Slides current until 2008

Diagnosis, classification and

prevention of diabetes
Diagnosis and types
Slide 2 of 48
Slides current until 2008
Definition of diabetes
Characterized by hyperglycaemia
Defects in insulin production
Autoimmune or other
destruction of beta cells
Insulin insensitiity
Impaired action of insulin on
target tissues
Diagnosis and types
Slide ! of 48
Slides current until 2008
Definition of diabetes
Chronic hyperglycaemia associated
"ith long#term damage to$
%yes
&idneys
'eres
(eart and blood essels
Diagnosis and types
Slide 4 of 48
Slides current until 2008
The diabetes epidemic
2!0 million affected in 200)
!*0 million "ithin 20 years
+ost rapid in Indian and Asian
subcontinents
ID, Diabetes Atlas
Diagnosis and types
Slide * of 48
World Statistics:
Diagnosis and types
Slide ) of 48
Normal Pancreatic Islet:
cells
cells (Insulin)

cells
cells (Glucagon)

cells
cells (Somatostatin)
pp Cells
pp Cells (pan prot)

Diagnosis and types

Slide - of 48
Insulin # Anabolic Steroid
.ransmembrane transport of glucose
/ier0 muscle 1 fat blood glucose
/ier 1 s2eletal muscle # glycogen
Conerts glucose to triglycerides
'ucleic acid 1 3rotein synthesis

Diabetes
Diabetes

Increased catabolism.
Increased catabolism.
(yperglycemia0 protein synthesis0 /ipolysis0
"asting0 "eight loss4
Diagnosis and types
Slide 8 of 48
5lood 6lucose 1 (ormones
Hormone
Insulin
6lucortocoids
6lucagon
6ro"th (ormone
%pinephrine
ction
!lucose
!lucose
!lucose
!lucose
!lucose
Diagnosis and types
Slide 7 of 48
Cellular 6lucose 8pta2e
Insulin "e#uiring
Striated $uscle
%ardiac $uscle
&ibroblasts
&T
Non'Insulin "e#uiring
5lood 9essels
'eres
&idney
%ye /ens
Diagnosis and types
Slide :0 of 48
Patholog( in Diabetes:
)o* glucose inside cell
; decreased cell metabolism <muscle0
lier=
High glucose outside
;6lycosylation damage <59=
;3olyol products ; osmotic damage>
Diagnosis and types
Slide :: of 48
Slides current until 2008
%lassification
.ype : diabetes
;autoimmune
;/ADA
;idiopathic
.ype 2 diabetes

