Diagnosis and Classification of

Diabetes Mellitus

Boby Veland Ardiansyah

Contents
Definition and description of Diabetes Mellitus
Classification of Diabetes Milletus and other categories
of glucose regulation
Pathophysiology of Diabetes Mellitus
Diagnostic criteria for Diabetes Mellitus

Refferrences
American Diabetes Association. Position and statement, 2014
PERKENI. Konsensus pengelolaan dan pencegahan DM tipe 2 di
Indonesia, 2011

Definition and description of diabetes

mellitus
Diabetes mellitus is a group of metabolic diseases
characterized by hyperglycemia resulting from defects in
insulin secretion, insulin action, or both
The chronic hyperglycemia of diabetes is associated with
long-term damage, dysfunction, and failure of various
organs, especially the eyes, kidneys, nerves, heart, and
blood vessels

Classification of Diabetes Mellitus and

other categories of gucose regulations
I. Type 1 diabetes (-cell destruction, usually leading to
absolute insulin deficiency)
A. Immune mediated B. Idiopathic
II. Type 2 diabetes (may range from predominantly insulin
resistance with relative insulin deficiency to a predominantly
secretory defect with insulin resistance)
III. Other specific types
IV. Gestational diabetes mellitus (GDM)

I. Type 1 diabetes mellitus (1)

Immune-mediated diabetes
- only 510% of those with diabetes
- previously encompassed by the terms insulin-dependent
diabetes, type I diabetes, or juvenile-onset diabetes
- Autoimmune disease, markers: ICA, autoantibodies to
insulin, anti-GAD, autoantibodies to the tyrosine
phosphatases
- HLA-DR/DQ alleles

I. Type 1 diabetes mellitus (2)

- Some patients, particularly children and adolescents,
may present with ketoacidosis as the first manifestation
of the disease
- At this latter stage of the disease, there is little or no
insulin secretion, as manifested by low or undetectable
levels of plasma C-peptide
- These patients are also prone to other autoimmune
disorders such as Graves disease, Hashimotos
thyroiditis, Addisons disease, vitiligo, celiac sprue,
autoimmune hepatitis, myasthenia gravis, and pernicious
anemia

I. Type 1 diabetes mellitus (3)

Idiopathic diabetes
- Some of these patients have permanent insulinopenia and
are prone to ketoacidosis, but have no evidence of
autoimmunity
- Individuals with this form of diabetes suffer from episodic
ketoacidosis and exhibit varying degrees of insulin
deficiency between episodes
- This form of diabetes is strongly inherited, lacks
immunological evidence for -cell autoimmunity, and is
not HLA associated

II. Type 2 diabetes mellitus (1)

Accounts for 9095% of those with diabetes
Previously referred to as non-insulin-dependent diabetes, type
II diabetes, or adult-onset diabetes
Ranging from predominantly insulin resistance with relative
insulin deficiency to predominantly an insulin secretory defect
with insulin resistance
Although the specific etiologies are not known, autoimmune
destruction of -cells does not occur
Most patients with this form of diabetes are obese, and obesity
itself causes some degree of insulin resistance
Ketoacidosis seldom occurs spontaneously in this type of
diabetes; when seen, it usually arises in association with the
stress of another illness such as infection

II. Type 2 diabetes mellitus (2)

This form of diabetes frequently goes undiagnosed for
many years because the hyperglycemia develops gradually
and at earlier stages is often not severe enough for the
patient to notice any of the classic symptoms of diabetes
Whereas patients with this form of diabetes may have
insulin levels that appear normal or elevated, the higher
blood glucose levels in these diabetic patients would be
expected to result in even higher insulin values had their cell function been normal
Insulin resistance may improve with weight reduction and/or
pharmacological treatment of hyperglycemia but is seldom
restored to normal

III. Other specific types of diabetes

A.
B.
C.
D.
E.
F.
G.
H.

Genetic defects of the -cell

Genetic defects in insulin action
Disease of the exocrine pankreas
Endocrinopathies
Drugs or chemical induced
Infections
Uncommon forms of immune-mediated diabetes
Other genetic syndromes sometimes associated
with diabetes

IV. Gestational diabetes mellitus (GDM)

GDM is defined as any degree of glucose intolerance
with onset or first recognition during pregnancy
The definition applies regardless of whether insulin or
only diet modification is used for treatment or whether
the condition persists after pregnancy
It does not exclude the possibility that unrecognized
glucose intolerance may have antedated or begun
concomitantly with the pregnancy
Deterioration of glucose tolerance occurs normally
during pregnancy, particularly in the 3rd trimester

Pathophysiology
of DM

Insufficient insulin
Reduced tissue uptake of glucose

Intracellular
hypoglycaemia
Glucogenesis and
gluconeogenesis
Breakdown of fats
High levels of
ketones
Diabetic
ketoacidosis

Extracellular
hyperglycaemia
Decreased
protein
synthesis
- cachexia
- lethargy
- polyphagia

Decreased
gamma
globulins
- susceptibility
to infections
- impaired
wound healing

Hyperosmotic
plasma
Dehydration of
cells
Hyperglycaemic
coma

Blood glucose >

renal treshold
Glucosuria
Osmotic
diuresis
-polyuria
-polydipsia
-hyponatraemia
-hipokalemia

Disorders of glycemia : etiologic types

and stages

ADA.. Diabetes Care 2014;

Criteria for the diagnosis of diabetes

mellitus

Prediabetes

Screening for and diagnosis of GDM

Criteria for diagnosis of DM

(PERKENI 2011)

Criteria for diagnosis of DM

(PERKENI 2011)

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