Concept of Diabetes Mellitus: Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long-term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder. Classification (Tables 1 and 2, and Figure 1): The classification of glucose metabolism disorders is principally derived from etiology, and includes staging of pathophysiology based on the degree of deficiency of insulin action. These disorders are classified into four groups: (i) type 1 diabetes mellitus; (ii) type 2 diabetes mellitus; (iii) diabetes mellitus due to other specific mechanisms or diseases; and (iv) gestational diabetes mellitus. Type 1 diabetes is characterized by destruction of pancreatic b-cells. Type 2 diabetes is characterized by combinations of decreased insulin secretion and decreased insulin sensitivity (insulin resistance). Glucose metabolism disorders in category (iii) are divided into two subgroups; subgroup A is diabetes in which a genetic abnormality has been identified, and subgroup B is diabetes associated with other pathologic disorders or clinical conditions. The staging of glucose metabolism includes normal, borderline and diabetic stages depending on the degree of hyperglycemia occurring as a result of the lack of insulin action or clinical condition. The diabetic stage is then subdivided into three substages: non-insulin-requiring, insulin-requiring for glycemic control, and insulin-dependent for survival. The two former conditions are called non-insulin-dependent diabetes and the latter is known as insulin-dependent diabetes. In each individual, these stages may vary according to the deterioration or the improvement of the metabolic state, either spontaneously or by treatment. Diagnosis (Tables 3-7 and Figure 2): Categories of the State of Glycemia: Confirmation of chronic hyperglycemia is essential for the diagnosis of diabetes mellitus. When plasma glucose levels are used to determine the categories of glycemia, patients are classified as having a diabetic type if they meet one of the following criteria: (i) fasting plasma glucose level of ‡126 mg/dL ( ‡7.0 mmol/L); (ii) 2-h value of ‡200 mg/dL ( ‡11.1 mmol/L) in 75 g oral glucose tolerance test (OGTT); or (iii) casual plasma glucose level of ‡200 mg/dL ( ‡11.1 mmol/L). Normal type is defined as fasting plasma glucose level of <110 mg/dL (<6.1 mmol/L) and 2-h value of <140 mg/dL (<7.8 mmol/L) in OGTT. Borderline type (neither diabetic nor normal type) is defined as falling between the diabetic and normal values. According to the current revision, in addition to the earlier listed plasma glucose values, hemoglobin A 1c (HbA 1c ) has been given a more p...
Very little information is available related to possible differences in immunological character istics of IDDM among Asian populations, though it has been reported that IDDM is associated with Bw54-DR4 and B17-DR3 in Japanese and Chinese, respectively. There is virtually no report related to comparative studies on Bf-DM association among Asian populations, while Bf-DM association is reported to be stronger than HLA-DM association in Caucasians. In the present paper, the results of our studies on anti-thyroid antibodies (ATA) of IDDM in Japanese, Chinese and Filipinos are presented. In Japanese, the incidence of ATA positive was higher in IDDM with a duration of less than one year (35.7%) than that in the patients with a duration of one year or more (12.5%). But, there was no such a duration depen dent decrease in the incidences of ATA among Chinese or Filipino IDDM. The frequency of BfSS in Filipinos is lower than in Japanese or Chinese. However, no association was found between Bf phenotypes and IDDM in Asian populations. These results indicate that autoimmunity is transient in Japanese IDDM, but persistent in Chinese and Filipinos, and that it is too early to postulate in general that Bf-IDDM association in general populations is stronger than HLA-IDDM association.IDDM, HLA, immunological characteristics.
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