Diagnosis and types
Slide :2 of 48
Slides current until 2008
?ther specific types
+?D@
Defects in insulin action
Diseases of the pancreas
%ndocrine disorders
Drug# or chemical#induced
Infections
%lassification
Diagnosis and types
Slide :! of 48
Slides current until 2008
8ncommon forms of immune#
mediated diabetes
?ther genetic syndromes
6estational diabetes
%lassification
Diagnosis and types
Slide :4 of 48
Slides current until 2008
Insulin
6luconeogenesis
6lycogenolysis
6lycogen synthesis
6lucose upta2e
6lycogen
synthesis
5lood glucose
Insulin and glucose disposal
,ree fatty acid release
Diagnosis and types
Slide :* of 48
T(pe + Diabetes
5eta cell destruction
Absolute insulin deficiency
8sually immune#mediated
Circulating mar2ers of immune destruction
<ICA0 IAA0 6AD antibodies=
Aarely obese at onset
Associated "ith other autoimmune diseases
<6raeBs0 (ashimotoBs0 AddisonBs0 3A0 itiligo=
Diagnosis and types
Slide :) of 48
Pathogenesis of T(pe I D$
Genetic
Genetic
HLA-DR3/4
HLA-DR3/4
Environment
Environment
Viral infe..?
Viral infe..?
Insulin deficienc
Insulin deficienc
!"e I / IDD#
!"e I / IDD#
Autoimmune Insulitis
Autoimmune Insulitis
A$ to % cells/insulin
A$ to % cells/insulin
cell
cell
Destruction
Destruction
3S 6lomerulonephritis
6raes0 (ashimoto thyroiditis4
Aheumatic heart disease
S/%0 Collagen ascular disease
Aheumatoid arthritis4
Diagnosis and types
Slide :- of 48
Progression of T(pe I
Diagnosis and types
Slide :8 of 48
Slides current until 2008
6lucose upta2e
6lycogenolysis
6luconeogenesis <amino acids=
&etone production <fatty acids=
6lucose upta2e
3rotein degradation amino acids
5lood glucose
Insulin deficienc( in
t(pe + diabetes
.riglyceride degradation fatty acids
Diagnosis and types
Slide :7 of 48
Slides current until 2008
Pathogenesis of t(pe + diabetes
Immunological actiation
3rogressie beta#cell destruction
Insufficient beta#cell function
Dependent on eCogenous insulin
Ais2 of 2etoacidosis
Diagnosis and types
Slide 20 of 48
Slides current until 2008
Pathogenesis of t(pe + diabetes
6enetic susceptibility
Immune factors
; other autoimmune disease
; antigen#specific antibodies
%nironmental trigger
; iruses
; boine serum albumin
; nitrosamines$ cured meats
; chemicals$ acor <rat poison=0
streptozotin
Diagnosis and types
Slide 2: of 48
Slides current until 2008
5eta#cell
mass
Pathogenesis of t(pe + diabetes
.ime <months # years=
.rigger
6enetic
3re#diabetes
D(oneymoonB
%hronic
phase
%linical
diabetes
Immunological
abnormalities
Diagnosis and types
Slide 22 of 48
Slides current until 2008
Idiopathic t(pe + diabetes
'on#autoimmune type : diabetes
'o autoimmune mar2ers
3ermanent insulinopenia
&etoacidosis
3eople of African and Asian origin
Diagnosis and types
Slide 2! of 48
Slides current until 2008
,pidemiolog( of t(pe + diabetes
Increasing in recent years
6eographic ariation
Aelatie affluence
/ac2 of treatment
ID, Diabetes Atlas
Diagnosis and types
Slide 24 of 48
Slides current until 2008
Age of onset pea2s
;preschool
;puberty
AutumnE"inter pea2s
,pidemiolog( of t(pe + diabetes
Diagnosis and types
Slide 2* of 48
T(pe - Diabetes
+ost hae insulin resistance
Insulin secretory defect
Aelatie insulin deficiency
'o immune mar2ers
+ost are obese at onset
&etosis may occur "ith stress
3rogressie
3art of Fdysmetabolic syndromeG
Accounts for 70#7*H of ne" cases
Diagnosis and types
Slide 2) of 48
T(pe - diabetes
Characterized by chronic hyperglycemia
Associated "ith microascular and macroascular
complications
6enerally arises from a combination
of insulin resistance and
#cell dysfunction
Definition0 Diagnosis and Classification of Diabetes +ellitus and its Complications4 Department of 'oncommunicable Disease Sureillance0
Iorld (ealth ?rganization0 6enea :7774 Aailable at$ http$EE"""4diabetes4org4u2EinfocentreEcarerecEdiagnosi4doc
Diagnosis and types
Slide 2- of 48
IDD#
IDD#
Genetic /
Genetic /
% cell defect
% cell defect
Pathogenesis of T(pe II D$
&$esit /
&$esit /
Life stle ?
Life stle ?
% cell
% cell
e'(austion
e'(austion
!"e II )IDD#
!"e II )IDD#
A$nor. *ecretion
A$nor. *ecretion
Insulin Resistance
Insulin Resistance
Relative
Relative
Insulin Def.
Insulin Def.
Diagnosis and types
Slide 28 of 48
Slides current until 2008
6lucose upta2e
6lycolysis
6luconeogenesis <amino acids=
6lucose upta2e
3rotein degradation amino acids
5lood glucose
Insulin insensitivit( in

t
t(pe - diabetes
Diagnosis and types
Slide 27 of 48
Slides current until 2008
5lood glucose
6lucose upta2e
Insensitivit( to insulin in
t
t(pe - diabetes
6lucose upta2e
6lycolysis
6luconeogenesis <amino acids=
6lucose upta2e
3rotein degradation amino acids
Diagnosis and types
Slide !0 of 48
Slides current until 2008
5lood glucose
Conerted to triglycerides
,ffect of insulin resistance in

t
t(pe - diabetes
6lucose upta2e
6lycolysis
6luconeogenesis <amino acids=
6lucose upta2e
3rotein degradation amino acids
6lucose upta2e

Major defect in individuals with type 2

diabetes
1

Reduced biological response to insulin

13

Strong predictor of type 2 diabetes

4

Closely associated with obesity

Ihat is insulin resistanceJ

I"
:
American Diabetes Association4 Diabetes Care :778K 2:$!:0;!:44
2
5ec2#'ielsen ( 1 6roop /C4 J Clin Invest :774K 74$:-:4;:-2:4
!
5loomgarden L.4 Clin Ther :778K 20$2:);2!:4
4
(affner S+0 et al. Circulation 2000K :0:$7-*;7804
*
5oden 64 Diabetes :77-K 4)$!;:04
What is -cell dysfunction?

