Diabetes. Classification of diabetes

Diabetes mellitus (DM) is one of the most serious diseases, fraught with serious complications, disability and death of patients, characterized by disorders of all types of metabolism and vital functions of the body as a whole. The registered incidence varies in different countries from 1 to 3% (in Russia about 2%), and in individuals with obesity of varying degrees reaches 15-25%. Obesity and diabetes, on the one hand, and arterial hypertension and coronary heart disease, on the other, make up the so-called metabolic syndrome, the “deadly quartet”. According to WHO experts, diabetes increases the overall mortality of patients by 2-3 (!) Times. About 3 times more often they have revealed cardiovascular pathology and cases of stroke, 10 times – blindness, 20 times – gangrene of the extremities. DM is one of the causes of kidney damage leading to the death of patients. Diabetes reduces life expectancy by an average of 7% of its total average. Diabetes mellitus: • a disease that is characterized by a violation of all types of metabolism and • a disorder of the body; • develops as a result of hypoinsulinism (ie, absolute or relative insulin deficiency). Classification of diabetes mellitus The WHO Expert Committee on Diabetes Mellitus has developed a classification that is constantly updated and refined. It distinguishes primary and secondary forms of diabetes. Primary forms of diabetes Primary forms of diabetes are characterized by the absence in the patient of any specific diseases that lead to the development of diabetes for the second time. Two types of primary diabetes mellitus are distinguished: • insulin-dependent diabetes mellitus (IDDM); • non-insulin-dependent diabetes mellitus (NIDDM). The term “insulin-dependent diabetes mellitus” implies: • Absolute insulin deficiency. • The need for continuous use of insulin. • The real threat of ketoacidosis. Patients with insulin-dependent diabetes mellitus are prescribed a dose of insulin that is necessary to maintain an optimal level of GPC. Withdrawal or deficiency of insulin causes ketoacidosis in them. The term “insulin-dependent diabetes mellitus” refers to forms of diabetes due to insufficient effects of insulin with normal or even elevated levels of the hormone in the blood. • The function of the beta cells of the pancreas is partially or fully preserved. • Most patients do not need to take insulin. • Disorders of the body develop relatively slowly. • NIDDM accounts for at least 80% of all diabetes cases. Secondary forms of diabetes Secondary forms of diabetes are characterized by the presence in the patient of any underlying disease or pathological condition that damages the pancreas, as well as the effect of physical or chemical factors on it. This leads to diabetes. Such diseases, pathological conditions, and factors include: • Diseases affecting pancreatic tissue (eg, pancreatitis). • Other diseases of the endocrine system (for example, familial polyendocrine adenomatosis). • Exposure to the pancreas of chemical or physical agents. Type I and II diabetes mellitus In earlier classifications, type I and II diabetes mellitus was isolated. These designations were initially used as synonyms for IDDM and NIDDM, respectively. Modern experts believe this approach is not entirely correct. This is because, for example, patients with NIDDM can also become dependent on insulin. With its deficiency, they develop ketoacidosis, which is fraught with a coma (for example, this is observed in many patients without obesity who have AT in their blood for beta cells of islets of Langerhans). • The term “Type I diabetes mellitus” was used to refer to its variants, the main pathogenetic link of which was the immune (immunoaggressive) mechanism. Type I diabetes was observed in 10-15% of patients with diabetes. The term “Type II diabetes mellitus” was recommended to be used for that form of diabetes mellitus, the pathogenesis of which was not included ascausal (!) immune mechanism. Type II diabetes was diagnosed in more than 85% of patients with diabetes. Thus, diabetes mellitus develops as a result of either insulin deficiency (i.e., as a result of hypoinsulinism or absolute insulin deficiency), or insufficiency of the effects of insulin with its normal or even increased content in blood plasma.

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