diabetes mellitus

糖尿病 DM

WordNet

1. suffering from diabetes
2. someone who has diabetes
3. of or relating to or causing diabetes
4. a polygenic disease characterized by abnormally high glucose levels in the blood; any of several metabolic disorders marked by excessive urination and persistent thirst

PrepTutorEJDIC

1. 糖尿病の / 糖尿病患者
2. Deutsche mark
3. 糖尿病(尿に糖が異常に出る病気)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/06 19:57:57」(JST)

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"Diabetes" redirects here. For other uses, see Diabetes (disambiguation).

Diabetes mellitus
Universal blue circle symbol for diabetes.
Classification and external resources
Specialty	Endocrinology
ICD-10	E10–E14
ICD-9-CM	250
MedlinePlus	001214
eMedicine	med/546 emerg/134
Patient UK	Diabetes mellitus
MeSH	C18.452.394.750

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:

• Type 1 DM results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.
• Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.
• Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood-sugar levels.

Prevention and treatment involve a healthy diet, physical exercise, maintaining a normal body weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care are important for people with the disease. Type 1 DM must be managed with insulin injections. Type 2 DM may be treated with medications with or without insulin. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM. Gestational diabetes usually resolves after the birth of the baby.

As of 2014, an estimated 387 million people have diabetes worldwide, with type 2 DM making up about 90% of the cases. This represents 8.3% of the adult population, with equal rates in both women and men. From 2012 to 2014, diabetes is estimated to have resulted in 1.5 to 4.9 million deaths each year. Diabetes at least doubles a person's risk of death. The number of people with diabetes is expected to rise to 592 million by 2035. The global economic cost of diabetes in 2014 was estimated to be $612 billion USD. In the United States, diabetes cost $245 billion in 2012.

Signs and symptoms

Overview of the most significant symptoms of diabetes

The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM.

Several other signs and symptoms can mark the onset of diabetes, although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes.

Diabetic emergencies

Low blood sugar is common in persons with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Mild cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.

People (usually with type 1 DM) may also experience episodes of diabetic ketoacidosis, a metabolic disturbance characterized by nausea, vomiting and abdominal pain, the smell of acetone on the breath, deep breathing known as Kussmaul breathing, and in severe cases a decreased level of consciousness.

A rare but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 DM and is mainly the result of dehydration.

Complications

Main article: Complications of diabetes mellitus

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time.

The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to coronary artery disease. Other "macrovascular" diseases are stroke, and peripheral vascular disease.

The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is caused by damage to the blood vessels in the retina of the eye, and can result in gradual vision loss and blindness. Damage to the kidneys, known as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and eventually chronic kidney disease, sometimes requiring dialysis or kidney transplant. Damage to the nerves of the body, known as diabetic neuropathy, is the most common complication of diabetes. The symptoms can include numbness, tingling, pain, and altered pain sensation, which can lead to damage to the skin. Diabetes-related foot problems (such as diabetic foot ulcers) may occur, and can be difficult to treat, occasionally requiring amputation. Additionally, proximal diabetic neuropathy causes painful muscle wasting and weakness.

There is a link between cognitive deficit and diabetes. Compared to those without diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline in cognitive function.

Causes

Comparison of type 1 and 2 diabetes

Feature	Type 1 diabetes	Type 2 diabetes
Onset	Sudden	Gradual
Age at onset	Mostly in children	Mostly in adults
Body size	Thin or normal	Often obese
Ketoacidosis	Common	Rare
Autoantibodies	Usually present	Absent
Endogenous insulin	Low or absent	Normal, decreased or increased
Concordance in identical twins	50%	90%
Prevalence	~10%	~90%

Diabetes mellitus is classified into four broad categories: type 1, type 2, gestational diabetes, and "other specific types". The "other specific types" are a collection of a few dozen individual causes. The term "diabetes", without qualification, usually refers to diabetes mellitus.

Type 1

Main article: Diabetes mellitus type 1

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which a T-cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin. It causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of these diabetes cases were in children.

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used. Still, type 1 diabetes can be accompanied by irregular and unpredictable high blood sugar levels, frequently with ketosis, and sometimes with serious low blood sugar levels. Other complications include an impaired counterregulatory response to low blood sugar, infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease). These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.

Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as a viral infection or diet. There is some evidence that suggests an association between type 1 DM and Coxsackie B4 virus. Unlike type 2 DM, the onset of type 1 diabetes is unrelated to lifestyle.

Type 2

Main article: Diabetes mellitus type 2

Type 2 DM is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 DM is the most common type of diabetes mellitus.

In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At this stage, high blood sugar can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce the liver's glucose production.

Type 2 DM is due primarily to lifestyle factors and genetics. A number of lifestyle factors are known to be important to the development of type 2 DM, including obesity (defined by a body mass index of greater than 30), lack of physical activity, poor diet, stress, and urbanization. Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60–80% of cases in those of European and African descent, and 100% of Pima Indians and Pacific Islanders. Even those who are not obese often have a high waist–hip ratio.

Dietary factors also influence the risk of developing type 2 DM. Consumption of sugar-sweetened drinks in excess is associated with an increased risk. The type of fats in the diet is also important, with saturated fats and trans fatty acids increasing the risk and polyunsaturated and monounsaturated fat decreasing the risk. Eating lots of white rice also may increase the risk of diabetes. A lack of exercise is believed to cause 7% of cases.

Gestational diabetes

Main article: Gestational diabetes

Gestational diabetes mellitus (GDM) resembles type 2 DM in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2–10% of all pregnancies and may improve or disappear after delivery. However, after pregnancy approximately 5–10% of women with gestational diabetes are found to have diabetes mellitus, most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. Management may include dietary changes, blood glucose monitoring, and in some cases insulin may be required.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital heart and central nervous system abnormalities, and skeletal muscle malformations. Increased levels of insulin in a fetus's blood may inhibit fetal surfactant production and cause respiratory distress syndrome. A high blood bilirubin level may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

Other types

Prediabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 DM. Many people destined to develop type 2 DM spend many years in a state of prediabetes.

Latent autoimmune diabetes of adults (LADA) is a condition in which type 1 DM develops in adults. Adults with LADA are frequently initially misdiagnosed as having type 2 DM, based on age rather than etiology.

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

"Type 3 diabetes" has been suggested as a term for Alzheimer's disease as the underlying processes may involve insulin resistance by the brain.

The following is a comprehensive list of other causes of diabetes:

• Genetic defects of β-cell function
  • Maturity onset diabetes of the young
  • Mitochondrial DNA mutations
• Genetic defects in insulin processing or insulin action
  • Defects in proinsulin conversion
  • Insulin gene mutations
  • Insulin receptor mutations
• Exocrine pancreatic defects
  • Chronic pancreatitis
  • Pancreatectomy
  • Pancreatic neoplasia
  • Cystic fibrosis
  • Hemochromatosis
  • Fibrocalculous pancreatopathy

• Endocrinopathies
  • Growth hormone excess (acromegaly)
  • Cushing syndrome
  • Hyperthyroidism
  • Pheochromocytoma
  • Glucagonoma
• Infections
  • Cytomegalovirus infection
  • Coxsackievirus B
• Drugs
  • Glucocorticoids
  • Thyroid hormone
  • β-adrenergic agonists
  • Statins

Pathophysiology

The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during the course of a day with three meals — one of the effects of a sugar-rich vs a starch-rich meal is highlighted.

Mechanism of insulin release in normal pancreatic beta cells — insulin production is more or less constant within the beta cells. Its release is triggered by food, chiefly food containing absorbable glucose.

Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, muscle, and adipose tissue. Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.

The body obtains glucose from three main places: the intestinal absorption of food, the breakdown of glycogen, the storage form of glucose found in the liver, and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body. Insulin plays a critical role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.

Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by the body cells that require it, and it will not be stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.

When the glucose concentration in the blood remains high over time, the kidneys will reach a threshold of reabsorption, and glucose will be excreted in the urine (glycosuria). This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst (polydipsia).

