Maturity-onset diabetes of the young (MODY) is an autosomal dominantly inherited type of diabetes that results from heterozygous mutations in various transcription factors acting in the development and maturation of pancreatic β-cells. In addition, mutations in enzymes involved in glucose sensing of the β-cell have also been shown to result in early-onset diabetes. Characteristic features of MODY are autosomal inheritance, early onset of diabetes (with diagnosis generally before the age of 25 years), no signs related to the autoimmune process or insulin resistance, and preservation of endogenous insulin secretion. Continue reading “MODY subtypes: gene mutations, pathophysiology, and clinical characteristics”
Diabetes is a heterogeneous, complex metabolic disorder characterized by elevated blood glucose concentrations secondary to either resistance to the action of insulin, insufficient insulin secretion, or both. The most common classifications include Type 1 diabetes mellitus, Type 2 diabetes mellitus, gestational diabetes and other specific types. Continue reading “Classification of Diabetes Mellitus”
A diagnosis of diabetic ketoacidosis (DKA) requires the patient’s plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. Continue reading “Diagnostic Criteria for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State”
Foot ulcerations are among the most complex and heterogeneous complications in patients with diabetes. Skin ulcers need to be managed in different ways dependent on their etiology and pathogenesis.
The 10 Saint Elian Wound Score System (SEWSS) categories is helpful in guiding treatment decisions based on severity subcategories.
Continue reading “Saint Elian Wound Score System for Diabetic Foot Ulcers”
Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes. Recommendations from the International Hypoglycaemia Study Group regarding the classification of hypoglycemia considers a blood glucose <54 mg/dL (3.0 mmol/L) detected by self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM) (for at least 20 min), or laboratory measurement of plasma glucose as sufficiently low to indicate serious, clinically significant hypoglycemia that should be included in reports of clinical trials of glucose-lowering drugs for the treatment of diabetes. However, a glucose alert value of </=70 mg/dL (3.9 mmol/L) can be important for therapeutic dose adjustment of glucose-lowering drugs in clinical care and is often related to symptomatic hypoglycemia. Severe hypoglycemia is defined as severe cognitive impairment requiring assistance from another person for recovery.
Continue reading “Classification of Hypoglycemia”
Latent autoimmune diabetes in adults (LADA) accounts for 2%-12% of all cases of diabetes. Patients are typically diagnosed after 35 years of age and are often misdiagnosed as type II Diabetes Mellitus (DM). Glycemic control is initially achieved with sulfonylureas, but patients eventually become insulin dependent more rapidly than with type II DM patients.
Continue reading “Diagnostic Criteria of Latent Autoimmune Diabetes in Adults (LADA)”
“Prediabetes” is the term used for individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and indicates an increased risk for the future development of diabetes. IFG and IGT should not be viewed as clinical entities in their own right but rather risk factors for diabetes and cardiovascular disease (CVD). IFG and IGT are associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.
Continue reading “Criteria for Testing for Diabetes or Prediabetes in Asymptomatic Adults”
The American Diabetes Association (ADA) and the Veterans Health Administration (VHA) recommend diabetes screening beginning at 45 years of age; the ADA advises earlier screening in patients with risk factors.
Continue reading “American Diabetes Association Recommendations for the Screening of Asymptomatic Persons for Diabetes”
The levels in this new diabetic retinopathy disease severity scale consist of five scales with increasing risks of retinopathy.
Continue reading “International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales”
The metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension. These conditions are interrelated and share underlying mediators, mechanisms and pathways. Continue reading “Criteria for the Metabolic Syndrome”