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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The new diagnostic criteria and new classes of diabetes mellitus have caused a certain amount of confusion. This work reviews and analyses the practical aspects of this chronic condition. The oral glucose tolerance test has specific indications which should be kept in mind. Type I and type II diabetes mellitus remain the two principal groups of classification, but individualisation of subtypes la and lb allows a better understanding of the pathogenesis of the disease. The third syndrome or type III is mainly found in tropical and subtropical areas. Its pathogenesis, toxic or malnutritive, is still unclear.
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PMID:[Current diagnostic criteria, current classification of and clinical approach to diabetes mellitus]. 630 83

Our objective was to determine the prevalence of non-insulin dependent diabetes mellitus Type 2 Diabetes, in the province of Leon, Spain, and to investigate the relationship between birth order and the presence of diabetes. A cross-sectional study was therefore carried out on a stratified sample of the adult population (n = 569). The participants completed a socio-demographic questionnaire and an analysis of their basal capillary glycaemia and an oral glucose tolerance test (OGTT) after a 75 g load according to WHO recommendations. Type 2 diabetes prevalence was 5.62%. It was higher in subjects with a birth order above 4 than among those with a birth order below or equal to 4. (16.81% vs 2.85%, p < 0.001). This remained after adjusting for age. It was not proved that either sex, obesity or a family history of diabetes could amount to confusion factors. Greater values of fasting glycaemia (5.12 vs 4.73 mmol/l, p < 0.001) and less satisfactory post-OGTT glycaemic curves were also shown is subjects with a birth order > 4. Although it was not-possible to definitely conclude, from our study, that children born after the fourth birth have a greater risk of presenting alterations in their carbohydrate metabolism, there are indicators arguing for a more detailed study of such a possibility.
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PMID:Is there a relationship between non-insulin diabetes mellitus and birth order? 833 55

Maturity onset diabetes of the young is characterized by early onset diabetes inherited in an autosomal dominant pattern. Classic MODY occurs predominantly in Caucasians and presents before age 25, is nonketotic, and is generally not insulin-requiring. Less than 5% of cases of childhood diabetes in Caucasians are caused by MODY. ADM is a subtype of MODY that occurs in approximately 10% of African-Americans with youth onset diabetes. In contrast to MODY in Caucasians, ADM presents clinically as acute onset diabetes often associated with weight loss, ketosis, and even diabetic ketoacidosis. Approximately 50% of patients with ADM are obese. Therefore, based strictly on clinical grounds, at onset, ADM cannot be distinguished from type 1 diabetes. Months to years following diagnosis, a non-insulin-dependent clinical course develops in patients with ADM that is clearly different from type 1 diabetes. Mutations in five genes can cause MODY. These genes encode hepatocyte nuclear factor-4 alpha (HNF-4 alpha, MODY1), glucokinase (MODY2), hepatocyte nuclear factor-1 alpha (HNF-1 alpha, MODY3), insulin promoter factor-1 (IPF-1, MODY4), and hepatocyte nuclear factor-1 beta (HNF-1 beta, MODY5). These monogenic forms of MODY have been used as model systems to investigate the inheritance and pathophysiology of type 2 diabetes. Clinicians, should be able to diagnose MODY. Type 1 diabetes, the most common form of diabetes in Caucasians, is always insulin-requiring for control and survival, whereas patients with MODY do not usually require long-term insulin for survival. Diagnostic confusion can lead to inappropriate management and patient expectations. Primary care physicians must be alert to avoid therapeutic confusion when patients with ADM enter into the non-insulin-dependent stage. An approach to the diagnosis of childhood diabetes is offered in Table 4. The majority of youth onset diabetes remains type 1; however, the frequency of type 2 diabetes is rising in obese children and adolescents and especially in obese minority youth. The diagnosis of MODY can be made through a careful review of the patient's clinical course, severity of hyperglycemia, and family history. The identification of islet autoantibodies is confirmatory evidence of autoimmune (type 1) diabetes. Because testing for MODY mutations is expensive and is performed at a select number of research laboratories only, routine molecular genetic studies to search for the various MODY mutations should be limited to research investigations. In the future, the availability of gene chip technology may allow rapid screening of mitochondrial and MODY mutations.
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PMID:Monogenic diabetes mellitus in youth. The MODY syndromes. 1060 19

A 59-year-old man with a 30-year history of type 2 diabetes mellitus presented with fatigue, confusion, and weight loss over a 3-month period. He was found to be hypercalcemic (11.8 mg/dL) and dehydrated, and his hypercalcemia improved with intravenous fluids. While in the hospital, he developed hyponatremia, hypoglycemia, and hypotension. He was found to have a subnormal cortisol level of 2.3 microg/dL at baseline, which increased to only 5.6 microg/dL 60 minutes after a 250-microg corticotropin intravenous stimulation test. The patient developed pneumonia and adult respiratory distress syndrome and died of an acute myocardial infarction. During the autopsy, he was found to have lymphocytic hypophysitis with a severe reduction in corticotropin-producing anterior pituitary cells. No malignancy was identified at autopsy. He is the first male patient to be described in the literature who presented with hypercalcemia caused by lymphocytic hypophysitis.
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PMID:Lymphocytic hypophysitis in a man presenting with hypercalcemia. 1126