Diagnosis

See also: Glycated hemoglobin and Glucose tolerance test

WHO diabetes diagnostic criteria  

Condition	2 hour glucose	Fasting glucose	HbA1c
Unit	mmol/l(mg/dl)	mmol/l(mg/dl)	mmol/mol	DCCT %
Normal	<7.8 (<140)	<6.1 (<110)	<42	<6.0
Impaired fasting glycaemia	<7.8 (<140)	≥6.1(≥110) & <7.0(<126)	42-46	6.0–6.4
Impaired glucose tolerance	≥7.8 (≥140)	<7.0 (<126)	42-46	6.0–6.4
Diabetes mellitus	≥11.1 (≥200)	≥7.0 (≥126)	≥48	≥6.5

Diabetes mellitus is characterized by recurrent or persistent high blood sugar, and is diagnosed by demonstrating any one of the following:

• Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)
• Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two hours after a 75 g oral glucose load as in a glucose tolerance test
• Symptoms of high blood sugar and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
• Glycated hemoglobin (HbA_1C) ≥ 48 mmol/mol (≥ 6.5 DCCT %).

A positive result, in the absence of unequivocal high blood sugar, should be confirmed by a repeat of any of the above methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. According to the current definition, two fasting glucose measurements above 126 mg/dl (7.0 mmol/l) is considered diagnostic for diabetes mellitus.

Per the World Health Organization people with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered to have impaired fasting glucose. people with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not over 11.1 mmol/l (200 mg/dl), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two prediabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus, as well as cardiovascular disease. The American Diabetes Association since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l (100 to 125 mg/dl).

Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.

The rare disease diabetes insipidus has similar symptoms to diabetes mellitus, but without disturbances in the sugar metabolism (insipidus means "without taste" in Latin) and does not involve the same disease mechanisms. Diabetes is a part of the wider condition known as metabolic syndrome.

Prevention

See also: Prevention of diabetes mellitus type 2

There is no known preventive measure for type 1 diabetes. Type 2 diabetes can often be prevented by a person being a normal body weight, physical exercise, and following a healthful diet. Dietary changes known to be effective in helping to prevent diabetes include a diet rich in whole grains and fiber, and choosing good fats, such as polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help in the prevention of diabetes. Active smoking is also associated with an increased risk of diabetes, so smoking cessation can be an important preventive measure as well.

Management

Main article: Diabetes management

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).

Learning about the disease and actively participating in the treatment is important, since complications are far less common and less severe in people who have well-managed blood sugar levels. The goal of treatment is an HbA_1C level of 6.5%, but should not be lower than that, and may be set higher. Attention is also paid to other health problems that may accelerate the negative effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialized footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet. Evidence for the efficacy of this remains equivocal, however.

Lifestyle

See also: Diabetic diet

People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve a normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

Medications

See also: Anti-diabetic medication

Medications used to treat diabetes do so by lowering blood sugar levels. There are a number of different classes of anti-diabetic medications. Some are available by mouth, such as metformin, while others are only available by injection such as GLP-1 agonists. Type 1 diabetes can only be treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs.

Metformin is generally recommended as a first line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver's production of glucose. Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type II DM. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased to effect.

Since cardiovascular disease is a serious complication associated with diabetes, some recommend blood pressure levels below 120/80 mmHg. However, evidence supports less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg; the only additional benefit found for blood pressure targets beneath this range was an isolated decrease in stroke risk, and this was accompanied by an increased risk of other serious adverse events. Amongst medications that lower blood pressure, angiotensin converting enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications angiotensin receptor blockers (ARBs) do not. Aspirin is also recommended for patient with cardiovascular problems, however routine use of aspirin has not been found to improve outcomes in uncomplicated diabetes.

Surgery

A pancreas transplant is occasionally considered for people with type 1 diabetes who have severe complications of their disease, including end stage kidney disease requiring kidney transplantation.

Weight loss surgery in those with obesity and type two diabetes is often an effective measure. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. There however is some short-term mortality risk of less than 1% from the surgery. The body mass index cutoffs for when surgery is appropriate are not yet clear. It is recommended that this option be considered in those who are unable to get both their weight and blood sugar under control.

Support

In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or research projects. In other circumstances, general practitioners and specialists share care in a team approach. Home telehealth support can be an effective management technique.

