedifficulttotreat,occasionallyrequiringamputation.Additionally,proximaldiabeticneuropathycausespainfulmusclewastingand
weakness.
Thereisalinkbetweencognitivedeficitanddiabetes.Comparedtothosewithoutdiabetes,thosewiththediseasehavea1.2to1.5foldgreaterrateofdeclinein
cognitivefunction.[27]
Causes
Diabetesmellitusisclassifiedintofourbroadcategories:type1,type2,gestationaldiabetes,and
"otherspecifictypes".[5]The"otherspecifictypes"areacollectionofafewdozenindividual
causes.[5]Diabetesisamorevariablethanoncethoughtandpeoplemayhavecombinationsof
forms.[29]Theterm"diabetes",withoutqualification,usuallyreferstodiabetesmellitus.
Type1
Type1diabetesmellitusischaracterizedbylossoftheinsulinproducingbetacellsoftheisletsof
Langerhansinthepancreas,leadingtoinsulindeficiency.Thistypecanbefurtherclassifiedas
immunemediatedoridiopathic.Themajorityoftype1diabetesisoftheimmunemediated
nature,inwhichaTcellmediatedautoimmuneattackleadstothelossofbetacellsandthus
insulin.[30]Itcausesapproximately10%ofdiabetesmellituscasesinNorthAmericaandEurope.
Mostaffectedpeopleareotherwisehealthyandofahealthyweightwhenonsetoccurs.Sensitivity
andresponsivenesstoinsulinareusuallynormal,especiallyintheearlystages.Type1diabetes
canaffectchildrenoradults,butwastraditionallytermed"juvenilediabetes"becauseamajority
ofthesediabetescaseswereinchildren.
Comparisonoftype1and2diabetes[12]
Feature
Type1diabetes Type2diabetes
Onset
Ageatonset
Bodysize
Ketoacidosis
Autoantibodies
Sudden
Mostlyinchildren Mostlyinadults
Thinornormal[28] Oftenobese
Common
Rare
Usuallypresent
Absent
Endogenousinsulin Loworabsent
Concordance
50%
inidenticaltwins
Prevalence
Gradual
~10%
Normal,decreased
orincreased
90%
~90%
"Brittle"diabetes,alsoknownasunstablediabetesorlabilediabetes,isatermthatwastraditionallyusedtodescribethedramaticandrecurrentswingsinglucose
levels,oftenoccurringfornoapparentreasonininsulindependentdiabetes.Thisterm,however,hasnobiologicbasisandshouldnotbeused.[31]Still,type1
diabetescanbeaccompaniedbyirregularandunpredictablehighbloodsugarlevels,frequentlywithketosis,andsometimeswithseriouslowbloodsugarlevels.
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Othercomplicationsincludeanimpairedcounterregulatoryresponsetolowbloodsugar,infection,gastroparesis(whichleadstoerraticabsorptionofdietary
carbohydrates),andendocrinopathies(e.g.,Addison'sdisease).[31]Thesephenomenaarebelievedtooccurnomorefrequentlythanin1%to2%ofpersonswith
type1diabetes.[32]
Type1diabetesispartlyinherited,withmultiplegenes,includingcertainHLAgenotypes,knowntoinfluencetheriskofdiabetes.Theincreaseofincidenceof
type1diabetesreflectsthemodernlifestyle.[33]Ingeneticallysusceptiblepeople,theonsetofdiabetescanbetriggeredbyoneormoreenvironmentalfactors,[34]
suchasaviralinfectionordiet.Severalviruseshavebeenimplicated,buttodatethereisnostringentevidencetosupportthishypothesisinhumans.[34][35]Among
dietaryfactors,datasuggestthatgliadin(aproteinpresentingluten)mayplayaroleinthedevelopmentoftype1diabetes,butthemechanismisnotfully
understood.[36][37]
Type2
Type2DMischaracterizedbyinsulinresistance,whichmaybecombinedwithrelativelyreducedinsulinsecretion.[5]Thedefectiveresponsivenessofbody
tissuestoinsulinisbelievedtoinvolvetheinsulinreceptor.However,thespecificdefectsarenotknown.Diabetesmellituscasesduetoaknowndefectare
classifiedseparately.Type2DMisthemostcommontypeofdiabetesmellitus.
Intheearlystageoftype2,thepredominantabnormalityisreducedinsulinsensitivity.Atthisstage,highbloodsugarcanbereversedbyavarietyofmeasuresand
medicationsthatimproveinsulinsensitivityorreducetheliver'sglucoseproduction.
Type2DMisdueprimarilytolifestylefactorsandgenetics.[38]Anumberoflifestylefactorsareknowntobeimportanttothedevelopmentoftype2DM,
includingobesity(definedbyabodymassindexofgreaterthan30),lackofphysicalactivity,poordiet,stress,andurbanization.[12]Excessbodyfatisassociated
with30%ofcasesinthoseofChineseandJapanesedescent,6080%ofcasesinthoseofEuropeanandAfricandescent,and100%ofPimaIndiansandPacific
Islanders.[5]Eventhosewhoarenotobeseoftenhaveahighwaisthipratio.[5]
Dietaryfactorsalsoinfluencetheriskofdevelopingtype2DM.Consumptionofsugarsweeteneddrinksinexcessisassociatedwithanincreasedrisk.[39][40]The
typeoffatsinthedietisalsoimportant,withsaturatedfatsandtransfattyacidsincreasingtheriskandpolyunsaturatedandmonounsaturatedfatdecreasingthe
risk.[38]Eatinglotsofwhitericealsomayincreasetheriskofdiabetes.[41]Alackofexerciseisbelievedtocause7%ofcases.[42]
Gestationaldiabetes
Gestationaldiabetesmellitus(GDM)resemblestype2DMinseveralrespects,involvingacombinationofrelativelyinadequateinsulinsecretionand
responsiveness.Itoccursinabout210%ofallpregnanciesandmayimproveordisappearafterdelivery.[43]However,afterpregnancyapproximately510%of
womenwithgestationaldiabetesarefoundtohavediabetesmellitus,mostcommonlytype2.[43]Gestationaldiabetesisfullytreatable,butrequirescarefulmedical
supervisionthroughoutthepregnancy.Managementmayincludedietarychanges,bloodglucosemonitoring,andinsomecases,insulinmayberequired.
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Thoughitmaybetransient,untreatedgestationaldiabetescandamagethehealthofthefetusormother.Riskstothebabyincludemacrosomia(highbirthweight),
congenitalheartandcentralnervoussystemabnormalities,andskeletalmusclemalformations.Increasedlevelsofinsulininafetus'sbloodmayinhibitfetal
surfactantproductionandcauserespiratorydistresssyndrome.Ahighbloodbilirubinlevelmayresultfromredbloodcelldestruction.Inseverecases,perinatal
deathmayoccur,mostcommonlyasaresultofpoorplacentalperfusionduetovascularimpairment.Laborinductionmaybeindicatedwithdecreasedplacental
function.ACaesareansectionmaybeperformedifthereismarkedfetaldistressoranincreasedriskofinjuryassociatedwithmacrosomia,suchasshoulder
dystocia.
Othertypes
Prediabetesindicatesaconditionthatoccurswhenaperson'sbloodglucoselevelsarehigherthannormalbutnothighenoughforadiagnosisoftype2DM.Many
peopledestinedtodeveloptype2DMspendmanyyearsinastateofprediabetes.
Latentautoimmunediabetesofadults(LADA)isaconditioninwhichtype1DMdevelopsinadults.AdultswithLADAarefrequentlyinitiallymisdiagnosedas
havingtype2DM,basedonageratherthanetiology.
