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Diabetes mellitus is a large group of diseases characterized by an increase in the level of glucose in the blood, i.e., a violation of carbohydrate metabolism in the human body. The disease is polyetiological, that is, it can develop for various reasons. Pathology is chronic and tends to progress, causing the development of a large number of complications.
The problem of diabetes is currently very relevant: as of 2017, more than 420 million people worldwide suffer from this disease. The disease tends to progressively increase the number of cases, so every year the ranks of diabetic patients are constantly replenished. According to the forecasts of the World Health Organization (WHO), by 2030 every tenth person on the planet will suffer from diabetes. By the same year, diabetes is expected to be the 7th leading cause of death in patients.
Currently, the International Classification of Diseases of the Tenth Revision (ICD-X) provides for the division of diabetes into two types: the first (insulin-dependent) and the second (insulin-independent). Separately, they also distinguish diabetes mellitus (DM), associated with the course of pregnancy – gestational, and unspecified forms of the disease. This division is based on the pathogenetic principle: the forms of diabetes mellitus are divided into two groups depending on the characteristics of the pathogenesis (formation) of the disease. According to the statistics obtained by WHO experts, about 92% of diabetics suffer from type 7 diabetes. Type I diabetes accounts for about 1% of cases. Less than XNUMX% of patients have other forms of diabetes.
Despite the fact that diabetes is divided into insulin-dependent and non-insulin dependent, insulin is present in the complex therapy of both the first and second types of the disease. Thus, the existing classification is misleading and does not give those characteristics that affect the prescription of insulin. The issue of developing a correct classification of pathology has long been overdue. The world’s leading endocrinologists are busy searching for the optimal division of DM into types (subgroups, types), which would make it possible to establish the most accurate diagnosis for a patient and unify their treatment regimens.
New classification
Swedish endocrinologists do not agree with the current classification of DM. The basis for distrust was the results of studies conducted by scientists at Lund University. About 15 thousand patients with various forms of diabetes mellitus took part in large-scale studies. Statistical analysis has proven that the existing types of diabetes mellitus do not allow doctors to prescribe adequate treatment. One and the same type of DM can be provoked by various reasons, in addition, it can have a different clinical course, therefore, it requires an individual approach to therapy.
Swedish scientists have proposed their own classification of diabetes mellitus, which provides for the division of the disease into 5 subgroups:
- Mild diabetes associated with obesity;
- mild age-related diabetes;
- severe autoimmune diabetes;
- severe insulin deficiency diabetes mellitus;
- severe insulin resistant diabetes.
The Swedes believe that such a classification of diabetic pathology allows the patient to establish a more accurate diagnosis, on which the composition of the etiotropic and pathogenetic treatment and tactics of managing patients directly depend. The introduction of a new classification of diabetes mellitus, according to its developers, will make therapy relatively individual and effective.
Mild diabetes associated with obesity
The severity of this type of diabetes is directly related to the degree of obesity: the higher it is, the more malignant the pathological changes in the body. Obesity itself is a disease accompanied by metabolic disorders in the body. The main cause of obesity is overeating and eating foods high in simple carbohydrates and trans fats. A constant increase in blood glucose levels provokes an overproduction of insulin.
The main task of insulin in the body is the utilization of blood glucose: by increasing the permeability of cell walls for glucose, insulin accelerates its entry into cells. In addition, insulin promotes the conversion of glucose into glycogen, and with its excess – into adipose tissue. Thus, a “vicious circle” is closed: obesity leads to hyperglycemia, and prolonged hyperglycemia leads to obesity.
Over time, this situation leads to the development of insulin resistance in the peripheral tissues of the human body, as a result of which even a high level of insulin in the blood does not lead to the expected hypoglycemic effect. Since muscles are one of the main consumers of glucose in the body, physical inactivity, which is typical for obese people, exacerbates the pathological condition of patients.
