Diagnosis of Diabetes (mmol/L / mg/dl) |
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Stage | Fasting Plasma Glucose Test (FPG) | Random Plasma Glucose Test | Oral Glucose Tolerance Test (OGTT) |
Diabetes | greater than or equal to 7.0 / 126 | greater than or equal to 11.1 / 200 plus symptoms *** | greater than or equal to 11.1 / 200 **** |
Impaired Glucose Homeostasis | Impaired Fasting Glucose (IFG) greater than or equal to 6.1 / 110 and less than 7.0 / 126 | Impaired Glucose Tolerance (IGT) greater than or equal to 7.8 / 140 and less than 11.1 / 200 | |
Normal | less than 6.1 / 110 | less than 7.8 / 140 |
The first classification of diabetes dates back to about 56 years ago in 1947 where diabetes was classified into two main types: the Juvenile onset diabetes and maturity onset diabetes, In 1979 both WHO and the national diabetes data group established a new classification: Insulin Dependent Diabetes Mellitus IDDM & Non Insulin Dependent Diabetes Mellitus NIDDM and this classification was published by WHO in 1980 and modified in 1985. In both the 1980 and 1985 reports other classes of diabetes included also other types like Impaired Glucose Tolerance (IGT) and Gestational Diabetes Mellitus (GDM). In 1995 an international Expert Committee, working under the sponsorship of the American Diabetes Association, was established to review the scientific outcome since the last classification 1979 to decide if there should be some changes to the classification and diagnosis of diabetes or not .
This report of this committee indicated a strong need to do significant changes either in the criteria for diagnosis or for the classification of diabetes, this classification was based on the etiology of the disease. This means that the old classification of diabetes in 1947 was based on the on age of the patients wether they are juvenile or mature, the 1979 classification was based upon the type of treatment received wether it is Insulin or not While the last classification in 1998 was based upon the aetiology of diabetes which seems to be the most logic and accepted classification till now.
I. Type 1 diabetes (ß-cell destruction, usually leading to absolute insulin deficiency) | |
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A. Immune mediated | B. Idiopathic |
II. Type 2 diabetes (may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with insulin resistance) | |
III. Other specific types | |
A. Genetic defects of ß-cell function | |
1. Chromosome 12, HNF-1 (MODY3) | 2. Chromosome 7, glucokinase (MODY2) |
3. Chromosome 20, HNF-4 (MODY1) | 4. Mitochondrial DNA |
5. Others | |
B. Genetic defects in insulin action | |
1. Type A insulin resistance | 2. Leprechaunism |
3. Rabson-Mendenhall syndrome | 4. Lipoatrophic diabetes |
5. Others | |
C. Diseases of the exocrine pancreas | |
1. Pancreatitis | 2. Trauma/pancreatectomy |
3. Neoplasia | 4. Cystic fibrosis |
5. Hemochromatosis | 6. Fibrocalculous pancreatopathy |
7. Others | |
D. Endocrinopathies | |
1. Acromegaly | 2. Cushing’s syndrome |
3. Glucagonoma | 4. Pheochromocytoma |
5. Hyperthyroidism | 6. Somatostatinoma |
7. Aldosteronoma | 8. Others |
E. Drug- or chemical-induced | |
1. Vacor | 2. Pentamidine |
3. Nicotinic acid | 4. Glucocorticoids |
5. Thyroid hormone | 6. Diazoxide |
7. ß-adrenergic agonists | 8. Thiazides |
9. Dilantin | 10. -Interferon |
11. Others | |
F. Infections | |
1. Congenital rubella | 2. Cytomegalovirus |
3. Others | |
G. Uncommon forms of immune-mediated diabetes | |
1. "Stiff-man" syndrome | 2. Anti-insulin receptor antibodies |
3. Others | |
H. Other genetic syndromes sometimes associated with diabetes | |
1. Down’s syndrome | 2. Klinefelter’s syndrome |
3. Turner’s syndrome | 4. Wolfram’s syndrome |
5. Friedreich’s ataxia | 6. Huntington’s chorea |
7. Laurence-Moon-Biedl syndrome | 8. Myotonic dystrophy |
9. Porphyria | 10. Prader-Willi syndrome |
11. Others | |
IV. Gestational diabetes mellitus (GDM) |