Somecasesofdiabetesarecausedbythebody'stissuereceptorsnotrespondingtoinsulin(evenwheninsulinlevelsarenormal,whichiswhatseparatesitfrom
type2diabetes)thisformisveryuncommon.Geneticmutations(autosomalormitochondrial)canleadtodefectsinbetacellfunction.Abnormalinsulinaction
mayalsohavebeengeneticallydeterminedinsomecases.Anydiseasethatcausesextensivedamagetothepancreasmayleadtodiabetes(forexample,chronic
pancreatitisandcysticfibrosis).Diseasesassociatedwithexcessivesecretionofinsulinantagonistichormonescancausediabetes(whichistypicallyresolvedonce
thehormoneexcessisremoved).Manydrugsimpairinsulinsecretionandsometoxinsdamagepancreaticbetacells.TheICD10(1992)diagnosticentity,
malnutritionrelateddiabetesmellitus(MRDMorMMDM,ICD10codeE12),wasdeprecatedbytheWorldHealthOrganizationwhenthecurrenttaxonomywas
introducedin1999.[44]
Otherformsofdiabetesmellitusincludecongenitaldiabetes,whichisduetogeneticdefectsofinsulinsecretion,cysticfibrosisrelateddiabetes,steroiddiabetes
inducedbyhighdosesofglucocorticoids,andseveralformsofmonogenicdiabetes.
"Type3diabetes"hasbeensuggestedasatermforAlzheimer'sdiseaseastheunderlyingprocessesmayinvolveinsulinresistancebythebrain.[45]
Thefollowingisacomprehensivelistofothercausesofdiabetes:[46]
Geneticdefectsofcellfunction
Maturityonsetdiabetesoftheyoung
MitochondrialDNAmutations
Geneticdefectsininsulinprocessingorinsulinaction
Defectsinproinsulinconversion
Insulingenemutations
Insulinreceptormutations
Endocrinopathies
Growthhormoneexcess(acromegaly)
Cushingsyndrome
Hyperthyroidism
Pheochromocytoma
Glucagonoma
Infections
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Exocrinepancreaticdefects
Chronicpancreatitis
Pancreatectomy
Pancreaticneoplasia
Cysticfibrosis
Hemochromatosis
Fibrocalculouspancreatopathy
Cytomegalovirusinfection
CoxsackievirusB
Drugs
Glucocorticoids
Thyroidhormone
adrenergicagonists
Statins[47]
Pathophysiology
Insulinistheprincipalhormonethatregulatestheuptakeofglucosefromthebloodintomostcellsofthe
body,especiallyliver,muscle,andadiposetissue.Therefore,deficiencyofinsulinortheinsensitivityofits
receptorsplaysacentralroleinallformsofdiabetesmellitus.[48]
Thebodyobtainsglucosefromthreemainplaces:theintestinalabsorptionoffood,thebreakdownof
glycogen,thestorageformofglucosefoundintheliver,andgluconeogenesis,thegenerationofglucosefrom
noncarbohydratesubstratesinthebody.[49]Insulinplaysacriticalroleinbalancingglucoselevelsinthe
body.Insulincaninhibitthebreakdownofglycogenortheprocessofgluconeogenesis,itcanstimulatethe
transportofglucoseintofatandmusclecells,anditcanstimulatethestorageofglucoseintheformof
glycogen.[49]
Insulinisreleasedintothebloodbybetacells(cells),foundintheisletsofLangerhansinthepancreas,in
responsetorisinglevelsofbloodglucose,typicallyaftereating.Insulinisusedbyabouttwothirdsofthe
body'scellstoabsorbglucosefromthebloodforuseasfuel,forconversiontootherneededmolecules,orfor
storage.Lowerglucoselevelsresultindecreasedinsulinreleasefromthebetacellsandinthebreakdownof
glycogentoglucose.Thisprocessismainlycontrolledbythehormoneglucagon,whichactsintheopposite
mannertoinsulin.[50]
Thefluctuationofbloodsugar(red)andthesugar
loweringhormoneinsulin(blue)inhumansduring
thecourseofadaywiththreemealsoneofthe
effectsofasugarrichvsastarchrichmealis
highlighted.
Iftheamountofinsulinavailableisinsufficient,ifcellsrespondpoorlytotheeffectsofinsulin(insulin
insensitivityorinsulinresistance),oriftheinsulinitselfisdefective,thenglucosewillnotbeabsorbedproperlybythebodycellsthatrequireit,anditwillnotbe
storedappropriatelyintheliverandmuscles.Theneteffectispersistentlyhighlevelsofbloodglucose,poorproteinsynthesis,andothermetabolicderangements,
suchasacidosis.[49]
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Whentheglucoseconcentrationinthebloodremainshighovertime,thekidneyswillreachathresholdof
reabsorption,andglucosewillbeexcretedintheurine(glycosuria).[51]Thisincreasestheosmoticpressureof
theurineandinhibitsreabsorptionofwaterbythekidney,resultinginincreasedurineproduction(polyuria)
andincreasedfluidloss.Lostbloodvolumewillbereplacedosmoticallyfromwaterheldinbodycellsand
otherbodycompartments,causingdehydrationandincreasedthirst(polydipsia).[49]
Diagnosis
Condition
WHOdiabetesdiagnosticcriteria[52][53]
2hourglucose
Fastingglucose
HbA1c
Unit
mmol/l(mg/dl)
mmol/l(mg/dl)
mmol/mol DCCT%
Normal
<7.8(<140)
<6.1(<110)
<42
<6.0
Impairedfastingglycaemia
<7.8(<140)
6.1(110)&<7.0(<126)
4246
6.06.4
Impairedglucosetolerance
7.8(140)
<7.0(<126)
4246
6.06.4
Diabetesmellitus
11.1(200)
7.0(126)
48
6.5
Mechanismofinsulinreleaseinnormalpancreatic
betacellsinsulinproductionismoreorless
constantwithinthebetacells.Itsreleaseistriggered
byfood,chieflyfoodcontainingabsorbableglucose.
Diabetesmellitusischaracterizedbyrecurrentorpersistenthighbloodsugar,andisdiagnosedbydemonstratinganyoneofthefollowing:[44]
Fastingplasmaglucoselevel7.0mmol/l(126mg/dl)
Plasmaglucose11.1mmol/l(200mg/dl)twohoursaftera75goralglucoseloadasinaglucosetolerancetest
Symptomsofhighbloodsugarandcasualplasmaglucose11.1mmol/l(200mg/dl)
Glycatedhemoglobin(HbA1C)48mmol/mol(6.5DCCT%).[54]
Apositiveresult,intheabsenceofunequivocalhighbloodsugar,shouldbeconfirmedbyarepeatofanyoftheabovemethodsonadifferentday.Itispreferable
tomeasureafastingglucoselevelbecauseoftheeaseofmeasurementandtheconsiderabletimecommitmentofformalglucosetolerancetesting,whichtakestwo
hourstocompleteandoffersnoprognosticadvantageoverthefastingtest.[55]Accordingtothecurrentdefinition,twofastingglucosemeasurementsabove
126mg/dl(7.0mmol/l)isconsidereddiagnosticfordiabetesmellitus.