The abrupt interruption of insulin therapy in a severely obese diabetic woman submitted to a protein-sparing modified fast in a metabolic ward led to a severe ketoacidosis. This complication occurred because the patient had type 1 rather than type 2 diabetes, and the diagnosis of ketoacidosis was delayed because of confusion between ketonuria resulting from insulin deprivation and ketonuria associated with carbohydrate and energy restriction. This case report illustrates the danger of accepting an apparently obvious diagnosis which might be in fact erroneous. More particularly, it points out the importance of a correct differential diagnosis between C-peptide positive insulin-requiring type 2 diabetes and C-peptide negative (insulin-dependent) type 1 diabetes.
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PMID:[One type of diabetes may conceal another]. 1214 66

There is a relationship between coping with chronic illness and a person's psychosocial development. The aim of this study was to describe dimensions of psychosocial development based on results of a previous factor analysis of the Modified Erikson Psychosocial Stage Inventory among people with type 2 diabetes. Interviews were carried out with 10 people with diabetes. The transcribed interviews were analysed by qualitative content analysis into main categories, categories and themes. The categories were trust, lack of trust, positive identity, identity confusion, integrity and lack of integrity. Themes that permeated the categories in a positive way were 'activity' and 'involvement', while themes that permeated the categories in a negative way were 'passivity' and 'alienation'. Our interpretation is that the category 'trust' is the basis for 'identity', and together 'trust' and 'identity' are the basis for maturity and 'integrity'. A conclusion is that positive psychosocial maturity has to do with attaining trust, identity and integrity through activity and involvement. Qualities important for maturation through trust, identity and integrity are understanding, capacity, purposefulness and fortitude. Our interpretation of maturity is considered as being an important and interesting focus in nursing, while the above related qualities are closely connected to coping with diabetes.
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PMID:Psychosocial maturity among people with diabetes mellitus. 1242 83

Maturity onset diabetes of the young (MODY) is characterized by youth-onset diabetes that is inherited in an autosomal dominant (monogenic) pattern. Classic MODY accounts for less than 5% of cases of childhood diabetes in Caucasians, presents prior to age 25 years, is nonketotic, and may not require insulin treatment. A variant form of MODY that lacks a clearly defined genetic basis occurs in African Americans [atypical diabetes mellitus (ADM)] clinically presents more acutely and is initially insulin requiring. To date, five molecular causes of classic MODY have been identified: hepatocyte nuclear factor-4 alpha (HNF-4 alpha; MODY1), glucokinase (MODY2), hepatocyte nuclear factor-1 alpha (HNF-1 alpha; MODY3), insulin promoter factor-1 (IPF-1, MODY4), and hepatocyte nuclear factor-1 beta (HNF-1 beta; MODY5). MODY is studied as a model of beta cell hypofunction and modest insulinopenia. Clinical recognition of ADM is important for patient management to avoid confusion with type 1 diabetes mellitus.
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PMID:Molecular and biochemical analysis of the MODY syndromes. 1501 34

The study explored the confusion in diabetes terminology as illustrated by the use of insulin in NIDDM. It is proposed that a new terminology for both types of diabetes be introduced. In order to investigate this proposal, we invited a total of 84 medical professionals to contribute their views via a one-page questionnaire, personally handed to the participants. Considering the variety of terms in the sample polled for this study, and the fact that patients with type 2 diabetes might need insulin management at any stage of their life, some professionals persist in using the old names, a fact that seems to fly in the face of logic. Most pharmacists will be aware that not only are the professionals confused by the current situation but that patients are also perplexed when, for example, receiving treatment with insulin after being told that they have non-insulin dependent diabetes.
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PMID:Is it time to change diabetic disease nomenclature? 1501 50

Cardiovascular disease (CVD) is currently the leading cause of morbidity and mortality worldwide and its incidence is likely to increase. Multiple risk factors contribute to CVD. Elevated LDL-cholesterol (LDL-C) and triglyceride levels, low HDL-cholesterol levels, hypertension, type 2 diabetes, and smoking are key modifiable risk factors. Such risk factors are present in 80-90% of coronary heart disease (CHD) patients. For many factors, modification can significantly reduce CVD incidence. For example, statin-induced LDL-C reductions reduce cardiovascular events by 24-37% and smoking cessation reduces CHD mortality by 36%. The need to identify and treat these risk factors has led many national and local groups to develop clinical practice guidelines for management of CVD. Although the aim of such guidelines is to provide practitioners with a framework to identify, prioritize, and manage patients, the plethora of guidelines can cause confusion. In addition, research indicates that guidelines are not being optimally implemented. This review considers these practical issues, highlights the common goals shared by many guidelines, and focuses on how these can be best achieved. It also highlights areas where the guidelines differ and discusses points to consider when selecting the most appropriate recommendation.
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PMID:Lipids and CVD management: towards a global consensus. 1597 89

The constellation of metabolic abnormalities including centrally distributed obesity, decreased high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, elevated blood pressure (BP), and hyperglycaemia is known as the metabolic syndrome. Associated with a 3 fold and 2 fold increase in type 2 diabetes and cardiovascular disease (CVD), respectively, it is thought to be a driver of the modern day epidemics of diabetes and CVD and has become a major public health challenge around the world. Since its initial description, several definitions of the syndrome have emerged. Each of these definitions used differing sets of criteria, which reflected contrasting views on pathogenic mechanisms and the need for clinical usefulness. The use of these definitions to conduct research into the metabolic syndrome in diverse populations resulted in wide ranging prevalence rates, inconsistencies and confusion, and spurred on the vigorous debate regarding how the metabolic syndrome should be defined. In response to this controversy, the International Diabetes Federation (IDF) has recently proposed a new definition, which is applicable to populations around the world. It is envisaged that the development of the new definition for the metabolic syndrome will help resolve the confusion caused by the number of earlier attempts to define this important entity.
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PMID:The metabolic syndrome: a global public health problem and a new definition. 1639 10


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