Major defect in individuals with type 2

diabetes

Reduced ability of !cells to secrete insulin

in response to hyperglyce"ia

De,ronzo AA0 et al. Diabetes Care :772K :*$!:8;

!*44
Insulin resistance and -cell dysfunction
are core defects of type 2 diabetes
Insulin
resistance
!enetic
susceptibilit(,
obesit(, Western
lifest(le
T(pe - diabetes
I"
'cell
d(sfunction

Ahodes CM 1 Ihite +,4 Eur J Clin Invest 2002K !2 <Suppl4 !=$!;:!4

#nsulin resistance reduced response to
circulating insulin
Insulin
resistance
!lucose output !lucose upta.e !lucose upta.e
H(pergl(cemia
)iver $uscle
dipose
tissue
I"
$hy does the !cell fail%
%hronic
h(pergl(cemia
/versecretion of
insulin to
compensate for
insulin resistance
+,-
High
circulating
free fatt( acids
!lucoto0icit(
-
Pancre
as
)ipoto0icit(
1
'cell
d(sfunction
:
5oden 6 1 Shulman 6I4 Eur J Clin Invest 2002K !2$:4;2!4
2
&aiser '0 et al. J Pediatr Endocrinol Metab 200!K :)$*;224
!
,inegood D. 1 .opp 54 Diabetes Obes Metab 200:K ! <Suppl4 :=$S20;S2-4
Diagnosis and types
Slide !) of 48
Slides current until 2008
T(pe - diabetes
70H#7*H of people "ith
diabetes
Insulin insensitiity and
relatie insulin deficiency
?besity or oer"eight
Complications often present
at diagnosis
Diagnosis and types
Slide !- of 48
Slides current until 2008
Pathogenesis of t(pe - diabetes
+ultiple genes inoled
(yperinsulinaemia
3oor fetal nutrition beta#cell
formation
/o" birth "eightE"eight change
F.hrifty geneG
-H beta#cell loss
Diagnosis and types
Slide !8 of 48
Slides current until 2008
Age <years=
%ndogenous
insulin
Insulin
reNuirements
5eta#cell loss
The natural histor( of
t(pe - diabetes
Insulin
reNuirements
"ith age
3rimary
failure
Diagnosis and types
Slide !7 of 48
Slides current until 2008
Age <years=
%ndogenous
insulin
Insulin
reNuirements
5eta#cell loss
Insulin
insensitiity
(yper#
insulinaemia
The natural histor( of
t(pe - diabetes
Insulin
reNuirements
"ith age
Diagnosis and types
Slide 40 of 48
Slides current until 2008
Age <years=
%ndogenous
insulin
Insulin
reNuirements
Secondary
failure
The natural histor( of
t(pe - diabetes
%ffect of
oral drugs
Insulin
reNuirements
"ith age
5eta#cell loss
(yper#
insulinaemia
Insulin
insensitiity
Diagnosis and types
Slide 4: of 48
Slides current until 2008
,pidemiolog( of t(pe - diabetes
Dramatic increase
Aging population
Disturbing trends parallel obesity
epidemic
%specially in adolescents and
minority groups
Increasing in young people
Type-I Type-II