PertheWorldHealthOrganizationpeoplewithfastingglucoselevelsfrom6.1to6.9mmol/l(110to125mg/dl)areconsideredtohaveimpairedfasting
glucose.[56]peoplewithplasmaglucoseatorabove7.8mmol/l(140mg/dl),butnotover11.1mmol/l(200mg/dl),twohoursaftera75goralglucoseloadare
consideredtohaveimpairedglucosetolerance.Ofthesetwoprediabeticstates,thelatterinparticularisamajorriskfactorforprogressiontofullblowndiabetes
mellitus,aswellascardiovasculardisease.[57]TheAmericanDiabetesAssociationsince2003usesaslightlydifferentrangeforimpairedfastingglucoseof5.6to
6.9mmol/l(100to125mg/dl).[58]
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Glycatedhemoglobinisbetterthanfastingglucosefordeterminingrisksofcardiovasculardiseaseanddeathfromanycause.[59]
Therarediseasediabetesinsipidushassimilarsymptomstodiabetesmellitus,butwithoutdisturbancesinthesugarmetabolism(insipidusmeans"withouttaste"in
Latin)anddoesnotinvolvethesamediseasemechanisms.Diabetesisapartofthewiderconditionknownasmetabolicsyndrome.
Prevention
Thereisnoknownpreventivemeasurefortype1diabetes.[3]Type2diabeteswhichaccountsfor8590%ofallcasescanoftenbepreventedordelayedby
maintaininganormalbodyweight,engaginginphysicalexercise,andconsumingahealthfuldiet.[3]Higherlevelsofphysicalactivityreducetheriskofdiabetes
by28%.[60]Dietarychangesknowntobeeffectiveinhelpingtopreventdiabetesincludemaintainingadietrichinwholegrainsandfiber,andchoosinggoodfats,
suchasthepolyunsaturatedfatsfoundinnuts,vegetableoils,andfish.[61]Limitingsugarybeveragesandeatinglessredmeatandothersourcesofsaturatedfatcan
alsohelppreventdiabetes.[61]Tobaccosmokingisalsoassociatedwithanincreasedriskofdiabetesanditscomplications,sosmokingcessationcanbean
importantpreventivemeasureaswell.[62]
Therelationshipbetweentype2diabetesandthemainmodifiableriskfactors(excessweight,unhealthydiet,physicalinactivityandtobaccouse)issimilarinall
regionsoftheworld.Thereisgrowingevidencethattheunderlyingdeterminantsofdiabetesareareflectionofthemajorforcesdrivingsocial,economicand
culturalchange:globalization,urbanization,populationageing,andthegeneralhealthpolicyenvironment.[63]
Management
Diabetesmellitusisachronicdisease,forwhichthereisnoknowncureexceptinveryspecificsituations.[64]Management
concentratesonkeepingbloodsugarlevelsasclosetonormal,withoutcausinglowbloodsugar.Thiscanusuallybe
accomplishedwithahealthydiet,exercise,weightloss,anduseofappropriatemedications(insulininthecaseoftype1
diabetesoralmedications,aswellaspossiblyinsulin,intype2diabetes).
Learningaboutthediseaseandactivelyparticipatinginthetreatmentisimportant,sincecomplicationsarefarlesscommon
andlesssevereinpeoplewhohavewellmanagedbloodsugarlevels.[65][66]ThegoaloftreatmentisanHbA1Clevelof
Overviewofmanagement
6.5%,butshouldnotbelowerthanthat,andmaybesethigher.[67]Attentionisalsopaidtootherhealthproblemsthatmay
acceleratethenegativeeffectsofdiabetes.Theseincludesmoking,elevatedcholesterollevels,obesity,highbloodpressure,
andlackofregularexercise.[67]Specializedfootweariswidelyusedtoreducetheriskofulceration,orreulceration,inatriskdiabeticfeet.Evidenceforthe
efficacyofthisremainsequivocal,however.[68]
Lifestyle
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Peoplewithdiabetescanbenefitfromeducationaboutthediseaseandtreatment,goodnutritiontoachieveanormalbodyweight,andexercise,withthegoalof
keepingbothshorttermandlongtermbloodglucoselevelswithinacceptablebounds.Inaddition,giventheassociatedhigherrisksofcardiovasculardisease,
lifestylemodificationsarerecommendedtocontrolbloodpressure.[69]
Medications
Medicationsusedtotreatdiabetesdosobyloweringbloodsugarlevels.Thereareanumberofdifferentclassesofantidiabeticmedications.Someareavailable
bymouth,suchasmetformin,whileothersareonlyavailablebyinjectionsuchasGLP1agonists.Type1diabetescanonlybetreatedwithinsulin,typicallywith
acombinationofregularandNPHinsulin,orsyntheticinsulinanalogs.
Metforminisgenerallyrecommendedasafirstlinetreatmentfortype2diabetes,asthereisgoodevidencethatitdecreasesmortality.[70]Itworksbydecreasing
theliver'sproductionofglucose.[71]Severalothergroupsofdrugs,mostlygivenbymouth,mayalsodecreasebloodsugarintypeIIDM.Theseincludeagentsthat
increaseinsulinrelease,agentsthatdecreaseabsorptionofsugarfromtheintestines,andagentsthatmakethebodymoresensitivetoinsulin.[71]Wheninsulinis
usedintype2diabetes,alongactingformulationisusuallyaddedinitially,whilecontinuingoralmedications.[70]Dosesofinsulinarethenincreasedto
effect.[70][72]
Sincecardiovasculardiseaseisaseriouscomplicationassociatedwithdiabetes,somehaverecommendedbloodpressurelevelsbelow130/80mmHg.[73]However,
evidencesupportslessthanorequaltosomewherebetween140/90mmHgto160/100mmHgtheonlyadditionalbenefitfoundforbloodpressuretargetsbeneath
thisrangewasanisolateddecreaseinstrokerisk,andthiswasaccompaniedbyanincreasedriskofotherseriousadverseevents.[74][75]A2016reviewfound
potentialharmtotreatinglowerthan140mmHg.[76]Amongmedicationsthatlowerbloodpressure,angiotensinconvertingenzymeinhibitors(ACEIs)improve
outcomesinthosewithDMwhilethesimilarmedicationsangiotensinreceptorblockers(ARBs)donot.[77]Aspirinisalsorecommendedforpeoplewith
cardiovascularproblems,howeverroutineuseofaspirinhasnotbeenfoundtoimproveoutcomesinuncomplicateddiabetes.[78]
Surgery
Apancreastransplantisoccasionallyconsideredforpeoplewithtype1diabeteswhohaveseverecomplicationsoftheirdisease,includingendstagekidney
diseaserequiringkidneytransplantation.[79]
Weightlosssurgeryinthosewithobesityandtypetwodiabetesisoftenaneffectivemeasure.[80]Manyareabletomaintainnormalbloodsugarlevelswithlittleor
nomedicationsfollowingsurgery[81]andlongtermmortalityisdecreased.[82]Therehoweverissomeshorttermmortalityriskoflessthan1%fromthe
surgery.[83]Thebodymassindexcutoffsforwhensurgeryisappropriatearenotyetclear.[82]Itisrecommendedthatthisoptionbeconsideredinthosewhoare
unabletogetboththeirweightandbloodsugarundercontrol.[84]
Support
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Incountriesusingageneralpractitionersystem,suchastheUnitedKingdom,caremaytakeplacemainlyoutsidehospitals,withhospitalbasedspecialistcare
usedonlyincaseofcomplications,difficultbloodsugarcontrol,orresearchprojects.Inothercircumstances,generalpractitionersandspecialistssharecareina
teamapproach.Hometelehealthsupportcanbeaneffectivemanagementtechnique.[85]
Epidemiology
Asof2016,422millionpeoplehavediabetesworldwide,[86]upfromanestimated382millionpeoplein
2013[13]andfrom108millionin1980.[86]Accountingfortheshiftingagestructureoftheglobalpopulation,
theprevalenceofdiabetesis8.5%amongadults,nearlydoubletherateof4.7%in1980.[86]Type2makesup
about90%ofthecases.[12][14]Somedataindicateratesareroughlyequalinwomenandmen,[14]butmale
excessindiabeteshasbeenfoundinmanypopulationswithhighertype2incidence,possiblyduetosex
relateddifferencesininsulinsensitivity,consequencesofobesityandregionalbodyfatdeposition,andother
contributingfactorssuchashighbloodpressure,tobaccosmokingandalcoholintake.[87][88]
TheWorldHealthOrganization(WHO)estimatesthatdiabetesmellitusresultedin1.5milliondeathsin
2012,makingitthe8thleadingcauseofdeath.[7][86]Howeveranother2.2milliondeathsworldwidewere
attributabletohighbloodglucoseandtheincreasedrisksofcardiovasculardiseaseandotherassociated
complications(e.g.kidneyfailure),whichoftenleadtoprematuredeathandareoftenlistedastheunderlying
causeondeathcertificatesratherthandiabetes.[86][89]Forexample,in2014,theInternationalDiabetes
Federation(IDF)estimatedthatdiabetesresultedin4.9milliondeathsworldwide,[15]usingmodellingto
estimatethetotalamountofdeathsthatcouldbedirectlyorindirectlyattributedtodiabetes.[16]
Ratesofdiabetesworldwidein2000(per1,000
inhabitants)worldaveragewas2.8%.
