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糖尿病的英文文章
第一篇
Diabetes
mellitus type 2 From Wikipedia, the free
encyclopedia
Diabetes
mellitus
type
2
Classification
and
external
resources
Universal
blue
circle
symbol
for
diabetes.[1] ICD-10 E11 ICD-9 250. 00,
250. 02 OMIM 125853
DiseasesDB 3661
MedlinePlus 000313 eMedicine article/117853
MeSH
D003924
Diabetes
mellitus
type
2
(formerly
noninsulin-
dependent
diabetes
mellitus
(NIDDM)
or
adult-
onset
diabetes)
is
a
metabolic
disorderthat
is
characterized
by
high
blood
glucose
in
the
context
of
insulin
resistance
and
relative
insulin
deficiency.[2]
This
is
in
contrast
todiabetes
mellitus
type 1, in which
there is an absolute insulin deficiency due
to destruction of islet cells in the
pancreas.[3] The classic
symptoms are
excess thirst, frequent urination, and constant
hunger.
Type
2
diabetes
makes
up
about
90%
of
cases
of
diabetes
with the other 10% due primarily to
diabetes mellitus type 1
and
gestational
diabetes.
Obesity
is
thought
to
be
the
primary
cause
of
type
2
diabetes
in
people
who
are
genetically
predisposed
to
the
disease.
Type
2
diabetes
is
initially
managed by increasing exercise and
dietary modification. If
blood
glucose
levels
are
not
adequately
lowered
by
these
1
/
18
measures,
medications
such
as
metformin
or
insulin
may
be
needed.
In
those
on
insulin,
there
is
typically
the
requirement
to
routinely
check
blood
sugar
levels.
Rates
of
type
2
diabetes
have
increased
markedly
over
the
last
50
years
in
parallel
with
obesity:
As
of
2010
there
are
approximately
285
million
people
with
the
disease
compared
to
around
30
million
in
1985.[4][5]Long-term
complications from high blood sugar can
include
heart
disease,strokes,
diabetic
retinopathy
where
eyesight
is
affected,
kidney
failurewhich
may
require
dialysis,
and
poor
circulation
of
limbs
leading
toamputations.
The
acute
complication
of
ketoacidosis,
a
feature
of
type
1
diabetes,
is
uncommon.[6]
However,
nonketotic
hyperosmolar
coma
may
occur.
Contents [hide] 1
Signs
and symptoms
o
1.
1
Complications
2
Cause
o
2.
1
Lifestyle
o
2.
2
Genetics
o
2.
3
Medical
conditions
3
Pathophysiology
4
Diagnosis
5
Screening
6
Prevention
7
Management o 7. 1 Lifestyle o 7. 2
Medications o 7. 3 Surgery
8
Epidemiology
9
History
10
References
11
External
links
Signs
and symptoms
Overview of the most significant symptoms of
diabetes.
The
classic
symptoms
of
diabetes
are
polyuria
(frequent
urination),
polydipsia
(increased
thirst),
polyphagia
(increased
hunger),
and
weight
loss.[7]
Other
symptoms that are
commonly present at diagnosis include: a
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history of blurred
vision,itchiness, peripheral neuropathy,
recurrent
vaginal
infections,
and
fatigue.
Many
people,
however, have no
symptoms during the first few years and are
diagnosed
on
routine
testing.
