Diabetes mellitus

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Introduction

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia due to defects in insulin secretion, insulin action, or both. This condition leads to long-term damage and dysfunction of various organs, including the eyes, kidneys, nerves, heart, and blood vessels.

Key Insights

Pathogenesis and Classification:
- Diabetes mellitus involves multiple pathogenic processes, ranging from autoimmune destruction of pancreatic β-cells (Type 1 diabetes) to insulin resistance and inadequate insulin secretion (Type 2 diabetes) .
- Type 1 diabetes is characterized by an absolute deficiency of insulin secretion, often identified by autoimmune markers .
- Type 2 diabetes involves a combination of insulin resistance and inadequate compensatory insulin secretion, often asymptomatic for long periods .
Diagnosis:
- Diabetes is diagnosed based on blood glucose levels: fasting plasma glucose ≥ 126 mg/dL, random plasma glucose ≥ 200 mg/dL with symptoms, or a 2-hour plasma glucose ≥ 200 mg/dL after an oral glucose challenge .
- New diagnostic categories include Impaired Fasting Glycaemia (IFG) and Impaired Glucose Tolerance (IGT) to identify individuals at risk.
Complications:
- Long-term complications include retinopathy, nephropathy, neuropathy, cardiovascular diseases, and increased risk of infections .
- Oxidative stress and abnormalities in peroxide and transition metal metabolism are linked to the development and complications of diabetes.
Management:
- Management strategies include lifestyle modifications (weight reduction, exercise), oral glucose-lowering agents, and insulin therapy depending on the severity and type of diabetes .
- Intensive glycemic control can reduce the incidence of microvascular and macrovascular complications, although many patients still develop these issues.

Conclusion

Diabetes mellitus is a complex metabolic disorder with significant long-term health implications. It is primarily classified into Type 1 and Type 2 diabetes, each with distinct pathophysiological mechanisms. Effective management and early diagnosis are crucial in mitigating the severe complications associated with this disease. Despite advancements in treatment, ongoing research is essential to improve patient outcomes and quality of life.