nodata
4552.5
7.5
52.560
7.515
6067.5
1522.5
67.575
22.530
7582.5
3037.5
82.5
Diabetesmellitusoccursthroughouttheworldbutismorecommon(especiallytype2)inmoredeveloped
37.545
countries.Thegreatestincreaseinrateshashoweverbeenseeninlowandmiddleincomecountries,[86]
wheremorethan80%ofdiabeticdeathsoccur.[90]Thefastestprevalenceincreaseisexpectedtooccurin
AsiaandAfrica,wheremostpeoplewithdiabeteswillprobablylivein2030.[91]Theincreaseinratesindevelopingcountriesfollowsthetrendofurbanizationand
lifestylechanges,includingincreasinglysedentarylifestyles,lessphysicallydemandingworkandtheglobalnutritiontransition,markedbyincreasedintakeof
foodsthatarehighenergydensebutnutrientpoor(oftenhighinsugarandsaturatedfats,sometimesreferredtoasthe"Westernstyle"diet).[86][91]
History
11/19
10/8/2016
Diabeteswasoneofthefirstdiseasesdescribed,[92]withanEgyptianmanuscriptfromc.1500BCE
mentioning"toogreatemptyingoftheurine".[93]Thefirstdescribedcasesarebelievedtobeoftype1
diabetes.[93]Indianphysiciansaroundthesametimeidentifiedthediseaseandclassifieditasmadhumehaor
"honeyurine",notingtheurinewouldattractants.[93]Theterm"diabetes"or"topassthrough"wasfirstused
in230BCEbytheGreekApolloniusofMemphis.[93]Thediseasewasconsideredrareduringthetimeofthe
Romanempire,withGalencommentinghehadonlyseentwocasesduringhiscareer.[93]Thisispossiblydue
tothedietandlifestyleoftheancients,orbecausetheclinicalsymptomswereobservedduringtheadvanced
stageofthedisease.Galennamedthedisease"diarrheaoftheurine"(diarrheaurinosa).Theearliestsurviving
workwithadetailedreferencetodiabetesisthatofAretaeusofCappadocia(2ndorearly3rdcenturyCE).
Hedescribedthesymptomsandthecourseofthedisease,whichheattributedtothemoistureandcoldness,
reflectingthebeliefsofthe"PneumaticSchool".Hehypothesizedacorrelationofdiabeteswithother
diseasesandhediscusseddifferentialdiagnosisfromthesnakebitewhichalsoprovokesexcessivethirst.His
workremainedunknownintheWestuntil1552,whenthefirstLatineditionwaspublishedinVenice.[94]
Diabetesmellitusdeathspermillionpersonsin2012
2891
164184
310404
92114
185209
4051879
115141
210247
142163
248309
Type1andtype2diabeteswereidentifiedasseparateconditionsforthefirsttimebytheIndianphysicians
SushrutaandCharakain400500CEwithtype1associatedwithyouthandtype2withbeingoverweight.[93]Theterm"mellitus"or"fromhoney"wasaddedby
theBritonJohnRolleinthelate1700stoseparatetheconditionfromdiabetesinsipidus,whichisalsoassociatedwithfrequenturination.[93]Effectivetreatment
wasnotdevelopeduntiltheearlypartofthe20thcentury,whenCanadiansFrederickBantingandCharlesHerbertBestisolatedandpurifiedinsulinin1921and
1922.[93]ThiswasfollowedbythedevelopmentofthelongactinginsulinNPHinthe1940s.[93]
Etymology
Theworddiabetes(/da.bitiz/or/da.bits/)comesfromLatindiabts,whichinturncomesfromAncientGreek(diabts)whichliterallymeans
"apasserthroughasiphon."[95]AncientGreekphysicianAretaeusofCappadocia(fl.1stcenturyCE)usedthatword,withtheintendedmeaning"excessive
dischargeofurine",asthenameforthedisease.[96][97]Ultimately,thewordcomesfromGreek(diabainein),meaning"topassthrough,"[95]whichis
composedof(dia),meaning"through"and(bainein),meaning"togo".[96]Theword"diabetes"isfirstrecordedinEnglish,intheformdiabete,ina
medicaltextwrittenaround1425.
Thewordmellitus(/mlats/or/mlts/)comesfromtheclassicalLatinwordmelltus,meaning"mellite"[98](i.e.sweetenedwithhoney[98]honeysweet[99]).
TheLatinwordcomesfrommell,whichcomesfrommel,meaning"honey"[98][99]sweetness[99]pleasantthing,[99]andthesuffixtus,[98]whosemeaningisthe
sameasthatoftheEnglishsuffix"ite".[100]ItwasThomasWilliswhoin1675added"mellitus"totheword"diabetes"asadesignationforthedisease,whenhe
noticedtheurineofadiabetichadasweettaste(glycosuria).ThissweettastehadbeennoticedinurinebytheancientGreeks,Chinese,Egyptians,Indians,and
Persians.
12/19
10/8/2016
Societyandculture
The1989"St.VincentDeclaration"[101][102]wastheresultofinternationaleffortstoimprovethecareaccordedtothosewithdiabetes.Doingsoisimportantnot
onlyintermsofqualityoflifeandlifeexpectancybutalsoeconomicallyexpensesduetodiabeteshavebeenshowntobeamajordrainonhealthand
productivityrelatedresourcesforhealthcaresystemsandgovernments.
Severalcountriesestablishedmoreandlesssuccessfulnationaldiabetesprogrammestoimprovetreatmentofthedisease.[103]
Peoplewithdiabeteswhohaveneuropathicsymptomssuchasnumbnessortinglinginfeetorhandsaretwiceaslikelytobeunemployedasthosewithoutthe
symptoms.[104]
In2010,diabetesrelatedemergencyroom(ER)visitratesintheUnitedStateswerehigheramongpeoplefromthelowestincomecommunities(526per10,000
population)thanfromthehighestincomecommunities(236per10,000population).Approximately9.4%ofdiabetesrelatedERvisitswerefortheuninsured.[105]
Naming
Theterm"type1diabetes"hasreplacedseveralformerterms,includingchildhoodonsetdiabetes,juvenilediabetes,andinsulindependentdiabetesmellitus
(IDDM).Likewise,theterm"type2diabetes"hasreplacedseveralformerterms,includingadultonsetdiabetes,obesityrelateddiabetes,andnoninsulin
dependentdiabetesmellitus(NIDDM).Beyondthesetwotypes,thereisnoagreeduponstandardnomenclature.
