Classification

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Diabetes can be grouped into four major categories (T.a,bl.e...,2Q.9.-1).1 Type 1 diabetes [older terminology: insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes mellitus (JODM)] is characterized by an absolute deficiency of insulin secretion. The disease is believed to be primarily autoimmune in nature with a genetic predisposition and a possible link with viral infections or other environmental factors (such as absence of breast-feeding, diet, and factors related to low socioeconomic status) as possible triggers. Individuals with type 1 diabetes require insulin therapy to sustain life and are prone to DKA.

Type 2 diabetes [older terminology: non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes mellitus (AODM)] represents a combination of resistance to the action of insulin by the target organs and tissues with a relative inadequacy of compensatory insulin secretion. Type 2 diabetes is also believed to have a strong genetic predisposition, although it is clear that lifestyle issues such as diet and exercise can impact the development and severity of the disease. Patients with type 2 diabetes can have a variety of initial presentations ranging from life-threatening HHNS, or complications related to hyperglycemia alone, for years prior to having clinical symptoms of diabetes. Type 2 diabetics often require insulin at some point in their course for adequate glycemic control. The likelihood of insulin requirement increases with duration of disease, with 22 percent needing insulin in the first 4 years to about 60 percent after 20 years.

The third group represents secondary causes for diabetes. Collectively, patients with secondary diabetes represent only about 1 percent of all diabetes cases. The fourth group, gestational diabetes mellitus (GDM), is present only during pregnancy, and complicates about 4 percent of pregnancies in the United States annually (or about 135,000 cases). Excellent glycemic control is essential in preventing fetal cardiac and central nervous system abnormalities, as well as fetal macrosomia. 1

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