&ess co""on

Children ' 2 (ears

#nsulin! )ependent

)uration* $ee+s

,cute Metabolic
co"plications

,utoantibody* (es

-a"ily .istory* /o

#nsulin levels* very low

#slets* #nsulitis

01 in twins

More co""on

,dult 22 (ears

#nsulin #ndependent 3

Months to years

Chronic 4ascular
co"plications5

/o

(es

/or"al or high 3

/or"al 6 78haustion

90!:01 in twins
Insulitis Type I
Insulinitis Insulinitis
Islets in Type II Diabetes:
Loss of cells, replaced by Amyloid deposits (hyalinization) Loss of cells, replaced by Amyloid deposits (hyalinization)
Islets in Type II Diabetes:
Loss of cells, replaced by Amyloid deposits (hyalinization) Loss of cells, replaced by Amyloid deposits (hyalinization)
Diagnosis and types
Slide 4) of 48
Slides current until 2008
"is. factors for t(pe - diabetes
Age O 40 years
,irst#degree relatie "ith diabetes
+ember of high ris2 population
(istory of impaired glucose tolerance0
impaired fasting glucose
9ascular disease
(istory of gestational diabetes
(istory of deliery of macrosomic
baby
CDA 200!
Diagnosis and types
Slide 4- of 48
Slides current until 2008
(ypertension
Dyslipidaemia
Abdominal obesity
?er"eight
3olycystic oary disease
Acanthosis nigricans
Schizophrenia
"is. factors for t(pe - diabetes
Diagnosis and types
Slide 48 of 48
Slides current until 2008
3olydipsia
3olyuria
'octuria
9isual disturbance
,atigue
Ieight loss
Infections
Signs and s(mptoms
Diagnosis and types
Slide 47 of 48
Slides current until 2008
Diagnosing diabetes
'ormal Impaired fasting glucose>
Impaired glucose
tolerance>>
Diabetes
,36 P)4:mmolE/
P::0mgEd/
)4: to )47mmolE/>
::0 to :2)mgEd/
Q-40mmolE/
Q:2)mgEd/
2hr 36 P-48mmolE/
P:2)mgEd/
-48 to ::mmolE/>>
:2) to 200mgEd/
Q::4:mmolE/
Q200mgEd/
CDA 200!0 ADA 20040 I(? 2002
Diagnosis and types
Slide *0 of 48
Slides current until 2008
Impaired glucose tolerance
Impaired fasting glucose
Intermediate states
Increased ris2 of deeloping diabetes
3reention strategies to preent or
delay progression
Increased ris2 of cardioascular
disease
Diagnosis and types
Slide *: of 48
Slides current until 2008
2ncertain diagnosis:
/ral glucose tolerance test
-* g glucose load after 8 hours
fasting
Aeadings ta2en in fasting state
and at : and 2 hours
3ossible problems
Diagnosis and types
Slide *2 of 48
Slides current until 2008
8rinary 2etones
Antibodies
C#peptide
Tests for differential diagnosis
Diagnosis and types
Slide *! of 48
Slides current until 2008
$etabolic s(ndrome
Cluster of ris2 factors or syndrome
.ype 2 diabetes
Different criteria
.hree#fold increase in heart
disease and stro2e
."o#fold increase in cardioascular
disease deaths
Diagnosis and types
Slide *4 of 48
Slides current until 2008
Prevention of t(pe + diabetes
%arly eCposure to co"s mil2
protein
'icotinamide
Diagnosis and types
Slide ** of 48
Slides current until 2008
Prevention of t(pe + diabetes
Insulin
Diabetes 3reention .rial
Diabetes 3rediction and
3reention 3roRect
Diagnosis and types
Slide *) of 48
Slides current until 2008
Prevention of t(pe - diabetes
/ifestyle modification
Da Sing Study
,innish Diabetes 3reention Study

Diagnosis and types
Slide *- of 48
Slides current until 2008
Prevention of t(pe - diabetes
/ifestyle s medication
Diabetes 3reention 3rogram
S.?3#'IDD+
Complications:

Short ter" Co"plications* ;"etabolic<

.ypoglyce"ia

)iabetic =etoacidosis

/on =etotic hyperos"olar diabetic co"a

&actic acidosis

&ong ter" Co"plications*;,ngiopathy<

Microngiopathy ! Retinopathy>
/ephropathy> /europhathy> der"atopathy5

Macroangiopathy ,therosclerosis5
Microangiopathy athogenesis:

.yperglyce"ia chronic5

?lycosylation of base"ent "e"brane

proteins &ea+y blood vessels5

78cess deposition of proteins

glycosylation cycle5

@hic+ and &ea+y blood vessels5

/arrow lu"en

#sche"ic Argan da"age555

Diabetic Microangiopathy
'ormal
Diabetic

6lucose

6lycosylation

5+ damage lea2

DA6%B deposition
!europathy

Sensory Motor ;"yelin<

Beripheral /europathy

"ilateral# symmetric

rogressi$e# irre$ersible

araesthesia# pain# muscle

atrophy

4isceral neuropathy

Cranial ner$e diplopia# "ell palsy

%IT- constipation# diarrhoea

C&' orthostatic hypotension

!europathy
+yelin loss in nere
Chronic olyneuropathy
Cla" foot ; Dermopathy 1 'europathy
Diabetic (myotrophy
3ainful muscle "asting
Diabetic !europathic ulcer
!europathic ulcer
%tiology$

peripheral sensory
neuropathy0 .rauma
1 deformity4
,actors$

Ischemia0 callus
formation0 and
edema4
!europathic ulcers
FEATURES:
Painless, surrounded by callus
At pressure points.
associated with good foot pulses
May not be associated with gangrene
!ephropathy

/odular ?lo"erulo
Sclerosis5

Co""on "orbidity C
"ortality5

)eposition of D,?7E
,dvanced ?lycosylation
7nd!products as nodules5

/ephrotic syndro"e

Byelonephritis

7nd stage renal failure

)iabetic /ephropathy
Microangiopathy> atherosclerosis C infections*

)iffuse or nodular diabetic

glo"erulosclerosis ;=i""elstiel $ilson Sy<

Renal arteriolosclerosis C atherosclerosis

/ecrotiFing renal papillitis5

Byelonephritis5

7nd stage +idney5

!odular %lomerulosclerosis
)W lesion*
Diabetic %lomerulosclerosis
Hyaline nodules
Hyaline nodules
Diabetic %lomerulosclerosis
!ormal +etina
!on roliferati$e +etinopathy

4enous dilation and s"all red dots posterior retinal

pole ! capillary "icro!aneurys"s5

Dot and blot retinal he"orrhages and deep!lying

ede"a and lipid e8udates i"pair "acular function5

&ate generaliFed di"inution of vision due to

ischemia and macular edema ! co""on cause of
visual defect ;best detected by fluorescein
angiography<

Cotton-,ool spots ;soft e8udates< ! "icroinfarcts

due to ische"ia5 @hey are white and obscure
underlying vessels5 .ard e8udates are caused by
chronic ede"a5 @hey are yellow and generally deep
to retinal vessels5
roliferati$e +etinopathy

/eovasculariFation ! which grows into the vitreous

cavity5

#n advanced disease> neovascular "e"branes can

occur> resulting in a traction retinal detach"ent5

4itreous he"orrhages "ay result5

sudden severe loss of vision can occur when there is

intravitreal he"orrhage5

Boor visual prognosis if severe retinal ische"ia>

e8tensive neovasculariFation> or e8tensive fibrous
tissue for"ation5

Banretinal photocoagulation "ay di"inish or

eli"inate proliferative retinopathy
+etinopathy

/on Broliferative

Microaneurys"s>

)ot blot he"orrhages

.ard and soft e8udates

Cotton wool infarcts

Macular ede"a5

Broliferative5

/eovasculariFation

&arge he"orrhages

Retinal detach"ent5
Diabetic +etinopathy
eo!ascularization Cotton "ool
spots
Diabetic +etinopathy
Dot blot ; (emorrhages <+icroaneurysms=
Diabetic +etinopathy
3re retinal (emorrhage # detachment
Diabetic +etinopathy
Adanced fibrous plaNues
-The past cannot be changed# but the
future can** by actions in the present
time*. !!G=
ast is history#
ast is history#
/uture is mystery
/uture is mystery
resent is the gift01
resent is the gift01
2abel the diagram*
15
25
35
45
5
(ard dep4
?ptic disc
+acula
5lot hem
Cotton "ool
Macroangiopathy ,therosclerosis

)yslipide"ia

.)&

/on!7nFy"atic ?lycosylation

Blatelet ,dhesiveness

@hro"bo8ane ,
2

Brostacyclin

3ndothelial damage (therosclerosis

M#> C4,> ?angrene of &eg ;B4)<> Renal

#nsufficiency
(therosclerosis:
'lide 'ho,
Diabetic %angrene
/ungal infections: Candidiasis
Macrosomia
Iith 3olycythemia
"lood $essel calcification:
Amputated thumb
Cataract
(canthosis !igricans