Diabetesmellitusisalsooccasionallyknownas"sugardiabetes"todifferentiateitfromdiabetesinsipidus.[106]
Otheranimals
Inanimals,diabetesismostcommonlyencounteredindogsandcats.Middleagedanimalsaremostcommonlyaffected.Femaledogsaretwiceaslikelytobe
affectedasmales,whileaccordingtosomesources,malecatsarealsomorepronethanfemales.Inbothspecies,allbreedsmaybeaffected,butsomesmalldog
breedsareparticularlylikelytodevelopdiabetes,suchasMiniaturePoodles.[107]Thesymptomsmayrelatetofluidlossandpolyuria,butthecoursemayalsobe
insidious.Diabeticanimalsaremorepronetoinfections.Thelongtermcomplicationsrecognisedinhumansaremuchrarerinanimals.Theprinciplesoftreatment
(weightloss,oralantidiabetics,subcutaneousinsulin)andmanagementofemergencies(e.g.ketoacidosis)aresimilartothoseinhumans.[107]
Research
13/19
10/8/2016
Inhalableinsulinhasbeendeveloped.[108]Theoriginalproductswerewithdrawnduetosideeffects.[108]Afrezza,underdevelopmentbypharmaceuticalscompany
MannKindCorporation,wasapprovedbytheFDAforgeneralsaleinJune2014.[109]Anadvantagetoinhaledinsulinisthatitmaybemoreconvenientandeasyto
use.[110]
Transdermalinsulinintheformofacreamhasbeendevelopedandtrialsarebeingconductedonpeoplewithtype2diabetes.[111][112]
References
1."DiabetesBlueCircleSymbol".InternationalDiabetesFederation.17March2006.
2."Aboutdiabetes".WorldHealthOrganization.Retrieved4April2014.
3."DiabetesFactsheetN312".WHO.October2013.Archivedfromtheoriginalon
26Aug2013.Retrieved25March2014.
4.Kitabchi,AEUmpierrez,GEMiles,JMFisher,JN(Jul2009)."Hyperglycemic
crisesinadultpatientswithdiabetes.".DiabetesCare.32(7):133543.
doi:10.2337/dc099032.PMC2699725 .PMID19564476.
5.Shoback,editedbyDavidG.Gardner,Dolores(2011)."Chapter17".Greenspan's
basic&clinicalendocrinology(9thed.).NewYork:McGrawHillMedical.
ISBN0071622438.
6.RSSDItextbookofdiabetesmellitus.(Rev.2nded.).NewDelhi:JaypeeBrothers
MedicalPublishers.2012.p.235.ISBN9789350254899.
7."Thetop10causesofdeathFactsheetN310".WorldHealthOrganization.Oct
2013.
8.Rippe,editedbyRichardS.Irwin,JamesM.(2010).Manualofintensivecare
medicine(5thed.).Philadelphia:WoltersKluwerHealth/LippincottWilliams&
Wilkins.p.549.ISBN9780781799928.
9.Picot,JJones,JColquitt,JLGospodarevskaya,ELoveman,EBaxter,L
Clegg,AJ(September2009)."Theclinicaleffectivenessandcosteffectivenessof
bariatric(weightloss)surgeryforobesity:asystematicreviewandeconomic
evaluation".HealthTechnologyAssessment(Winchester,England).13(41):1
190,215357,iiiiv.doi:10.3310/hta13410.PMID19726018.
10.Cash,Jill(2014).FamilyPracticeGuidelines(3rded.).Springer.p.396.
ISBN9780826168757.
11."Update2015".IDF.InternationalDiabetesFederation.p.13.Retrieved21Mar
2016.
12.Williamstextbookofendocrinology(12thed.).Philadelphia:Elsevier/Saunders.
pp.13711435.ISBN9781437703245.
13.Shi,YuankaiHu,FrankB(7June2014)."Theglobalimplicationsofdiabetesand
cancer".TheLancet.383(9933):19478.doi:10.1016/S01406736(14)608862.
PMID24910221.
14.VosT,FlaxmanAD,NaghaviM,LozanoR,MichaudC,EzzatiM,ShibuyaK,
SalomonJA,AbdallaS,AboyansV,etal.(Dec15,2012)."Yearslivedwith
disability(YLDs)for1160sequelaeof289diseasesandinjuries19902010:a
systematicanalysisfortheGlobalBurdenofDiseaseStudy2010.".Lancet.380
(9859):216396.doi:10.1016/S01406736(12)617292.PMID23245607.
15."AnnualReport2014"(PDF).IDF.InternationalDiabetesFederation.Retrieved
13July2016.
16.IDFDIABETESATLAS(PDF)(6thed.).InternationalDiabetesFederation.2013.
p.7.ISBN2930229853.
17.AmericanDiabetes,Association(Apr2013)."Economiccostsofdiabetesinthe
U.S.in2012.".DiabetesCare.36(4):103346.doi:10.2337/dc122625.
PMC3609540 .PMID23468086.
18.CookeDW,PlotnickL(November2008)."Type1diabetesmellitusinpediatrics".
PediatrRev.29(11):37484quiz385.doi:10.1542/pir.2911374.
PMID18977856.
19.KennyC(April2014)."Whenhypoglycemiaisnotobvious:diagnosingand
treatingunderrecognizedandundisclosedhypoglycemia".Primarycarediabetes.
8(1):311.doi:10.1016/j.pcd.2013.09.002.PMID24100231.
20.VerrottiA,ScaparrottaA,OlivieriC,ChiarelliF(December2012)."Seizuresand
type1diabetesmellitus:currentstateofknowledge".EuropeanJournalof
Endocrinology.167(6):74958.doi:10.1530/EJE120699.PMID22956556.
21.Hsieh,Arthur."Drunkversusdiabetes:Howcanyoutell?".Retrieved29June
2016.
22."SymptomsofLowBloodSugar".WebMD.Retrieved29June2016.
23.KitabchiAE,UmpierrezGE,MilesJM,FisherJN(July2009)."Hyperglycemic
crisesinadultpatientswithdiabetes".DiabetesCare.32(7):133543.
doi:10.2337/dc099032.PMC2699725 .PMID19564476.
14/19
10/8/2016
24.SarwarN,GaoP,SeshasaiSR,GobinR,KaptogeS,DiAngelantonioE,
IngelssonE,LawlorDA,SelvinE,StampferM,StehouwerCD,LewingtonS,
PennellsL,ThompsonA,SattarN,WhiteIR,RayKK,DaneshJ(2010).
"Diabetesmellitus,fastingbloodglucoseconcentration,andriskofvascular
disease:Acollaborativemetaanalysisof102prospectivestudies".TheLancet.
375(9733):221522.doi:10.1016/S01406736(10)604849.PMC2904878 .
PMID20609967.
25.O'GaraPT,KushnerFG,AscheimDD,CaseyDE,ChungMK,deLemosJA,
EttingerSM,FangJC,FesmireFM,FranklinBA,GrangerCB,KrumholzHM,
LinderbaumJA,MorrowDA,NewbyLK,OrnatoJP,OuN,RadfordMJ,Tamis
HollandJE,TommasoCL,TracyCM,WooYJ,ZhaoDX,AndersonJL,Jacobs
AK,HalperinJL,AlbertNM,BrindisRG,CreagerMA,DeMetsD,GuytonRA,
HochmanJS,KovacsRJ,KushnerFG,OhmanEM,StevensonWG,YancyCW
(29January2013)."2013ACCF/AHAguidelineforthemanagementofST
elevationmyocardialinfarction:areportoftheAmericanCollegeofCardiology
Foundation/AmericanHeartAssociationTaskForceonPracticeGuidelines.".