People
with
type
2
diabetes
mellitus
may
rarely
present
with nonketotic
hyperosmolar
coma
(a
condition
of
very
high
blood
sugar
associated
with
a
decreased level of consciousness and
low blood pressure).[3]
Complications
Main
article:
Complications
of
diabetes
mellitus
Type
2
diabetes
is
typically
a
chronic
disease
associated
with
a
ten-year-shorter life expectancy.[4] This is
partly due to
a
number
of
complications
with
which
it
is
associated,
including:
two
to
four
times
the
risk
of
cardiovascular
disease,
includingischemic
heart
disease
and
stroke;
a
20-fold
increase
in
lower
limb
amputations,
and
increased
rates
of
hospitalizations.[4]
In
the
developed
world,
and
increasingly
elsewhere,
type
2
diabetes
is
the
largest
cause
of
nontraumatic
blindnessand
kidney failure.[8] It has also been associated
with
an
increased
risk
of
cognitive
dysfunction
and
dementiathrough
disease
processes
such
as
Alzheimer’s
disease
and
vascular
dementia.[9]
Other
complications
include:acanthosis
nigricans,
sexual
dysfunction,
and
3
/
18
frequent
infections.[7]
Cause
The
development
of
type
2
diabetes
is caused by a combination of lifestyle and
genetic
factors.[8][10]
While
some
are
under
personal
control,
such
as
diet
and
obesity,
others,
such
as
increasing
age,
female
gender,
and genetics, are not.[4] A lack of
sleep has been linked to
type
2
diabetes.[11]
This
is
believed
to
act
through
its
effect
on
metabolism.[11] The nutritional status of a mother
during
fetal
development
may
also
play
a
role,
with
one
proposed
mechanism
being
that
of
altered
DNA
methylation.[12]
Lifestyle
Main article:
Lifestyle causes of diabetes mellitus type 2 A
number of lifestyle factors are known
to be important to the
development
of type
2 diabetes,
including:obesity
(defined
by
a body mass index of
greater than thirty), lack of physical
activity, poor diet,
stress,
and urbanization.[4]
Excess
body
fat is associated with 30% of
cases in those of Chinese and
Japanese
descent, 60-80% of cases in those of European and
African
descent,
and
100%
of
Pima
Indians
and
Pacific
Islanders.[3]Those
who
are
not
obese
often
have
a
high
waisthip
ratio.[3]
Dietary
factors
also
influence
the
risk
of
developing
type
2
diabetes.
Consumption
of
sugar-sweetened
drinks
in
excess
is associated with an increased risk.[13][14] The
type
of
fats
in
the
diet
are
also
important,
withsaturated
fats
and
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trans
fatty acids increasing the risk and
polyunsaturated and
monounsaturated fat
decreasing the risk.[10] Eating lots of
white
rice
appears
to
also
play
a
role
in
increasing
risk.[15]
A
lack
of
exercise
is
believed
to
cause
7%
of
cases.[16]
Genetics
Main
article:
Genetic
causes
of
diabetes
mellitus
type
2 Most cases of
diabetes involve many genes, with each being
a small contributor to an increased
probability of becoming a
type 2
diabetic.[4] If one identical twin has diabetes,
the
chance
of
the
other
developing
diabetes
within
his
lifetime
is
greater than 90% while the rate for
nonidentical siblings is
25-50%.[3]As
of 2019, more than 36 genes have been found that
contribute to the risk of type 2
diabetes.[17] All of these
genes
together
still
only
account
for
10%
of
the
total
heritable
component
of
the
disease.
The
TCF7L2allele,
for
example,
increases the risk
of developing diabetes by 1.5 times and is
the greatest risk of the common genetic
variants. Most of the
genes
linked
to
diabetes
are
involved
in
beta
cell
functions.[3]
There are a number of rare cases of
diabetes that arise due to
an
abnormality in a single gene (known asmonogenic
forms of
diabetes or other specific
types of diabetes).[3][4] These
include
maturity onset diabetes of the young (MODY),
Donohue
5
/
18
syndrome,
and
Rabson-Mendenhall
syndrome,
among
others.[4]
Maturity
onset
diabetes
of
the
young
constitute
15%
of
all
cases
of
diabetes in young people.[18] Medical conditions
There are
a number of medications and
other health problems that can
predispose to diabetes.[19] Some of the
medications include:
glucocorticoids,
thiazides,
beta
blockers,
atypical
antipsychotics,[20]
andstatins.[21]Those who have previously
had
gestational
diabetes
are
at
a
higher
risk
of
developing
type
2
diabetes.[7]
Other
health
problems
that
are
associated
include:
acromegaly,
Cushing’s
syndrome,
hyperthyroidism,pheochromocytoma,
and
certain
cancers
such
as
glucagonomas.[19] Testosterone
deficiency is also associated
with
type
2 diabetes.[22][23]
Pathophysiology
Type
2
diabetes
is due
to insufficient insulin production from beta cells
in
the
setting
of
insulin
resistance.[3]
Insulin
resistance,
which
is
the
inability
of
cells
to
respond
adequately
to
normal
levels
of
insulin,
occurs
primarily
within
the
muscles,
liver,
and fat tissue.[24]
In the liver, insulin normally suppresses
glucose
release.