Epidemiology

Main article: Epidemiology of diabetes mellitus

Rates of diabetes worldwide in 2000 (per 1,000 inhabitants) — world average was 2.8%.

  no data

  ≤ 7.5

  7.5–15

  15–22.5

  22.5–30

  30–37.5

  37.5–45

  45–52.5

  52.5–60

  60–67.5

  67.5–75

  75–82.5

  ≥ 82.5

Disability-adjusted life year for diabetes mellitus per 100,000 inhabitants in 2004

  No data

  <100

  100–200

  200–300

  300–400

  400–500

  500–600

  600–700

  700–800

  800–900

  900–1,000

  1,000–1,500

  >1,500

As of 2013, 382 million people have diabetes worldwide. Type 2 makes up about 90% of the cases. This is equal to 8.3% of the adult population with equal rates in both women and men.

In 2014, the International Diabetes Federation (IDF) estimated that diabetes resulted in 4.9 million deaths. The World Health Organization (WHO) estimated that diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death. The discrepancy between the two estimates is due to the fact that cardiovascular diseases are often the cause of death for individuals with diabetes; the IDF uses modelling to estimate the amount of deaths that could be attributed to diabetes. More than 80% of diabetic deaths occur in low and middle-income countries.

Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in more developed countries. The greatest increase in rates was expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030. The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including a "Western-style" diet. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism(s) at present.

History

Main article: History of diabetes

Diabetes was one of the first diseases described, with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine". The first described cases are believed to be of type 1 diabetes. Indian physicians around the same time identified the disease and classified it as madhumeha or "honey urine", noting the urine would attract ants. The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius of Memphis. The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career. This is possibly due to the diet and life-style of the ancient people, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa). The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the "Pneumatic School". He hypothesized a correlation of diabetes with other diseases and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until the middle of the 16th century when, in 1552, the first Latin edition was published in Venice.

Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 CE with type 1 associated with youth and type 2 with being overweight. The term "mellitus" or "from honey" was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination. Effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922. This was followed by the development of the long-acting insulin NPH in the 1940s.

Etymology

The word diabetes (/ˌdaɪ.əˈbiːtiːz/ or /ˌdaɪ.əˈbiːtᵻs/) comes from Latin diabētēs, which in turn comes from Ancient Greek διαβήτης (diabētēs) which literally means "a passer through; a siphon." Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word, with the intended meaning "excessive discharge of urine", as the name for the disease. Ultimately, the word comes from Greek διαβαίνειν (diabainein), meaning "to pass through," which is composed of δια- (dia-), meaning "through" and βαίνειν (bainein), meaning "to go". The word "diabetes" is first recorded in English, in the form diabete, in a medical text written around 1425.

The word mellitus (/mᵻˈlaɪtəs/ or /ˈmɛlᵻtəs/) comes from the classical Latin word mellītus, meaning "mellite" (i.e. sweetened with honey; honey-sweet). The Latin word comes from mell-, which comes from mel, meaning "honey"; sweetness; pleasant thing, and the suffix -ītus, whose meaning is the same as that of the English suffix "-ite". It was Thomas Willis who in 1675 added "mellitus" to the word "diabetes" as a designation for the disease, when he noticed the urine of a diabetic had a sweet taste (glycosuria). This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.

Society and culture

Further information: List of films featuring diabetes

The 1989 "St. Vincent Declaration" was the result of international efforts to improve the care accorded to those with diabetes. Doing so is important not only in terms of quality of life and life expectancy, but also economically—expenses due to diabetes have been shown to be a major drain on health—and productivity-related resources for healthcare systems and governments.

Several countries established more and less successful national diabetes programmes to improve treatment of the disease.

People with diabetes who have neuropathic symptoms such as numbness or tingling in feet or hands are twice as likely to be unemployed as those without the symptoms.

In 2010, diabetes-related emergency room (ER) visit rates in the United States were higher among people from the lowest income communities (526 per 10,000 population) than from the highest income communities (236 per 10,000 population). Approximately 9.4% of diabetes-related ER visits were for the uninsured.

Naming

The term "type 1 diabetes" has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature.

Diabetes mellitus is also occasionally known as "sugar diabetes" to differentiate it from diabetes insipidus.