Circulation.127(4):e362425.doi:10.1161/CIR.0b013e3182742cf6.
PMID23247304.
26."DiabetesProgramme".WorldHealthOrganization.Retrieved22April2014.
27.Cukierman,T(8Nov2005)."Cognitivedeclineanddementiaindiabetes
systematicoverviewofprospectiveobservationalstudies".SpringerVerlag.
Retrieved28Apr2013.
28.LambertP,BingleyPJ(2002)."WhatisType1Diabetes?".Medicine.30:15.
doi:10.1383/medc.30.1.1.28264.
29.TuomiT,SantoroN,CaprioS,CaiM,WengJ,GroopL(2014)."Themanyfaces
ofdiabetes:adiseasewithincreasingheterogeneity".Lancet.383(9922):108494.
doi:10.1016/S01406736(13)622199.PMID24315621.
30.RotherKI(April2007)."Diabetestreatmentbridgingthedivide".TheNew
EnglandJournalofMedicine.356(15):1499501.doi:10.1056/NEJMp078030.
PMC4152979 .PMID17429082.
31."DiabetesMellitus(DM):DiabetesMellitusandDisordersofCarbohydrate
Metabolism:MerckManualProfessional".MerckPublishing.April2010.
Retrieved20100730.
32.DornerM,PingetM,BrogardJM(May1977)."Essentiallabilediabetes".MMW
MunchMedWochenschr(inGerman).119(19):6714.PMID406527.
33.PhillipsJE,CouperJJ,PennoMA,HarrisonLC,ENDIAStudyGroup(2016).
"Type1diabetes:adiseaseofdevelopmentalorigins.".PediatrDiabetes(Review).
doi:10.1111/pedi.12425.PMID27526948.
34.PetzoldA,SolimenaM,KnochKP(2015)."MechanismsofBetaCell
DysfunctionAssociatedWithViralInfection.".CurrDiabRep(Review).15(10):
73.doi:10.1007/s118920150654x.PMC4539350 .PMID26280364."Sofar,
noneofthehypothesesaccountingforvirusinducedbetacellautoimmunityhas
beensupportedbystringentevidenceinhumans,andtheinvolvementofseveral
mechanismsratherthanjustoneisalsoplausible."
35.ButaliaS,KaplanGG,KhokharB,RabiDM(Aug18,2016)."Environmental
RiskFactorsandType1Diabetes:Past,Present,andFuture".CanJDiabetes
(Review).pii:S14992671(15)300526.doi:10.1016/j.jcjd.2016.05.002.
PMID27545597.
36.SerenaG,CamhiS,SturgeonC,YanS,FasanoA(2015)."TheRoleofGlutenin
CeliacDiseaseandType1Diabetes.".Nutrients.7(9):714362.
doi:10.3390/nu7095329.PMC4586524 .PMID26343710.
37.VisserJ,RozingJ,SaponeA,LammersK,FasanoA(2009)."Tightjunctions,
intestinalpermeability,andautoimmunity:celiacdiseaseandtype1diabetes
paradigms.".AnnNYAcadSci.1165:195205.doi:10.1111/j.1749
6632.2009.04037.x.PMC2886850 .PMID19538307.
38.RisrusU,WillettWC,HuFB(January2009)."Dietaryfatsandpreventionof
type2diabetes".ProgressinLipidResearch.48(1):4451.
doi:10.1016/j.plipres.2008.10.002.PMC2654180 .PMID19032965.
39.MalikVS,PopkinBM,BrayGA,DesprsJP,HuFB(20100323)."Sugar
SweetenedBeverages,Obesity,Type2DiabetesandCardiovascularDiseaserisk".
Circulation.121(11):135664.doi:10.1161/CIRCULATIONAHA.109.876185.
PMC2862465 .PMID20308626.
40.MalikVS,PopkinBM,BrayGA,DesprsJP,WillettWC,HuFB(November
2010)."SugarSweetenedBeveragesandRiskofMetabolicSyndromeandType2
Diabetes:Ametaanalysis".DiabetesCare.33(11):247783.doi:10.2337/dc10
1079.PMC2963518 .PMID20693348.
41.HuEA,PanA,MalikV,SunQ(20120315)."Whitericeconsumptionandrisk
oftype2diabetes:metaanalysisandsystematicreview".BMJ(Clinicalresearch
ed.).344:e1454.doi:10.1136/bmj.e1454.PMC3307808 .PMID22422870.
42.LeeIM,ShiromaEJ,LobeloF,PuskaP,BlairSN,KatzmarzykPT(1July2012).
"Effectofphysicalinactivityonmajornoncommunicablediseasesworldwide:an
analysisofburdenofdiseaseandlifeexpectancy".TheLancet.380(9838):219
29.doi:10.1016/S01406736(12)610319.PMC3645500 .PMID22818936.
43."NationalDiabetesClearinghouse(NDIC):NationalDiabetesStatistics2011".
U.S.DepartmentofHealthandHumanServices.Retrieved22April2014.
44."Definition,DiagnosisandClassificationofDiabetesMellitusandits
Complications"(PDF).WorldHealthOrganisation.1999.
15/19
10/8/2016
45.delaMonte,SM(December2014)."Type3diabetesissporadicAlzheimers
disease:minireview.".Europeanneuropsychopharmacology:thejournalofthe
EuropeanCollegeofNeuropsychopharmacology.24(12):195460.
doi:10.1016/j.euroneuro.2014.06.008.PMC4444430 .PMID25088942.
46.Unlessotherwisespecified,referenceis:Table205inMitchell,Richard
SheppardKumar,VinayAbbas,AbulK.Fausto,Nelson.RobbinsBasic
Pathology(8thed.).Philadelphia:Saunders.ISBN1416029737.
47.SattarN,PreissD,MurrayHM,WelshP,BuckleyBM,deCraenAJ,Seshasai
SR,McMurrayJJ,FreemanDJ,JukemaJW,MacfarlanePW,PackardCJ,Stott
DJ,WestendorpRG,ShepherdJ,DavisBR,PresselSL,MarchioliR,Marfisi
RM,MaggioniAP,TavazziL,TognoniG,KjekshusJ,PedersenTR,CookTJ,
GottoAM,ClearfieldMB,DownsJR,NakamuraH,OhashiY,MizunoK,Ray
KK,FordI(February2010)."Statinsandriskofincidentdiabetes:acollaborative
metaanalysisofrandomisedstatintrials".TheLancet.375(9716):73542.
doi:10.1016/S01406736(09)619656.PMID20167359.
48."InsulinBasics".AmericanDiabetesAssociation.Retrieved24April2014.
49.Shoback,editedbyDavidG.Gardner,Dolores(2011).Greenspan'sbasic&
clinicalendocrinology(9thed.).NewYork:McGrawHillMedical.
ISBN9780071622431.
50.al.],KimE.Barrett,...[et(2012).Ganong'sreviewofmedicalphysiology.(24th
ed.).NewYork:McGrawHillMedical.ISBN0071780033.
51.al.],RobertK.Murray...[et(2012).Harper'sillustratedbiochemistry(29thed.).
NewYork:McGrawHillMedical.ISBN007176576X.
