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Harrison's Internal Medicine > Chapter 338. Diabetes Mellitus >

Diabetes Mellitus: Introduction

Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype
Several distinct types of DM exist and are caused by a complex interaction of genetics and envi
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin
glucose utilization, and increased glucose production. The metabolic dysregulation associated with DM
pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual w
the health care system. In the United States, DM is the leading cause of end-stage renal disease (ESRD),
extremity amputations, and adult blindness. It also predisposes to cardiovascular diseases. With an i
worldwide, DM will be a leading cause of morbidity and mortality for the foreseeable future.
Classification

DM is classified on the basis of the pathogenic process that leads to hyperglycemia, as opposed to earlier cr
onset or type of therapy (Fig. 338-1). The two broad categories of DM are designated type 1 and type 2
types of diabetes are preceded by a phase of abnormal glucose homeostasis as the pathogenic processes
diabetes is the result of complete or near-total insulin deficiency. Type 2 DM is a heterogeneous
characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose
genetic and metabolic defects in insulin action and/or secretion give rise to the common phenotype of hype
DM and have important potential therapeutic implications now that pharmacologic agents are availab
metabolic derangements. Type 2 DM is preceded by a period of abnormal glucose homeostasis classified
glucose (IFG) or impaired glucose tolerance (IGT).

Spectrum of glucose homeostasis and diabetes mellitus (DM). The spectrum from normal glucose tole
type 1 DM, type 2 DM, other specific types of diabetes, and gestational DM is shown from left to right. In
the individual traverses from normal glucose tolerance to impaired glucose tolerance to overt diabetes. A
changes in glucose tolerance may be bi-directional in some types of diabetes. For example, individuals w
return to the impaired glucose tolerance category with weight loss; in gestational DM diabetes may revert t
tolerance or even normal glucose tolerance after delivery. The fasting plasma glucose (FPG) and 2-h pla
after a glucose challenge for the different categories of glucose tolerance, are shown at the lower part o
values do not apply to the diagnosis of gestational DM. Some types of DM may or may not require insulin
the dotted line. (Conventional units are used in the figure.) (Adapted from the American Diabetes Associati

Table 338-1 Etiologic Classification of Diabetes Mellitus

I. Type 1 diabetes (

-cell destruction, usually leading to absolute insulin deficiency)

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