The need to separate this type of DM into a separate group is due to the unity of the pathogenesis of diabetes and obesity. Given the similar mechanisms of development of these two pathologies, it is necessary to reconsider the approach to the treatment of diabetes that has developed against the background of obesity. Diabetes in people who are overweight is treated only symptomatically – with the help of oral hypoglycemic agents. Although, strict diet therapy, together with dosed and regular physical activity, will help to cope much faster and more effectively with both the problem of diabetes and obesity.
This is a “mild”, benign form of SD. With age, the human body undergoes physiological involutive changes. In older people, insulin resistance of peripheral tissues gradually increases with age. The consequence of this is an increase in fasting blood glucose levels and prolonged postprandial (after eating) hyperglycemia. At the same time, the concentration of endogenous insulin in the elderly, as a rule, tends to decrease.
The causes of increased insulin resistance in the elderly are physical inactivity, which leads to a decrease in muscle mass, abdominal obesity, and unbalanced nutrition. For economic reasons, most old people eat cheap, poor quality food that is high in combined fats and simple carbohydrates. Such food provokes hyperglycemia, hypercholesterolemia and triglyceridemia, which are the first manifestations of diabetes in the elderly.
The situation is exacerbated by comorbidities and the use of a large number of medications. The risk of developing diabetes in the elderly increases with long-term use of thiazide diuretics, steroid drugs, indiscriminate beta-blockers, psychotropic drugs.
A feature of age-related diabetes is an atypical clinic. In some cases, blood glucose levels may even be within the normal range. To “catch” the onset of diabetes in the elderly using laboratory methods, it is necessary to determine not the concentration of glucose in the blood and urine on an empty stomach, but the percentage of glycated hemoglobin and the amount of protein in the urine, which are quite sensitive indicators.
Severe autoimmune diabetes
Doctors often call autoimmune diabetes mellitus “one and a half type” diabetes, since its clinical course combines signs of both the first and second “classic” types. This is an intermediate pathology that is more common in adults. The reason for its development is the death of pancreatic cells that produce insulin, the so-called islet of Langerhans, due to an attack by its own immunocompetent agents (autoantibodies). In some cases, this is a genetically determined pathology, in others it is a consequence of severe viral infections, in others it is a malfunction of the immune system as a whole.
The need to separate autoimmune DM into a separate type is explained not only by the characteristics of the clinical course of the disease, but also by the complexity of diagnosis and treatment of pathology. The sluggish course of “one and a half type” diabetes is dangerous because it is detected when pathological changes in the pancreas and target organs are already becoming irreversible.
Severe insulin deficiency diabetes
According to the modern classification, insulin-deficient type of diabetes mellitus is called type XNUMX diabetes, or insulin-dependent. Most often it develops in childhood. The most common cause of the disease is a genetic pathology, which is characterized by underdevelopment or progressive fibrosis of the pancreatic islets that provoke insulin.
The disease is severe and always requires hormone replacement therapy in the form of regular injections of insulin. Oral antihyperglycemic drugs in type XNUMX diabetes have no effect. The expediency of separating insulin-deficient diabetes into a separate nosological unit lies in the fact that this is the most common form of the disease in young and childhood.
Severe insulin resistant diabetes
Pathogenetically, insulin resistant diabetes corresponds to type XNUMX diabetes according to the current classification. In this type of disease, insulin is produced in the human body, but the cells are insensitive to it (resistant). Under the influence of insulin, glucose from the blood must penetrate into the cells, but this does not happen with insulin resistance. As a result, there is constant hyperglycemia in the blood, and glucosuria in the urine.
In this type of diabetes, a balanced low-carbohydrate diet and exercise are effective. Oral hypoglycemic drugs are the mainstay of drug therapy for insulin resistant DM.
Given the etiological diversity, the pathogenetic difference between the listed types of diabetes mellitus and the differences in the scheme of their treatment, the conclusions of Swedish scientists sound convincing. The revision of the clinical classification will make it possible to modernize the tactics of managing patients with different types of diabetes, influencing its etiological factor and various stages in the development of the pathological process.