However,
in
the
setting
of
insulin
resistance,
the liver
inappropriately
releases
glucose into the
blood.[4]
The
proportion
of
insulin
resistance
versus
beta
cell
dysfunction
differs
among
individuals,
with
some
having
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primarily
insulin
resistance
and
only
a
minor
defect
in
insulin
secretion
and
others
with
slight
insulin
resistance
and
primarily a lack of insulin
secretion.[3] Other potentially
important
mechanisms
associated
with
type
2
diabetes
and
insulin
resistance
include:
increased
breakdown
of
lipids
within
fat cells, resistance to and lack of incretin,
high
glucagon levels in the blood,
increased retention of salt and
water
by
the
kidneys,
and
inappropriate
regulation
of
metabolism by thecentral nervous
system.[4] However, not all
people
with
insulin
resistance
develop
diabetes,
since
an
impairment of insulin
secretion by pancreatic beta cells is
also
required.[3]
Diagnosis
The
World
Health
Organizationdefinition
of
diabetes
(both
type
1
and
type
2)
is
for a single raised glucose reading
with symptoms, otherwise
tolerance
test,
two
hours
after
the
oral
dose
a
plasma
glucose
11.1 mmol/l (200
mg/dl) A random blood sugar of greater than
11.1
mmol/l
(200
mg/dL)
in
association
with
typical
symptoms[7]
or
aglycated
hemoglobin
(HbA1c)
of
greater
than
6.5%
is
another
method of diagnosing diabetes.[4] In
2009 an International
7
/
18
Expert
Committee
that
included
representatives
of
the
American
Diabetes
Association
(ADA),
the
International
Diabetes
Federation (IDF), and the European
Association for the Study
of Diabetes
(EASD) recommended that a threshold of 6.5% HbA1c
should be used to diagnose diabetes.
This recommendation was
adopted
by
the
American
Diabetes
Association
in
2010.[28]
Positive tests should be repeated
unless the person presents
with
typical
symptoms
and
blood
sugars
11.1
mmol/l
(200
mg/dl).[29]
Threshold
for
diagnosis
of
diabetes
is
based
on
the
relationship
between
results
of
glucose
tolerance
tests,
fasting glucose or
HbA1c and complications such as retinal
problems.[4]
A
fasting
or
random
blood
sugar
is
preferred
over
the glucose tolerance test, as they are
more convenient for
people.[4]
HbA1c
has
the
advantages
that
fasting
is
not
required and results are more stable
but has the disadvantage
that
the
test
is
more
costly
than
measurement
of
blood
glucose.[30] It is
estimated that 20% of people with diabetes
in
the
United
States
do
not
realize
that
they
have
the
disease.[4] Diabetes mellitus type 2 is
characterized by high
blood
glucose
in
the
context
of
insulin
resistance
and
relative
insulin
deficiency.[2]
This
is
in
contrast
to
diabetes
mellitus
type
1
in
which
there is an
absolute insulin
deficiency
due
to
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destruction of islet cells in the
pancreas and gestational
diabetes
mellitus that is a new onset of high blood sugars
in
associated with pregnancy.[3] Type 1
and type 2 diabetes can
typically
be
distinguished
based
on
the
presenting
circumstances.[29]
If
the
diagnosis
is
in
doubt
antibody
testing
may
be
useful
to
confirm
type
1
diabetes
and
C-peptide
levels
may
be
useful
to
confirm
type
2
diabetes,[31]
with
C-peptide levels normal
or
high in
type 2
diabetes,
but
low
in
type 1 diabetes.
Screening No major organization recommends
universal screening for diabetes as
there is no evidence that
such
a
program
would
improve
outcomes.[32]
Screening
is
recommended
by
the
United
States
Preventive
Services
Task
Force
in
adults
without
symptoms
whose
blood
pressure
is
greater
than
135/80 mmHg.[33] For those whose blood
pressure is less, the
evidence
is
insufficient
to
recommend
for
or
against
screening.[33] The World Health
Organizationrecommends only
testing
those
groups
at
high
risk.[32]
High-risk
groups
in
the
United
States include: those over 45 years old; those
with a
first
degree
relative
with
diabetes;
some
ethnic
groups,
including
Hispanics,
African-Americans,
and
Native-Americans;
a
history
of
gestational diabetes;
polycystic ovary
syndrome;
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