Diabetes Mellitus

Overview of Diabetes Mellitus and its Major Complications:

Genetics and Diabetes Mellitus:

  • Genetics and Diabetes Mellitus: a comprehensive review - http://www.who.int/genomics/about/Diabetis-fin.pdf

  • The Human Genome Project and Diabetes: Genetics of Type 2 Diabetes - http://darwin.nmsu.edu/~molbio/diabetes/disease.html

  • Transmission test for linkage disequilibrium: the insulin gene region and insulin-dependent diabetes mellitus: A population association has consistently been observed between insulin-dependent diabetes mellitus (IDDM) and the "class 1" alleles of the region of tandem-repeat DNA (5' flanking polymorphism [5'FP]) adjacent to the insulin gene on chromosome 11p. This finding suggests that the insulin gene region contains a gene or genes contributing to IDDM susceptibility - http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=93190982&dopt=Citation

  • The Finland-United States Investigation of Non-Insulin-Dependent Diabetes Mellitus Genetics (FUSION) Study. II. An Autosomal Genome Scan for Diabetes-Related Quantitative-Trait Loci:  In this study the authors have described genomewide results from the Finland-United States Investigation of NIDDM Genetics (FUSION) study, a multicenter effort to positionally clone genes for type 2 diabetes in the Finnish population.  An important component of FUSION was the measurement of a variety of type 2 diabetes-related quantitative traits in subjects with and without disease - http://www.journals.uchicago.edu/AJHG/journal/issues/v67n5/001950/001950.text.html

  • Virus infection triggers insulin-dependent diabetes mellitus in a transgenic model: Role of anti-self (virus) immune response: In this study the researchers investigated the potential association between viruses and insulin-dependent (type 1) diabetes (IDDM) by developing a transgenic mouse model. The results show that the induced anti-self (viral) CTL response leads to selective and progressive damage of beta cells, resulting in IDDM -

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1901765&dopt=Abstract

  • Mutation in mitochondrial tRNALeu(UUR) gene in a large pedigree with maternally transmitted type II diabetes mellitus and deafness: Inherited factors are important for the development of type 2 diabetes mellitus, but the genes involved are unknown. In this study the researchers have identified a large pedigree in which type 2 diabetes mellitus, in combination with a sensorineural hearing loss, is maternally inherited. The maternal inheritance and the observed decrease in mitochondrial enzyme activities of the respiratory chain indicate a genetic defect in the mitochondrial DNA. An A to G transition was identified at nucleotide 3,243, a conserved position in the mitochondrial gene for tRNALeu(UUR). This mutation cosegregates with the disease in this family and is absent in controls, and indicates that a point mutation in mitochondrial DNA is a pathogenetic factor for type 2 diabetes mellitus - http://www.nature.com/ng/journal/v1/n5/abs/ng0892-368.html

Statistics:

Measures:

Diabetes Risk Test:

Role of laboratory in Diabetes Mellitus:

  • WHO Laboratory Diagnosis and Monitoring of Diabetes Mellitus 2002: In this report we can find a comprehensive account on the role of the medical laboratory in diabetes mellitus, methods for blood glucose  determination, urine glucose, quality control of glucose determination, self-monitoring of blood glucose,  oral glucose tolerance test (OGTT), analysis and standardization of glycosylated proteins (HbA1c), Fructosamine test, urinary albumin excretion - http://whqlibdoc.who.int/hq/2002/9241590483.pdf

Blood Glucose Test:

The ‘Edmonton’ Protocol:

  • Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid - Free Immunosuppressive Regimen: Seven consecutive patients with type 1 diabetes and a history of severe hypoglycaemia and metabolic instability underwent islet transplantation in conjunction with a glucocorticoid-free immunosuppressive regimen consisting of sirolimus, tacrolimus, and daclizumab. All seven patients quickly attained sustained insulin independence after transplantation. The researchers conclude that islet transplantation in patients with type 1 diabetes mellitus can result in insulin independence with excellent metabolic control when glucocorticoid-free immunosuppression is combined with the infusion of an adequate islet mass - MailScanner has detected a possible fraud attempt from "www.paho.org" claiming to be http://content.nejm.org/cgi/content/abstract/343/4/230

Diabetic Neuropathy - Investigative Work-up:

Diabetic Retinopathy - Investigative Work-up:

Diabetic Nephropathy - Investigative Work-up:

Autoimmune type 1 Diabetes Mellitus:

Diabetes Mellitus and Pregnancy - Investigative Work-up:

First trimester (in addition to normal prenatal laboratory tests):

 

Lab Studies:

Imaging Studies:

Other Tests:

Second trimester:

 

Lab Studies:

  • Repeat 24-hour urine studies in women with elevated creatinine value in first trimester or 24-hour protein or creatinine clearance less than 100 mL/min.

  • Repeat HbA1C.

  • Blood sugar levels from capillary device 4-7 times daily in all women with diabetes.

If preeclampsia is suggested:

Imaging Studies:

Third trimester:

  • Growth ultrasonogram to assess fetal size every 4-6 weeks from 26-36 weeks' gestation in women with overt pre-existing diabetes.

  • Growth ultrasonogram for fetal size at least once at 36-37 weeks' gestation for women with gestational diabetes mellitus (consider performing this study more frequently if macrosomia is suggested.)

  • Amniocentesis for fetal lung profile if delivery is contemplated prior to 39 weeks' gestation - http://www.nlm.nih.gov/medlineplus/ency/article/003921.htm

    •

Infant of a Diabetic Mother - Investigative Work-up:

Lab Studies:

Imaging Studies:

Diabetic Ulcers - Investigative Work-up: Besides routine investigations:

·        Medline Plus:  Plethysmography - http://www.nlm.nih.gov/medlineplus/ency/article/003771.htm

Diabetes Mellitus and Meal Planner Guide:

Body Mass Index:

 

Document Provenance and History

Document Author: Dr. Fazal Danish

Document Created: 20th March 2006

Document Edits:

 

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