52.Definitionanddiagnosisofdiabetesmellitusandintermediatehyperglycemia:
reportofaWHO/IDFconsultation(PDF).Geneva:WorldHealthOrganization.
2006.p.21.ISBN9789241594936.
53.Vijan,S(March2010)."Type2diabetes".AnnalsofInternalMedicine.152(5):
ITC3115.doi:10.7326/00034819152520100302001003.PMID20194231.
54." "DiabetesCare"January2010".AmericanDiabetesAssociation.Retrieved
20100129.
55.SaydahSH,MiretM,SungJ,VarasC,GauseD,BrancatiFL(August2001).
"PostchallengehyperglycemiaandmortalityinanationalsampleofU.S.adults".
DiabetesCare.24(8):1397402.doi:10.2337/diacare.24.8.1397.
PMID11473076.
56.Definitionanddiagnosisofdiabetesmellitusandintermediatehyperglycemia:
reportofaWHO/IDFconsultation(PDF).WorldHealthOrganization.2006.p.21.
ISBN9789241594936.
57.SantaguidaPL,BalionC,HuntD,MorrisonK,GersteinH,RainaP,BookerL,
YazdiH."Diagnosis,Prognosis,andTreatmentofImpairedGlucoseToleranceand
ImpairedFastingGlucose".SummaryofEvidenceReport/TechnologyAssessment,
No.128.AgencyforHealthcareResearchandQuality.Retrieved20080720.
58.BartoliE,FraGP,CarnevaleSchiancaGP(Feb2011)."Theoralglucosetolerance
test(OGTT)revisited.".Europeanjournalofinternalmedicine.22(1):812.
doi:10.1016/j.ejim.2010.07.008.PMID21238885.
59.SelvinE,SteffesMW,ZhuH,MatsushitaK,WagenknechtL,PankowJ,Coresh
J,BrancatiFL(2010)."Glycatedhemoglobin,diabetes,andcardiovascularriskin
nondiabeticadults".N.Engl.J.Med.362(9):80011.
doi:10.1056/NEJMoa0908359.PMC2872990 .PMID20200384.
60.Kyu,HmweHBachman,VictoriaFAlexander,LilyTMumford,JohnEverett
Afshin,AshkanEstep,KaraVeerman,JLennertDelwiche,KristenIannarone,
MarissaLMoyer,MadelineLCercy,KellyVos,TheoMurray,ChristopherJ
LForouzanfar,MohammadH(9August2016)."Physicalactivityandriskof
breastcancer,coloncancer,diabetes,ischemicheartdisease,andischemicstroke
events:systematicreviewanddoseresponsemetaanalysisfortheGlobalBurden
ofDiseaseStudy2013".BMJ:i3857.doi:10.1136/bmj.i3857.
61."TheNutritionSource".HarvardSchoolofPublicHealth.Retrieved24April
2014.
62.WilliC,BodenmannP,GhaliWA,FarisPD,CornuzJ(Dec12,2007)."Active
smokingandtheriskoftype2diabetes:asystematicreviewandmetaanalysis.".
JAMA:TheJournaloftheAmericanMedicalAssociation.298(22):265464.
doi:10.1001/jama.298.22.2654.PMID18073361.
63.WorldHealthOrganization,Chronicdiseasesandtheircommonriskfactors.(htt
p://www.who.int/chp/chronic_disease_report/media/Factsheet1.pdf)Geneva,2005.
Accessed30August2016.
64.Nocurefordiabetes(http://www.webmd.com/diabetes/isthereadiabetescure)
(RetrievedMay2015,WebMDwebsite)
65.NathanDM,ClearyPA,BacklundJY,GenuthSM,LachinJM,OrchardTJ,
RaskinP,ZinmanB(December2005)."Intensivediabetestreatmentand
cardiovasculardiseaseinpatientswithtype1diabetes".TheNewEnglandJournal
ofMedicine.353(25):264353.doi:10.1056/NEJMoa052187.PMC2637991 .
PMID16371630.
66.TheDiabetesControlComplicationsTrialResearchGroup(April1995)."The
effectofintensivediabetestherapyonthedevelopmentandprogressionof
neuropathy.".AnnalsofInternalMedicine.122(8):5618.doi:10.1059/0003
4819122819950415000001.PMID7887548.
67.NationalInstituteforHealthandClinicalExcellence.Clinicalguideline66:Type2
diabetes(http://guidance.nice.org.uk/CG66).London,2008.
68.CavanaghPR(2004)."Therapeuticfootwearforpeoplewithdiabetes".Diabetes
Metab.Res.Rev.20(Suppl1):S515.doi:10.1002/dmrr.435.PMID15150815.
16/19
10/8/2016
69.AdlerAI,StrattonIM,NeilHA,YudkinJS,MatthewsDR,CullCA,WrightAD,
TurnerRC,HolmanRR(August2000)."Associationofsystolicbloodpressure
withmacrovascularandmicrovascularcomplicationsoftype2diabetes(UKPDS
36):prospectiveobservationalstudy".BMJ.321(7258):4129.
doi:10.1136/bmj.321.7258.412.PMC27455 .PMID10938049.
70.RipsinCM,KangH,UrbanRJ(2009)."Managementofbloodglucoseintype2
diabetesmellitus"(PDF).Americanfamilyphysician.79(1):2936.
PMID19145963.
71.Krentz,AJBailey,CJ(2005)."Oralantidiabeticagents:currentroleintype2
diabetesmellitus.".Drugs.65(3):385411.doi:10.2165/00003495200565030
00005.PMID15669880.
72.ConsumerReportsAmericanCollegeofPhysicians(April2012),"Choosinga
type2diabetesdrugWhythebestfirstchoiceisoftentheoldestdrug"(PDF),
HighValueCare,ConsumerReports,retrievedAugust14,2012
73.Nelson,Mark."Drugtreatmentofelevatedbloodpressure".AustralianPrescriber
(33):108112.Retrieved11August2010.
74.Arguedas,JAPerez,MIWright,JM(Jul8,2009).Arguedas,JoseAgustin,ed.
"Treatmentbloodpressuretargetsforhypertension".CochraneDatabaseof
SystematicReviews(3):CD004349.doi:10.1002/14651858.CD004349.pub2.
PMID19588353.
75.Arguedas,JALeiva,VWright,JM(Oct30,2013)."Bloodpressuretargetsfor
hypertensioninpeoplewithdiabetesmellitus.".TheCochranedatabaseof
systematicreviews.10:CD008277.doi:10.1002/14651858.cd008277.pub2.
PMID24170669.
76.Brunstrm,MattiasCarlberg,Bo(24February2016)."Effectofantihypertensive
treatmentatdifferentbloodpressurelevelsinpatientswithdiabetesmellitus:
systematicreviewandmetaanalyses".BMJ:i717.doi:10.1136/bmj.i717.
77.ChengJ,ZhangW,ZhangX,HanF,LiX,HeX,LiQ,ChenJ(Mar31,2014).
"EffectofAngiotensinConvertingEnzymeInhibitorsandAngiotensinIIReceptor
BlockersonAllCauseMortality,CardiovascularDeaths,andCardiovascular
EventsinPatientsWithDiabetesMellitus:AMetaanalysis.".JAMAinternal
medicine.174(5):77385.doi:10.1001/jamainternmed.2014.348.
PMID24687000.
