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Diagnosis and Classification of Diabetes Mellitus: New Criteria:American Academy of Family Physicions:"New recommendations for the classification and diagnosis of diabetes mellitus include the preferred use of the terms "type 1" and "type 2" instead of "IDDM" and "NIDDM" to designate the two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These changes provide an easier and more reliable means of diagnosing persons at risk of complications from hyperglycemia. Currently, only one half of the people who have diabetes mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors, and should begin earlier and be repeated more often in those with risk factors. Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of blood glucose levels and a reduction in the severity of complications associated with this disease"
http://www.aafp.org/afp/981015ap/mayfield.html

ADA and WHO Announce New Classification and Diagnostic Criteria for Diabetes :diabetesmonitor.com:"TYPE 1 Characterized by beta cell destruction, usually leading to absolute insulin deficiency. It has two forms: Immune-Mediated Diabetes Mellitus: Results from a cellular mediated autoimmune destruction of the beta cells of the pancreas. Idiopathic Diabetes Mellitus: Refers to forms of the disease that have no known etiologies. TYPE 2 Diseases of insulin resistance that usually have relative (rather than absolute) insulin deficiency. Can range from predominant insulin resistance with relative insulin deficiency to predominant insulin deficiency with some insulin resistance. Impaired Glucose Homeostasis A metabolic stage intermediate between normal glucose homeostasis and diabetes. A risk factor for diabetes and cardiovascular disease."
http://www.diabetesmonitor.com/dx-class.htm

New Criteria for Classification of Diabetes:woundcare.org:"Eliminate the terms "insulin-dependent diabetes mellitus" and "non-insulin-dependent diabetes mellitus" in favor of"type I " and "type 2" but use Arabic rather than roman numerals to avoid confusion. Type l diabetes is characterized by beta cell destruction, usually leading to absolute insulin deficiency. Type 2 diabetes is defined as a term for individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency. A new stage of impaired glucose homeostasis called "impaired fasting glucose" (IFG) has been defined as a fasting plasma glucose of greater than110 mg/dl but less than126 mg/dl. The stage called "impaired glucose tolerance" (IGT) is retained, defined as an oral glucose tolerance test value of greater than140mg/dl but less than 200 mg/dl. No change is recommended to the current diagnostic criteria for gestational diabetes; however, selective screening, rather than universal screening, for glucose intolerance in pregnancy is now recommended"
http://www.woundcare.org/newsvol2n4/ar3.htm

Classification of diabetes:cssvc.health.webmd.compuserve.com:"Type 1 diabetes. About 5% to 10% of the people with diabetes have type 1 diabetes.1 Two forms of type 1 diabetes have been identified:2 Immune-mediated. This form develops as a result of an autoimmune response. An autoimmune response is an abnormal condition in which the body does not recognize some of its own cells and destroys them. In this case, the cells that produce insulin (beta cells within the islet tissue of the pancreas) are destroyed by the autoimmune response. Most people with type 1 have this form of the disease. Idiopathic. This form of type 1 has no known cause and there is no evidence of an autoimmune response. Type 2 diabetes. About 90% to 95% of all people with diabetes have this type."
http://cssvc.health.webmd.compuserve.com/encyclopedia/article/1667.53872

Classification of diabetes Two common types of diabetes are:Health A-Z:"Another type of diabetes can develop during pregnancy (gestational diabetes). Gestational diabetes is present in about 4% of all pregnancies in the United States.2 Other specific types of diabetes include:2 Genetic defects of certain cells (beta cells) within the islet tissue of the pancreas. Genetic defects in insulin action. Diseases or conditions of the part of the pancreas that produces substances (enzymes) that help in digestion, such as pancreatitis, cystic fibrosis, and injury or removal of the pancreas. Conditions that affect the body system that produces hormones (endocrine system), such as Cushing's syndrome, hyperthyroidism, and polycystic ovary syndrome. Side effects of medications or chemicals. Infections, such as measles in a fetus or newborn (congenital rubella) and cytomegalovirus. Uncommon forms of diabetes caused by immune system problems (immune-mediated diabetes)."
http://webmd.lycos.com/encyclopedia/article/1667.53872