Other animals

Main articles: Diabetes in dogs and Diabetes in cats

In animals, diabetes is most commonly encountered in dogs and cats. Middle-aged animals are most commonly affected. Female dogs are twice as likely to be affected as males, while according to some sources, male cats are also more prone than females. In both species, all breeds may be affected, but some small dog breeds are particularly likely to develop diabetes, such as Miniature Poodles. The symptoms may relate to fluid loss and polyuria, but the course may also be insidious. Diabetic animals are more prone to infections. The long-term complications recognised in humans are much rarer in animals. The principles of treatment (weight loss, oral antidiabetics, subcutaneous insulin) and management of emergencies (e.g. ketoacidosis) are similar to those in humans.

Research

Inhalable insulin has been developed. The original products were withdrawn due to side effects. Afrezza, under development by pharmaceuticals company MannKind Corporation, was approved by the FDA for general sale in June 2014.

An advantage to inhaled insulin is that it may be more convenient and easy to use.

References

Further reading

• Polonsky KS (2012). "The Past 200 Years in Diabetes". New England Journal of Medicine 367 (14): 1332–40. doi:10.1056/NEJMra1110560. PMID 23034021. 

External links

• Diabetes mellitus at DMOZ
• IDF Diabetes Atlas
• National Diabetes Education Program

UpToDate Contents

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• A review of exenatide: optimizing glycemic control and associated cardiovascular risk factors in type 2 diabetes.

• Htike ZZ, Khunti K, Davies M.SourceDepartment of Diabetes and Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.
• Diabetes therapy : research, treatment and education of diabetes and related disorders.Diabetes Ther.2012 Nov;3(1):1-16. Epub 2012 Mar 16.
• Type 2 diabetes mellitus (T2DM) is a well-recognized risk factor for the development of cardiovascular disease. With an increasing prevalence of obesity, this risk has increased further. Management of T2DM in obese patients is particularly challenging as treatment with the majority of glucose-loweri
• PMID 22422427

• Diagnostic value of transferrin.

• Szőke D, Panteghini M.AbstractDespite the growing interest in hepcidin and other relatively new biomarkers, guidelines and clinical pathways continue to recommend traditional markers, such as serum transferrin (Tf) and ferritin, as laboratory tests for the diagnostic evaluation of iron-related disorders. In this study, we aimed to critically evaluate the diagnostic role of Tf relying on the highest level of available evidence by a comprehensive literature search. The role of Tf in iron deficiency (ID) and iron overload (IO) syndrome as well as a risk marker was evaluated. The low accuracy of Tf and Tf saturation (TS) in the diagnosis and management of ID conditions does not permit definitively recommending their use, even if recently published guidelines still consider the TS investigation as a complementary test for ferritin. If a tissue IO is suspected, TS is often used, even if it may not be the best test for detecting this condition. Nevertheless, clinical guidelines strongly recommend the use of TS as a first-level test for performing genetic diagnosis of hereditary hemochromatosis. Recently reported data indicating elevated TS as a risk factor for diabetes mellitus, cancer, and total mortality, may provide useful additions to the debate over whether or not to screen for IO using TS.
• Clinica chimica acta; international journal of clinical chemistry.Clin Chim Acta.2012 Aug 16;413(15-16):1184-9. Epub 2012 Apr 23.
• Despite the growing interest in hepcidin and other relatively new biomarkers, guidelines and clinical pathways continue to recommend traditional markers, such as serum transferrin (Tf) and ferritin, as laboratory tests for the diagnostic evaluation of iron-related disorders. In this study, we aimed
• PMID 22546612

Japanese Journal

• Case of telangiectatic/inflammatory hepatocellular adenoma arising in a patient with primary sclerosing cholangitis

• Maylee Hsu,Harada Kenichi,Igarashi Saya,Tohda Gen,Yamamoto Makoto,Ren Xiang shan,Osawa Takeshi,Hasegawa Yasuhiro,Takahashi Norio,Nakanuma Yasuni
• Hepatology Research 42(6), 611-618, 2012-06
• … This case is a 30-year-old man with a past medical history of PSC, ulcerative colitis and diabetes mellitus. …
• NAID 120004161541

• 小児・思春期1型糖尿病患者における基礎および追加インスリン量を規定する因子の検討

• 鶴原 昭史
• 大阪市医学会雑誌 61(1/2), 27-35, 2012-06
• NAID 110009396057

Related Pictures

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★リンクテーブル★

リンク元	「糖尿病」「病理学」「DM」「diabetic」「真性糖尿病」
拡張検索	「slowly progressive insulin-dependent diabetes mellitus」「pregestational diabetes mellitus」
関連記事	「diabetes」

