Diabetes

Classification. Classification of diabetes is based on the pathogenic processes that can lead to either absolute or relative lack of insulin, resulting in hyperglycemia (high blood glucose).2 Insulin is a hormone produced by pancreatic islet beta cells, which is needed for the uptake of blood glucose by cells to produce energy. When there is a lack or absence of insulin, or when cells are insensitive to its actions, a high circulating level of blood glucose results (i.e., hyperglycemia).2 Although there are various causes for less common types of diabetes, including drug- or chemical-induced diabetes, exocrine pancreatic disease, or infections (e.g., cytomegalovirus), the two most common subtypes of diabetes are known as type 1 or type 2 diabetes.2

Type 1 diabetes, formerly known as juvenile diabetes, is a chronic autoimmune disease in which the beta cells in the pancreas create little to no insulin2, 3 and accounts for 5% to 10% of all diabetes cases.2 Autoimmune destruction of beta cells is the most common cause, although any loss of pancreatic tissue (e.g., pancreatitis, surgical removal of the pancreas) can lead to insulin dependence.2 Type 1 diabetes is generally diagnosed in younger individuals (usually younger than 25 years of age) and has a strong genetic predisposition.2 Exogenous insulin is needed to regulate blood glucose levels in people with type 1 diabetes.2

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In contrast, type 2 diabetes accounts for 85% to 90% or more of diabetes cases and is one of the most common chronic diseases, as well as one of the leading causes of death and disability in the U.S.4 Type 2 diabetes is characterized by decreased response of target tissues to normal levels of insulin, requiring increasing levels of insulin for an adequate response, and a relative hyperinsulinemia and insulin resistance.2 Type 2 diabetes is associated with excess weight, physical inactivity, family history of diabetes, and certain ethnicities.5, 6 Although some people with type 2 diabetes can help improve their glycemic control with diet, exercise, and weight loss, patients may require insulin sensitizers that help peripheral tissues take up glucose (i.e., biguanides [metformin] or thiazolidinediones) or oral hypoglycemic agents that stimulate release of insulin (i.e., insulin secretagogues such as sulfonylureas).2

Another type of diabetes is gestational diabetes, a state of glucose intolerance that occurs in pregnant women who do not otherwise have diabetes.2 Occurring in the second half of a pregnancy, gestational diabetes is caused by placental hormones and results in insulin resistance and relative insulin deficiency.2 Although true gestational diabetes resolves during the postpartum period, those who have had gestational diabetes are at increased risk of developing type 2 diabetes later in life.2

The term “prediabetes” is used when blood glucose levels are higher than normal, but not high enough for a formal diagnosis of diabetes.5 Prediabetes means a person is at increased risk for developing type 2 diabetes, as well as at increased risk for heart disease and stroke.5 Although lifestyle modification involving weight loss and engaging in moderate physical activity can help people with prediabetes delay or prevent the onset of type 2 diabetes,5 it is estimated that as many as 90% of those with prediabetes are unaware that they have prediabetes.7 Assessment of risk for prediabetes can be conducted using printed or online versions of a seven-item questionnaire available through the American Diabetes Association, Centers for Disease Control and Prevention, and American Medical Association (links available in the “Other Resources” section).

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Symptoms/Diagnosis. Initial symptoms of diabetes include increased thirst and urination. Other symptoms can include unexplained weight loss, fatigue, blurred vision, increased hunger, and sores that do not heal.

Blood tests are generally used in the diagnosis of diabetes and prediabetes.5 Tests used include measurement of hemoglobin A1c (HbA1c), which is a measure of glycosylation of the hemoglobin molecule, fasting blood glucose measurement, and/or an oral glucose tolerance test.8 The American Diabetes Association provides recommendations for classification and diagnosis of diabetes.

Complications. Over time, individuals with diabetes sustain progressive damage to nerves and blood vessels due to elevated levels of circulating glucose, which can increase the incidence and severity of complications such as heart disease, stroke, kidney disease, retinopathy, neuropathy, dental disease and amputations.9, 10 Additionally, diabetes may increase susceptibility to other diseases, impair mobility, contribute to depression, and cause problems during pregnancy.11

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