The World Health Organisation (1994) recognises five categories of diabetes and in addition lists a sixth condition.:University of Sunderland:"The other forms of diabetes account for 5% of all diabetic patients. These are: 1. Malnutrition related diabetes mellitus(MRDM) 2. Diabetes associated with other conditions and syndromes: Pancreatic disease Disease of hormonal aetiology Drug-induced or chemical-induced diabetes Abnormalities of insulin or its receptors Certain genetic syndromes Miscellaneous 3. Gestational diabetes 4. Impaired Glucose Tolerance(IGT)"
http://members.aol.com/m4ynk/classification.html

What Is Diabetes? - Classification:South Sefton Diabetes Group:"This table gives a detailed list of all the various types/causes of diabetes mellitus. For more information on Type 1, Type 2 and Gestational diabetes, see Types of Diabetes. For more information on some of the other types of diabetes, see Less Common Types of Diabetes. More information on the classification and diagnosis of diabetes can be found in the Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, published in the American Diabetes Association’s journal Diabetes Care, Volume 23, Supplement 1, January 2000 pp "
http://www.ssdg.org.uk/info/classification.php

Diagnosis and Classification of Diabetes Mellitus:World Health Organization 1999:"The new classification contains stages which reflect the various degrees of hyperglycaemia in individual subjects with any of the disease processes which may lead to diabetes mellitus. All subjects with diabetes mellitus can be categorized according to clinical stage, and this is achievable in all circumstances. The stage of glycaemia may change over time depending on the extent of the underlying disease processes (Figure 2). The disease process may be present but may not have progressed far enough to cause hyperglycaemia. The aetiological classification reflects the fact that the defect or process which may lead to diabetes may be identifiable at any stage in the development of diabetes - even at the stage of normoglycaemia. Thus the presence of islet cell antibodies in a normoglycaemic individual makes it likely that that person has the Type 1 autoimmune process. Unfortunately there are few sensitive or highly specific indicators of the Type 2 process at present, although these are likely to be revealed as aetiology is more clearly defined. The same disease processes can cause impaired fasting glycaemia and/or impaired glucose tolerance without fulfilling the criteria for the diagnosis of diabetes mellitus. In some individuals with diabetes, adequate glycaemic control can be achieved with weight reduction, exercise and/or oral agents"
http://www.staff.ncl.ac.uk/philip.home/who_dmc.htm#Classification

CLASSIFICATION OF DIABETES MELLITUS AND OTHER CATEGORIES OF GLUCOSE REGULATION:diabetesjournals.org:"A major requirement for epidemiological and clinical research and for the clinical management of diabetes is an appropriate system of classification that provides a framework within which to identify and differentiate its various forms and stages. While there have been a number of sets of nomenclature and diagnostic criteria proposed for diabetes, no generally accepted systematic categorization existed until the NDDG classification system was published in 1979 (1). The World Health Organization (WHO) Expert Committee on Diabetes in 1980 and, later, the WHO Study Group on Diabetes Mellitus endorsed the substantive recommendations of the NDDG (2). These groups recognized two major forms of diabetes, which they termed insulin-dependent diabetes mellitus (IDDM, type 1 diabetes) and non-insulin-dependent diabetes mellitus (NIDDM, type 2 diabetes), but their classification system went on to include evidence that diabetes mellitus was an etiologically and clinically heterogeneous group of disorders that share hyperglycemia in common. The overwhelming evidence in favor of this heterogeneity included the following"
http://care.diabetesjournals.org/cgi/content/full/25/suppl_1/s5

Recommendations for Diabetes Testing and Classification:elsevierhealth.com:"To clarify what is being diagnosed, the Committee recommended eliminating the old categories of “insulin-dependent diabetes mellitus” (IDDM) and “non-insulin-dependent diabetes mellitus” (NIDDM) because they are based on treatment which can vary considerably and does not indicate the underlying problem. Further, in discussing the types of diabetes, the use of Arabic (type 1 and type 2) rather than Roman (type I and type II) numerals is recommended to prevent confusion (e.g., type II being read as “type eleven”). Approximately 700,000 Americans have type 1 diabetes, a disease characterized by destruction of the pancreatic beta cells which produce insulin, usually leading to absolute insulin deficiency. It has two forms. Immune-Mediated Diabetes Mellitus results from an autoimmune destruction of the beta cells; it typically starts in children or young adults who are slim, but can arise in adults of any age. Idiopathic type 1 refers to rare forms of the disease that have no known cause "
http://www3.us.elsevierhealth.com/WOW/pu037.html



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Last updated by Andrew Lopez, RN on Tuesday, April 13, 2010


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