「糖尿病」

　　[★]

英

diabetes mellitus (SP), DM

関

糖尿病治療薬

• first aid step1 2006 p.first aid step1 2006 p.256,423

定義

• グルコースに関連した糖質代謝障害

インスリンの不足

病型

• 1型糖尿病(インスリン依存性糖尿病(IDDM)):自己免疫性、特発性(劇症1型糖尿病、緩徐進行1型糖尿病)

インスリン分泌の低下

血中インスリン濃度：低

遺伝や生活習慣病に関係なく発症。治療はインスリンの注射

• 2型糖尿病(インスリン非依存型糖尿病(NIDDM))

インスリン受容体や細胞内情報伝達系の質的・量的変化

一般に血中インスリン濃度：高

肥満、喫煙、運増などが関連

中高年に多い

運動療法と食事療法

参考1

• NIDDM：インスリン不要
• NIDDM：高血糖是正にインスリン必要
• IDDM：ケトーシス防止や生存にインスリン必要

• DM type1

• 治療にインスリンが必要～生存にインスリンが必要

• DM type2

• 境界領域～インスリン不要～治療にインスリンが必要

症状

• 慢性的な高血糖状態

• 尿糖陽性

• 血糖値が170-180mg/dl以上で尿糖陽性となる。

血糖150mg/dlでも尿糖陽性であれば腎性尿糖が疑われる

• 口渇、多飲、多尿
• ケトーシス、アシドーシス体重減少

合併症

• 糖尿病腎症
• 糖尿病網膜症
• 糖尿病神経障害

• 多発神経障害(広汎性左右対称性神経障害)
• 単神経障害

• 栄養血管の閉塞による脳神経障害
• 外眼筋(動眼神経、滑車神経、外転神経)麻痺、顔面神経麻痺

• 糖尿病足病変
• 歯周病
• 動脈硬化性病変

• 冠動脈硬化症(広義には冠動脈疾患(CAD))
• 脳血管障害
• 下肢閉塞性動脈硬化症

• 認知症
• 皮膚病変

• 直接デルマドローム：糖尿病性壊疽、糖尿病性浮腫性硬化症、糖尿病性黄色腫、リポイド類壊死症、糖尿病性水疱、デュピュイトラン拘縮、前脛骨部色素斑、播種状環状肉芽腫
• 間接デルマドローム：皮膚真菌症

• 糖尿病性ケトアシドーシス(type 1 DM)
• 高浸透圧性非ケトン性昏睡(type 2 DM)

医療系の雑誌より(日経カデット11月？)

