The term “Diabetes mellitus” (Syndrome X or Metabolic Syndrome) encompasses a heterogeneous group of disorders characterized by insulin hyposecretion and/or insensitivity. Type 1 (insulin-dependent) diabetes mellitus is thought to have an autosomal recessive inheritance and an autoimmune pathogenesis, exhibited by lymphocytic insulitis. The latter may be triggered by viruses or chemical agents. Type 2 (non-insulin-dependent) diabetes mellitus has a stronger genetic association. It is associated with obesity and Gestational diabetes mellitus (GDM) related with pregnancy.
All forms of diabetes, both inherited and acquired, are characterized by hyperglycemia, a relative or absolute lack of insulin, and the development of diabetes-specific microvascular pathology in the retina, renal glomerulus, and peripheral nerve. Diabetes is also associated with accelerated atherosclerotic macrovascular disease affecting arteries that supply the heart, brain, and lower extremities. Pathologically, this condition resembles macrovascular disease in nondiabetic patients, but it is more extensive and progresses more rapidly. As a consequence of its microvascular pathology, diabetes mellitus is now the leading cause of new blindness in people 20 to 74 years of age and the leading cause of end-stage renal disease (ESRD).
The present-day management of Diabetes Mellitus is significantly more effective and easier for patients than the situation that prevailed even in the 1990s. A better understanding of the barriers to effective diabetes management and how to overcome them would be of great benefit. Changes in the health care system in the US promise to eradicate access to care as the major barrier to prevention of disabling complications. The epidemic in diabetes and obesity that is under way, coupled with the predicted early death and disability that follow, threatens to over whelm health care systems globally. Screening for diabetes or prediabetes may be cost-saving. Practical, cost-effective public health approaches to stem this tide are desperately needed. Whether new blockbuster drugs exist in the pipeline of 235 novel pharmaceutical agents for the treatment of diabetes and its complications is uncertain. Although the prognosis for people with diabetes has never been better, the major challenges that they face relate to the complexity and cost of care. The opportunities for therapies that broadly address the metabolic under pinnings and consequences of diabetes are enormous.
- S.Melmed, KS Polonsky, PR Larsen, HM Kronenberg- Williams Textbook of Endocrinology
- M.F. Al Homsi and ML Lukic – An Update on the pathogenesis of Diabetes Mellitus