78.PignoneM,AlbertsMJ,ColwellJA,CushmanM,InzucchiSE,MukherjeeD,
RosensonRS,WilliamsCD,WilsonPW,KirkmanMS(June2010)."Aspirinfor
primarypreventionofcardiovasculareventsinpeoplewithdiabetes:aposition
statementoftheAmericanDiabetesAssociation,ascientificstatementofthe
AmericanHeartAssociation,andanexpertconsensusdocumentoftheAmerican
CollegeofCardiologyFoundation".DiabetesCare.33(6):1395402.
doi:10.2337/dc100555.PMC2875463 .PMID20508233.
79."PancreasTransplantation".AmericanDiabetesAssociation.Retrieved9April
2014.
80.Picot,JJones,JColquitt,JLGospodarevskaya,ELoveman,EBaxter,L
Clegg,AJ(September2009)."Theclinicaleffectivenessandcosteffectivenessof
bariatric(weightloss)surgeryforobesity:asystematicreviewandeconomic
evaluation".Healthtechnologyassessment(Winchester,England).13(41):1190,
215357,iiiiv.doi:10.3310/hta13410.PMID19726018.
81.Frachetti,KJGoldfine,AB(April2009)."Bariatricsurgeryfordiabetes
management".CurrentOpinioninEndocrinology,DiabetesandObesity.16(2):
11924.doi:10.1097/MED.0b013e32832912e7.PMID19276974.
82.Schulman,APdelGenio,FSinha,NRubino,F(SeptemberOctober2009).
" "Metabolic"surgeryfortreatmentoftype2diabetesmellitus".Endocrine
Practice.15(6):62431.doi:10.4158/EP09170.RAR.PMID19625245.
83.Colucci,RA(January2011)."Bariatricsurgeryinpatientswithtype2diabetes:a
viableoption".PostgraduateMedicine.123(1):2433.
doi:10.3810/pgm.2011.01.2242.PMID21293081.
84.Dixon,JBleRoux,CWRubino,FZimmet,P(16June2012)."Bariatric
surgeryfortype2diabetes".Lancet.379(9833):230011.doi:10.1016/S0140
6736(12)604012.PMID22683132.
85.PolisenaJ,TranK,CimonK,HuttonB,McGillS,PalmerK(2009)."Home
telehealthfordiabetesmanagement:asystematicreviewandmetaanalysis".
DiabetesObesMetab.11(10):91330.doi:10.1111/j.14631326.2009.01057.x.
PMID19531058.
86.WorldHealthOrganization,GlobalReportonDiabetes.Geneva,2016.
87.GaleEA,GillespieKM,Diabetesandgender.Diabetologia,200144(1):315.
88.MeisingerC,ThorandB,SchneiderAetal.,Sexdifferencesinriskfactorsfor
incidenttype2DiabetesMellitus:TheMONICAAugsburgCohortStudy.JAMA
InternalMedicine,2002162(1):8289.
89.PublicHealthAgencyofCanada,DiabetesinCanada:Factsandfiguresfroma
publichealthperspective.Ottawa,2011.
90.MathersCD,LoncarD(November2006)."Projectionsofglobalmortalityand
burdenofdiseasefrom2002to2030".PLoSMed.3(11):e442.
doi:10.1371/journal.pmed.0030442.PMC1664601 .PMID17132052.
91.WildS,RoglicG,GreenA,SicreeR,KingH(2004)."Globalprevalenceof
diabetes:Estimatesfortheyear2000andprojectionsfor2030".DiabetesCare.27
(5):104753.doi:10.2337/diacare.27.5.1047.PMID15111519.
92.Ripoll,BrianC.Leutholtz,Ignacio(20110425).Exerciseanddisease
management(2nded.).BocaRaton:CRCPress.p.25.ISBN9781439827598.
93.editor,LeonidPoretsky,(2009).Principlesofdiabetesmellitus(2nded.).New
York:Springer.p.3.ISBN9780387098401.
94.LaiosK,KaramanouM,SaridakiZ,AndroutsosG(2012)."Aretaeusof
Cappadociaandthefirstdescriptionofdiabetes".Hormones.11(1):109113.
PMID22450352.
95.OxfordEnglishDictionary.diabetes.Retrieved20110610.
17/19
10/8/2016
96.Harper,Douglas(20012010)."OnlineEtymologyDictionary.diabetes.".
Retrieved20110610.
97.Aretaeus,Decausisetsignisacutorummorborum(lib.2),..
(Chapter2,OnDiabetes,Greekoriginal(http://www.perseus.tufts.edu/hopper/tex
t?doc=Perseus:abo:tlg,0719,002:2:2&lang=original),onPerseus
98.OxfordEnglishDictionary.mellite.Retrieved20110610.
99."MyEtimology.mellitus.".Retrieved20110610.
100.OxfordEnglishDictionary.ite.Retrieved20110610.
101.TheodoreH.Tulchinsky,ElenaA.Varavikova(2008).TheNewPublicHealth,
SecondEdition.NewYork:AcademicPress.p.200.ISBN0123708907.
102.PiwernetzK,HomePD,SnorgaardO,AntsiferovM,StaehrJohansenK,KransM
(May1993)."MonitoringthetargetsoftheStVincentDeclarationandthe
implementationofqualitymanagementindiabetescare:theDIABCAREinitiative.
TheDIABCAREMonitoringGroupoftheStVincentDeclarationSteering
Committee".DiabeticMedicine.10(4):3717.doi:10.1111/j.1464
5491.1993.tb00083.x.PMID8508624.
103.Dubois,HFWBankauskaite,V(2005)."Type2diabetesprogrammesinEurope"
(PDF).EuroObserver.7(2):56.
104.StewartWF,RicciJA,CheeE,HirschAG,BrandenburgNA(June2007)."Lost
productivetimeandcostsduetodiabetesanddiabeticneuropathicpainintheUS
workforce".J.Occup.Environ.Med.49(6):6729.
doi:10.1097/JOM.0b013e318065b83a.PMID17563611.
105.WashingtonR.E.AndrewsR.M.MutterR.L.(November2013)."Emergency
DepartmentVisitsforAdultswithDiabetes,2010".HCUPStatisticalBrief#167.
RockvilleMD:AgencyforHealthcareResearchandQuality.
106.Parker,Katrina(2008).Livingwithdiabetes.NewYork:FactsOnFile.p.143.
ISBN9781438121086.
107."Diabetesmellitus".MerckVeterinaryManual,9thedition(onlineversion).2005.
Retrieved20111023.
108.MariaRotellaC,PalaL,MannucciE(Summer2013)."RoleofInsulininthe
Type2DiabetesTherapy:Past,PresentandFuture.".Internationaljournalof
endocrinologyandmetabolism.11(3):137144.doi:10.5812/ijem.7551.
PMC3860110 .PMID24348585.
109."PressAnnouncement".FDA.Retrieved11February2016.
110."InhaledInsulinClearsHurdleTowardF.D.A.Approval".NewYorkTimes.
Retrieved12April2014.
111.inPharmaTechnologist.com."World'sfirsttransdermalinsulinshowspromise".
Retrieved20160703.
112."PHOSPHAGENICSINITIATESTRIALOFTRANSDERMALINSULIN
GEL".www.fdanews.com.Retrieved20160703.
Furtherreading
PolonskyKS(2012)."ThePast200YearsinDiabetes".NewEnglandJournalofMedicine.367(14):133240.doi:10.1056/NEJMra1110560.
PMID23034021.
Externallinks
Diabetesmellitus(https://www.dmoz.org/Health/Conditions_and_Diseases/Endocrine_Disorders/Pancreas/Diabetes/)atDMOZ
IDFDiabetesAtlas(http://www.diabetesatlas.org/)
NationalDiabetesEducationProgram(http://ndep.nih.gov/)
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Diabetes_mellitus&oldid=742588432"
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