表5　糖尿病患者にみられる筋骨格系症状を呈する疾患と臨床的特徴

糖尿病との関係	疾患	臨床的特徴
糖尿病が直接病因に関与する疾患	糖尿病性手関節症(diabetic cheiroarthropathy)	コントロール不良の糖尿病に多い。原因不明の皮膚硬化が徐々に進行し、手指の屈曲拘縮を来し手全体に及び、強皮症と誤診される。手指を合わせることができない(Prayer徴候)。
	シャルコー関節	頻度は低い(1%)が、長期糖尿病コントロール不良患者に多い。通常、足根中足関節などの中足部が多く、足底表面、前足部、中足部に潰瘍形成の合併を認めることがあり、骨髄炎との鑑別が困難な例あり。
	糖尿病性骨溶解(diabetic osteolysis)	原因不明の足趾の末節骨や基節骨の骨吸収が起こリ、足痛の原因となる。X線ではickedcandy変形を呈し、骨髄炎との鑑別が困難。
	糖尿病性筋梗塞	外傷、感染、腫瘍がなく大腿部などに急激に増大する疼痛を伴う腫瘤を認める。生検は出血の危険があるため行わない。通常1～2カ月で自然寛解する
	糖尿病性筋萎縮症(diabetic amyotrophy)	糖尿病性末梢神経障害の一型。大腿前部の痛みで、時に脱力や萎縮が非対称性に起きる。CPKの上昇はなく、脳脊髄液で軽度蛋白上昇以外の有意な所見はない。神経伝導速度.筋電図では神経原性変化を認め、筋生検では炎症細胞浸潤を伴わない筋線経の萎縮あり。
直接の関係は不明だが糖尿病患者に頻度が高い疾患	癒着性関節包炎(凍結肩または五十肩)	糖尿病患者の10-33%にみられる。長期2型糖尿病を有する女性に多く、肩の痛みと可動域障害を呈する。約半数が両側性だが非利き手側で症状が強い。炎症反応やX線異常を認めず、数週～数カ月で自然寛解する。
	複合性局所疼痛症候群1型(complex regional pain syndrome CRPS)	四肢の疼痛、皮膚色変化、皮膚温の変化、浮腫、可動域制限などの症候を呈するまれな症候群。
	手掌屈筋鍵炎	糖尿病患者の5-33%に認められる。長期に罹患した女性に多く、利き手側の母指に頻度(75%)が高いが、どの指にもみられる。
	Dupuytren拘縮	手掌筋膜の短縮と肥厚(有痛性結節)を生じ、第4、5指の屈曲拘縮を呈する。1型糖尿病で長期に罹患した患者に多いが、血糖コントロールとの関係はない。
	手根管症候群	手根管症候群の全患者の最大15%に糖尿病を認める。
	広汎性特発性骨増殖症(diffuse idiopathic skeletal hyperostosis DISH)	2型糖尿病患者の約20%にみられ、50才以上の肥満患者に多い。頭部、腰部のこわばリ、関節の可動域制限を呈する。全身の腱付着部痛を呈することもある。
その他	感染性関節炎や骨髄炎	血糖上昇による免疫力低下が感染症リスクを上昇させることによる

診断

血糖値検査による分類

　　　　　　　　　　　　　正常　　　　　　　　　　　糖尿病型
　空腹時血糖値 　　　　　＜110mg/dL　　　　　　　　　≧126mg/dL
                         and                        or
　75g OGTT2時間値　　　＜140mg/dL　　　　　　　　　≧200mg/dL

• 正常型、境界型、糖尿病型に分類する

正常型であっても、食後1時間値が180mg/dL(10.0mmol/l)以上の場合には、180mg/dl未満のものに比べて糖尿病に進展する可能性が高いので、境界型に準じた取り扱い(経過観察)を行う(参考1)。

診断基準

参考2-4

• 1) 初回検査で、①空腹時血糖値≧126mg/dl、②75gOGTT2時間値≧200mg/dl、③随時血糖値≧200mg/dl、④HbA1c(国際標準値)≧ 6.5%のうちいずれかを認めた場合は、「糖尿病型」と判定する。別の日に再検査を行い、再び「糖尿病型」が確認されれば糖尿病と診断する。但し、HbA1cのみの反復検査による診断は不可とする。また、血糖値とHbA1cが同一採血で糖尿病型を示すこと(①～③のいずれかと④)が確認されれば、初回検査だけでも糖尿病と診断してよい。
• 2)血糖値が糖尿病型(①～③のいずれか)を示し、かつ次のいずれかの条件がみたされた場合は、初回検査だけでも糖尿病と診断できる。

• 糖尿病の典型的症状(口渇、多飲、多尿、体重減少)の存在
• 確実な糖尿病網膜症の存在

• 3)過去において、上記1)ないしは2)の条件がみたされていたことが確認できる場合には、現在の検査値が上記の条件に合致しなくても、糖尿病と診断するか、糖尿病の疑いを持って対応する必要がある。
• 4)上記1)～ 3)によっても糖尿病の判定が困難な場合には、糖尿病の疑いをもって患者を追跡し、時期をおいて再検査する。
• 5)初回検査と再検査における判定方法の選択には、以下に留意する。

• 初回検査の判定にHbA1cを用いた場合、再検査ではそれ以外の判定方法を含めることが診断に必須である。検査においては、原則として血糖値とHbA1cの双方を測定するものとする。
• 初回検査の判定が随時血糖値≧200mg/dlで行われた場合、再検査は他の検査方法によることが望ましい。
• HbA1cが見かけ上低値になり得る疾患・状況の場合には、必ず血糖値による診断を行う。

[show details]

