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INTRODUCTION AND EPIDEMIOLOGY

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Diabetes can be classified into type 1 diabetes (DM1), type 2 diabetes (DM2), gestational diabetes, and other specific types of diabetes based on the etiology (Table 223-1); however, many people with diabetes do not easily fit into a single class.1 About 5% of people with diabetes are estimated to have DM1, which is about 1.25 million American children and adults.2,3

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 TABLE 223-1Etiologic Classification of Diabetes Mellitus
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PATHOPHYSIOLOGY

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DM1 is characterized by an autoimmune, cellular-mediated destruction of β-cells of the pancreas. These patients usually have almost no circulating insulin.1 It is mostly diagnosed in children and young adults, but it can also develop in adults.4 Spontaneous ketoacidosis almost always develops in untreated cases, and insulin is required for survival.

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Chapter 224, “Type 2 Diabetes Mellitus,” discusses DM2 in detail. Hyperglycemia is present in all types of diabetes mellitus and is the main factor responsible for chronic complications. Therefore, maintaining euglycemic control is the cornerstone of management.

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DIAGNOSIS

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The American Diabetes Association criteria for diagnosis are listed in Table 223-2.1 Any one of these can be used to make the diagnosis. Patients with a fasting plasma glucose of 100 to 125 milligrams/dL (5.6 to 7.0 mmol/L), a hemoglobin A1C of 5.7% to 6.4%, or a 2-hour plasma glucose of 140 to 199 milligrams/dL (7.8 to 11.0 mmol/L) as part of an oral glucose tolerance test are classified as having prediabetes.4 This should be viewed as an increased risk for diabetes and cardiovascular disease rather than a clinical diagnosis.

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 TABLE 223-2American Diabetes Association Criteria for the Diagnosis of Diabetes

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