Insulin resistanceT
(canthosis !igricans

Insulin resistanceT
2abel the diagram*
15
25
35
45
Capillary
'odule ; A6%
5o"man caps
(yaline
arteriolo
sclerosis in
arteriole4
Infections in Diabetes:

)ecreased "etabolis" low i""unity5

)ecreased function of ly"phocytes C

neutrophils glycosylation5

?lycosylation of i""une "ediators5 ,b

Capillary thic+ening i"paired infla""ation5

#sche"ia C infarctions5

#ncreased glucose ;alone is not the cause3<

)iabetes State of i""unosuppression5

2aboratory Diagnosis:

Hrine glucose ! dip!stic+ Screening

Rando" or fasting blood glucose ;'11<

-asting 2 I""ol> Rando" 211""ol

#f -asting level is between I!11 then A?@@

.b,1c ! for follow!up> not for diagnosis

-ructosa"ine ! for long ter" "aintenance5

oints to remember:

)isorder of "etabolis" #nsulin

@ype!# Children> ,cute> Metabolic co"pl5

@ype!## ,dults> Chronic> 4ascular co"pl5

,ngiopathy ;"icro6"acro<>

.eart> Grain> =idney> Retina> S+in> G45

#ncreased #nfections +now reasons5

.ypoglyce"ia is "ore dangerous5 /ot hyper

?lucose control is critical 3

-GS> ?@@ C .b,1C5

4uestions**

.ow =etoacidosis%

.ow hypoglyce"ia %

,ngiopathy Macro C Micro %

#nfections in

@ypes of retinopathy %

)iabetes insipidus %

/ephrotic 6 /ephritic syndro"e %

=idney da"age in )iabetes %

-It5s not that I5m so smart#
it5s 6ust that I stay ,ith
problems longer.
!!,lbert 7instein
Diagnosis and types
Slide :02 of 48
%TI3IT4
Slides current until 2008
.ype 2 diabetes can be delayed in
people "ith I6.
/ifestyle modification is most
effectie
Ihat do you thin2 could be done at
community leel to preent or delay
diabetesJ
Diagnosis and types
Slide :0! of 48
Slides current until 2008
Summar(
.ype : diabetes
Aesults from progressie beta#
cell destruction
3eople "ith type : diabetes need
insulin therapy to lie
Diagnosis and types
Slide :04 of 48
Slides current until 2008
.ype 2 diabetes
?ften characterized by insulin
insensitiity and relatie rather
than absolute insulin deficiency
A progressie condition
+ost people "ith type 2 diabetes
"ill need insulin "ithin * to :0
years of diagnosis
Summar(
Diagnosis and types
Slide :0* of 48
Slides current until 2008
"evie* #uestion
:4 .he pathogenesis for type 2 diabetes
includes$
a4 Insulin deficiency and insulin
insensitiity
b4 Insensitiity to insulin and
autoimmune beta#cell destruction
c4 Autoimmune beta#cell destruction
and glucagon deficiency
d4 Insulin deficiency and glucagon
deficiency
Diagnosis and types
Slide :0) of 48
Slides current until 2008
"evie* #uestion
24 A person "ith type 2 diabetes0 recently
started on insulin0 as2s if there is a "ay
to measure if heEshe is still producing any
insulin4 .he correct response "ould be$
a4 Islet cell antibody tests
b4 C#peptide test
c4 (bA
:c
test
d4 Serum insulin test
Diagnosis and types
Slide :0- of 48
Slides current until 2008
"evie* #uestion
!4 .he Diabetes 3reention 3rogram <D33=$
a4 Included people "ith type :
diabetes
b4 Included only people "ith I6.
c4 .ested the alue of eCercise
d4 Included people "ith type 2
diabetes
Diagnosis and types
Slide :08 of 48
Slides current until 2008
"evie* #uestion
44 .ype : diabetes is usually caused by$
a4 InRury to the pancreas
b4 An autoimmune reaction
c4 Insulin insensitiity in the cells
d4 (ypersensitiity to insulin
Diagnosis and types
Slide :07 of 48
Slides current until 2008
ns*ers
:4 a
24 b
!4 b
44 b
Diagnosis and types
Slide ::0 of 48
Slides current until 2008
"eferences
