Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus

Classification, Pathophysiology, Diagnosis and Management of
Diabetes Mellitus
Abstract
Diabetes Mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia either
immune-mediated (Type 1 diabetes), insulin resistance (Type 2), gestational or others (environment, genetic
defects, infections, and certain drugs). According to International Diabetes Federation Report of 2011 an estimated
366 million people had DM, by 2030 this number is estimated to almost around 552 million. There are different
approaches to diagnose diabetes among individuals, The 1997 ADA recommendations for diagnosis of DM focus on
fasting Plasma Glucose (FPG), while WHO focuses on Oral Glucose Tolerance Test (OGTT). This is importance for
regular follow-up of diabetic patients with the health care provider is of great significance in averting any long
term
complications.
Keywords: Diabetes mellitus; Epidemiology; Diagnosis; Glycemic
management
Abbreviations: DM: Diabetes Mellitus; FPG: Fasting Plasma
Glucose; GAD: Glutamic Acid Decarboxylase; GDM: Gestational
Diabetes Mellitus; HDL-cholesterol: High Density Lipoprotein
cholesterol; HLA: Human Leucoid Antigen; IDDM: Insulin Dependent
Diabetes Mellitus; IFG: Impaired Fasting Glucose; IGH: Increased
Glycated Hemoglobin; IGT: Impaired Glucose Test; NIDDM: Non-
Insulin Dependent Diabetes Mellitus; OGTT: Oral Glucose Tolerance
Test
Introduction
Diabetes Mellitus (DM) is a metabolic disorder characterized by the
presence of chronic hyperglycemia accompanied by greater or lesser
impairment in the metabolism of carbohydrates, lipids and proteins.
DM is probably one of the oldest diseases known to man. It was first
reported in Egyptian manuscript about 3000 years ago [1]. In 1936, the
distinction between type 1 and type 2 DM was clearly made [2]. Type
2 DM was first described as a component of metabolic syndrome in
1988 [3].
The origin and etiology of DM can vary greatly but always include
defects in either insulin secretion or response or in both at some point
in the course of disease. Mostly patients with diabetes mellitus have
either type 1 diabetes (which is immune-mediated or idiopathic)
Type 2 DM (formerly known as non-insulin dependent DM) is the
most common form of DM characterized by hyperglycemia, insulin
resistance, and relative insulin deficiency [4].
Type 2 DM results from interaction between genetic, environmental
and behavioral risk factors [5,6]. Diabetes also can be related to the
gestational hormonal environment, genetic defects, other infections,
and certain drugs [7].
Epidemiology
The application of epidemiology to the study of DM has provided
valuable information on several aspects of this disease such as its
natural history, prevalence, incidence, morbidity and mortality in
diverse populations around the world. Identification of the cause of the
disease and the possible preventive measures that could be instituted
to arrest or delay the onset of this disease which has reached epidemic
proportions in both the developed and the developing nations [8].
Unfortunately, the improvement in outcomes for individual patients
with diabetes has not resulted in similar improvements from the public
health perspective.
The worldwide prevalence of diabetes has continued to increase
dramatically. Globally, as of 2011, an estimated 366 million people had
DM, with type 2 making up about 90% of the cases [9,10]. The number
of people with type 2 DM is increasing in every country with 80% of
people with DM living in low- and middle-income countries. Literature
search has shown that there are few data available on the prevalence of
type 2 DM in Africa as a whole. Studies examining data trends within
Africa point to evidence of adramatic increase in prevalence in both
rural and urban setting, and affecting both gender proportionally
[11]. According to the World Fact book report in 2008, in Africa the
prevalence of diabetes mellitus was 3.2%, and 40,895 persons (2.0%)
was in Ethiopia [12].
Although T2DM is widely diagnosed in adults, its frequency
has markedly increased in the pediatric age group over the past two
decades. Depending on the population studied, T2DM now represents
8-45% of all new cases of diabetes reported among children and escent
[13]. The prevalence of T2DM in the pediatric population is higher
among girls than boys, just as it is higher among women than men [14].
The mean age of onset of T2DM is 12-16 years; this period coincides
with puberty, when a physiologic state of insulin resistance develops.
In this physiologic state, T2DM develops only if inadequate beta-cell
function is associated with other risk factors (e.g. obesity) [15].
Certain literatures also stated that T1DM is the most common form
of diabetes in most part of the world. Wide variations exist between the incidence rates of different populations,
incidence is lowest in China
(0.1 per 105 per year) and highest in Finland (37 per 105 per year).In
most populations girls and boys are equally affected. In general, the
incidence increases with age, the incidence peak is at puberty. After the
pubertal years, the incidence rate significantly drops in young women,
but remains relatively high in young adult males up to the age 29-35
years [16].
Presently as many as 50% of people with diabetes are undiagnosed.
Since therapeutic intervention can reduce complications of the
disease, there is a need to detect diabetes early in its course. The risk
of developing Type 2 diabetes increases with age, obesity, and lack of
physical activity. Its incidence is increasing rapidly, and by 2030 this
number is estimated to almost around 552 million [17,5]. Diabetes
mellitus occurs throughout the world, but is more common (especially
type 2) in the more developed countries, where the majority of patients
are aged between 45 and 64 years. The greatest increase in prevalence
is, however, expected to occur in Asia and Africa, where most patients
will probably be found by 2030 [5] (Table 1). It is projected that the
latter will equal or even exceed the former in developing nations, thus
culminating in a double burden as a result of the current trend of
transition from communicable to non-communicable diseases [18].

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