以前の記事

• 1. 以下のいずれかの検査を行い、基準値を超えていれば糖尿病型と判定

• (1)空腹時血糖値 　　：≧126mg/dl
• (2)75g OGTT2時間値：≧200mg/dl
• (3)随時血糖値 　　　：≧200mg/dl

• 2. 1.で2回続けて(別の日に行う。異なる検査項目が好ましい)糖尿病型と判定されるか、1.で1回糖尿病型と判定されかつ、以下の条件を満たすとき、「糖尿病」と診断する

• a. 糖尿病の典型的症状が存在すること
• b. HbA_1c≧6.5%
• c. 糖尿病性網膜症が存在すること
• d. 過去に糖尿病型を示した資料(検査データ)がある場合

予後

• 糖尿病の死因の一位は心筋梗塞(Q book p.259)。

USMLE

• Q book p.245 38(死因)

高血圧と糖尿病を合併する病態

• クッシング症候群：糖質コルチコイドによる糖新生亢進・インスリン拮抗作用と鉱質コルチコイド様作用による。
• 先端巨大症：成長ホルモンの抗インスリン作用と電解質代謝作用(Na,K,Cl濃度増加、細胞外液増加)
• 褐色細胞腫：交感神経緊張亢進によるα1,β1作用による血圧上昇、α2, β2作用による血糖上昇
• 原発性アルドステロン症：過量のアルドステロンによるナトリウム再吸収、カリウム排泄亢進により体液量貯留、低カリウムによるインスリン作用低下

参考

• 1. 糖尿病の分類

http://www.uemura-clinic.com/dmlecture/newcriteria.htm

• 2. 糖尿病の新診断基準2010

http://d.hatena.ne.jp/bonbokorin/20100608/p1

• 3. 糖尿病の新しい診断基準を7月に施行　日本糖尿病学会-糖尿病NET-資料室

http://www.dm-net.co.jp/calendar/2010/010167.php

• 4. 委員会報告 糖尿病の分類と診断基準に関する委員会報告 2010

http://www.jds.or.jp/jds_or_jp0/uploads/photos/635.pdf

「病理学」

　　[★]

英

pathology

関

• 画像はまだありません

循環障害

• 浮腫 edema
• 鬱血 congestion
• 出血 hemorrhage
• 止血 hemostasis
• 血栓症 thrombus
• 塞栓症 embolism
• 梗塞 infarction
• ショック shock

代謝障害

• 蛋白質および核酸代謝障害

• アミロイドーシス amyloidosis
• 痛風 gout

• 脂質代謝障害

• 脂肪肝 fatty liver
• 非アルコール性脂肪肝炎 non-alcoholic steatohepatitis
• 粥状硬化症 atherosclerosis
• 脂質症 lipidosis

• 糖代謝障害

• 糖尿病 diabetes mellitus
• 糖原病 glycogen storage disease

• 無機質代謝障害

• カルシウム代謝障害

• 病的石灰化 pathologic calcification

• 結石 calculi

• 胆石症 cholelithiasis
• 尿路結石症 urolithiasis

• 色素代謝障害

• メラニン melanin
• リポフスチン lipofuscin
• ヘモジデリン hemosiderine

• ヘモクロマトーシス hemochromatosis

• ビリルビン bilirubin

• 黄疸

参考

• 東大病理学教室　病理標本が多い
• http://pathol.umin.ac.jp/gakubu.shtml

「DM」

　　[★]

• 糖尿病 diabetes mellitus
• 二重微小染色体 double minute chromosome double minute=微小染色体 minute chromosome
• 皮膚筋炎 dermatomyositis
• 筋強直性ジストロフィー 筋緊張性ジストロフィ myotonic dystrophy MD dystrophia myotonica DM
• デジタルマンモグラフィ digital mammography

　

「diabetic」

　　[★]

• adj.

• 糖尿病性の、糖尿病の

• n.

• 糖尿病患者

関

diabetes、diabetes mellitus、diabetic patient、diabetic subject、DM

　 　 　 　

「真性糖尿病」

　　[★]

英

diabetes mellitus

関

糖尿病

「slowly progressive insulin-dependent diabetes mellitus」

　　[★] 緩徐進行性インスリン依存糖尿病、SPIDDM

「pregestational diabetes mellitus」

　　[★]

同

preGDM

同

preGDM

「diabetes」

　　[★]

関

糖尿病 diabetes mellitus DM