:4 American Diabetes Association4 Diagnosis and classification of diabetes mellitus4 Diabetes Care
2004K 2-<suppl :=$ S*#S:04
24 Canadian Diabetes Association Clinical 3ractice 6uidelines %Cpert Committee4 Canadian
Diabetes Association 200! clinical practice guidelines for the preention and management of
diabetes in Canada4 Can M Diab 200!K 2-<suppl 2=4
!4 Chiasson M/0 Mosse A60 6omis A0 et al4 Acarbose for preention of type 2 diabetes mellitus$
.he S.?3#'IDD+ randomized trial4 /ancet 2002K !4)$ !7!#40!4
44 Delahanty /+ and (alford 5'4 .he role of Diet 5ehaiours in Achieing improed glycaemic
control in intensiely treated patients in the Diabetes Control and Complications .rial4 Diabetes
Care :77!K :)<::=$ :4*!#*84
*4 Diabetes Control and Complications .rial Aesearch 6roup4 %ffect of intensie diabetes
treatment on the deelopment and progression of long#term complications in adolescents "ith
insulin dependent diabetes mellitus$ Diabetes Control and Complications .rial4 .he Mournal of
3aediatrics :774K :2*<2=$ :--#884
)4 Diabetes Control and Complications .rialEepidemiology of diabetes interentions and
complications research group intensie diabetes therapy and carotid intima#media thic2ness in
type : diabetes mellitus4 'e" %ngl M +ed 200!K !48$ 2274#!0!4
-4 Diabetes Control and Complications .rial$ .he effect of intensie treatment of diabetes on the
deelopment and progression of long#term complications in insulin#dependent diabetes
mellitus4 ' %ngl M +ed :77!K !27$ 7--#8)4
Diagnosis and types
Slide ::: of 48
Slides current until 2008
"eferences
84 ,ord %S0 6iles I(0 Dietz I(4 3realence of the metabolic syndrome among 8S adults$ findings
from the third 'ational (ealth and 'utrition %Camination Surey4 MA+A 2002K 27-$ !*)#*74
74 Diabetes Atlas 200)4 5russels$ International Diabetes ,ederation0 200)4
:04 Isomaa 50 Almgren 30 .uomi .0 et al4 Cardioascular morbidity and mortality associated "ith the
metabolic syndrome4 Diabetes Care 200:K 24<4=$ )8!#74
::4 3an U0 /i 60 (u @0 et al4 %ffects of diet and eCercise in preenting 'IDD+ in people "ith impaired
glucose tolerance$ .he Da Sing I6. and Diabetes Study4 Diabetes Care :77-K 20<4=$ *!-#444
:24 Aeport of a I(? Consultation4 /aboratory Diagnosis and monitoring of Diabetes +ellitus4 Iorld
(ealth ?rganisation 20024 http$EE"hNlibdoc4"ho4intEhNE2002E724:*7048!4pdf cited April !00
200*4
:!4 .uomilehto M0 /indstrom M0 %ri2sson M60 et al4 3reention of type 2 diabetes mellitus by changes in
lifestyle among subRects "ith impaired glucose tolerance4 ' %ng M +ed 200:K !44$ :!4!#*04
:44 .he Diabetes 3reention 3rogram Aesearch 6roup4 .he diabetes preention 3rogram <D33=4
Diabetes Care 2002K 2!<:2=$ 2:)*#-:4
:*4 8& 3rospectie Diabetes Study 6roup4 Intensie blood#glucose control "ith sulpfonylureas or
insulin compared "ith conentional treatment and ris2 of complications in patients "ith type 2
diabetes4 /ancet :778K !*2$ 8!-#*!4
Diagnosis and types
Slide ::2 of 48
Slides current until 2008
"eferences
:)4 8& 3rospectie Diabetes Study 6roup4 .ight blood pressure control and ris2 of
macroascular and microascular complications in type 2 diabetes 8&3DS !84 5+M
:778K !:-$ -0!#:!4
:-4 ID, Clinical 6uidelines .as2 ,orce4 6lobal 6uideline for .ype 2 Diabetes4 5russels$
International Diabetes ,ederation0 200*4
:84 (arris S50 %2oe M+0 Ldano"icz @0 Iebster#5ogaert S4 6lycemic Control and
morbidity in the Canadian primary care setting <results of the diabetes in Canada
ealuation study=4 Diab Aesearch and Clin 3ract 200*K -0$ 70#-4