TYPE-2 DIABETES-MELLITUS - THE CHALLENGE OF A METABOLIC EPIDEMIC

Diabetes mellitus is a family of disorders that share chronic hypergly cemia (elevated plasma glucose [PG] concentration) as a common charact eristic. Hyperglycemia results from decreased insulin action. Diabetes is classified as: 1) type 1 diabetes; 2) type 2 diabetes; 3) other sp ecific types of diabetes; and 4) gestational diabetes. Ten percent of cases of diabetes result from autoimmune beta cell destruction (type 1 . diabetes) while 90% of cases result from insulin resistance and rela tive insulinopenia (type 2 diabetes). Overall, approximately 16 millio n Americans have diabetes. The American Diabetes Association (ADA) has developed new cutoff recommendations for the diagnosis of diabetes. A dditionally, routine screening for diabetes is recommended for all adu lts age 45 and above. Insulin resistance, a key factor in the developm ent of type 2 diabetes, is associated with elevated circulating levels of free fatty acids, tumor necrosis factor expression in adipose tiss ue, and the formation of hexosamines in tissue. Type 2 diabetes is pol ygenic with many genomic regions and candidate loci under investigatio n. The complications of type 2 diabetes include macrovascular, microva scular, and neurologic disease. Treatment for type 2 diabetes involves prudent diet, exercise, and weight loss. If these measures are insuff icient to control hyperglycemia, oral agents are the next line of ther apy followed by subcutaneous insulin injection. Unfortunately, type 2 diabetes is increasing in frequency as our population ages, gains weig ht, eats a higher fat, higher calorie diet, and exercises less. The la boratory contributes to the diagnosis and management of type 2 diabete s.