Hyperglycemia Introduction

The current classification of diabetes in different subtypes is based on the defect(s) that causes hyperglycemia, namely, aberrant or deficient insulin secretion or insufficient insulin action (1). Type 1 diabetes (T1D) originates from autoimmune-mediated destruction of the pancreatic P-cells that normally produce insulin, thus resulting in absolute insulin deficiency. Other types of pancreatic disease involving destruction of the P-cells, such as alcoholic pancreatitis, are classified otherwise. Previously, T1D was also known as juvenile-onset diabetes or insulin-dependent diabetes mellitus (IDDM). However, these expressions may result in misclassification and indistinct prognosis and therapeutic options. Criteria to diagnose T1D are shown in Table 1 (1). Note that diagnostic criteria do not include HbA1c levels, which are exclusively used to follow glycemic control, but not diagnosis.

Table 1

Diagnostic criteria for diabetes mellitus (ADA)

Diabetes mellitus (overall)

Symptoms of polyuria, polydipsia, unexplained weight loss or

Random plasma glucose > 11.1 mmol/l (200 mg/dl) on 2 subsequent days or

Fasting (>8 h) plasma glucose > 7.0 mmol/l (126 mg/dl) on 2 subsequent days Type 1 diabetes mellitus

Autoantibody GAD positive and/or autoantibody tyrosine phosphatase IA-2/IA-2P

Presenting with ketoacidosis

Additional criteria for diabetes mellitus type 1 (used for research purposes) Fasting C-peptide <0.1 nmol/l 2 mg Glucagon IV-stimulated C-peptide < 0.3 nmol/l

Adapted from ADA Position Statement (23) and an interpretation of data from Service etal. (63).

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