Clinical Classification Of Diabetes Mellitus And Other Categories Of Glucose Tolerance

Table 3.3 summarizes the etiological classification of diabetes mellitus. Etiological and clinical stages are presented in Figure 3.2.

The concepts for new staging/etiological classification were proposed by Kuzuya and Matsuda (20). Their proposals sought to separate clearly the criteria related to etiology and those related to degree of deficiency of insulin or insulin action and to define each patient on the basis of these two criteria.

The newly suggested WHO classification and the new ADA classification bring in both clinical stages of hyperglycemia as well as etiological types (Figure 3.2 and Table 3.3). The classification by etiological type results from new knowledge as to the causes of hyperglycemia including diabetes. The actual staging proposed reflects that any etiological type of diabetes can pass or progress through several clinical phases (both asymptomatic and symptomatic) during its natural history. Moreover individuals may move (in either direction), from stage to stage (Figure 3.2).

Table 3.4. Glucose levels for diagnosis of glucose tolerance abnormalities

Category

FPG mmol/1

PG 1 h after 75 g glucose load mmol/l

PG 2 h after 75 g glucose load mmol/l

Impaired fasting glucose (IFG) Impaired glucose tolerance (IGT) Diabetes mellitus (DM)

Gestational diabetes * (GM)

FPG = Fasting plasma glucose PG = Plasma glucose N/A = not applicable.

*A diagnosis of gestational diabetes mellitus requires two abnormal values among the three measurements according to the American Diabetes Association and the Canadian Diabetes Association.

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