Porth's Essentials of Pathophysiology, 4e

819

Diabetes Mellitus and the Metabolic Syndrome

C h a p t e r 3 3

BMI of 32 kg/m 2 , and waist circumference of 45 inches (114 cm). Complete blood count (CBC), thyroid-stimulating hormone (TSH), and alanine aminotransferase (ALT) are within normal limits. The lipid panel shows that his HDL cholesterol (30 mg/dL [0.8 mmol/L]) and LDL cholesterol (136 mg/dL [3.5 mmol/L]) are within the normal range, and triglycerides are elevated (290 mg/dL [2.3 mmol/L]; normal is <165 mg/dL [1.9 mmol/L]). A. What is this man’s probable diagnosis? B. Based on this man’s blood glucose level and the ADA diabetes classification system, what glucose intolerance status would you place this man in? Does he need a 75-g OGTT for further assessment of his IFG? C. His OGTT test result reveals a 2-hour glucose value of 175 mg/dL (9.6 mmol/L). What is the diagnosis? What type of treatment would be appropriate for this man? R E F E R E N C E S 1. American Diabetes Association. Diabetes statistics . 2013. Available at: http://www.diabetes.org/diabetes-basics/diabetes- statistics/. Accessed September 10, 2013. 2. Hall JE. Guyton and Hall’s Medical Physiology . 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:939–954. 3. Masharani U, German MS. Pancreatic hormones and diabetes mellitus. In: Gardner DG, Shoback D, eds. Greenspan’s Basic and Clinical Endocrinology . 9th ed. New York, NY: Lange Medical Books/McGraw-Hill; 2007:573–656. 4. Shepard PR, Kahn B. Glucose transporters and insulin action. N Engl J Med . 1999;341:248–256. 5. DeFronzo RA, Eldor R, Abdul-Ghani M. Pathophysiologic approach to therapy in patients with newly diagnosed type 2 diabetes. Diabetes Care. 2013;36(Suppl 2):S127–S138. 6. Drucker DJ. The biology of incretin hormones. Cell Metab . 2006;3:153–165. 7. Goldfine IR, Youngren JF. Contributions of the American Journal of Physiology to the discovery of insulin. Am J Physiol . 1998;274:E207–E209. 8. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;10:1183–1197. 9. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160–3167. 10. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care . 2013;36(Suppl 1):S62–S69. 11. American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care . 2013;36(Suppl 1):S11–S61. 12. Jones KL. Role of obesity in complicating and confusing the diagnosis and treatment of diabetes in children. Pediatrics. 2008;121(2):361–368. 13. The International Diabetes Federation Consensus Workshop. Type 2 diabetes in the young: The evolving epidemic. Diabetes Care. 2004;27:1798–1811. 14. Nolan CJ, Damm P, Prentki M. Type 2 diabetes across the generations: from pathophysiology to prevention and management. Lancet . 2011;378:169–181.

15. Gerich JE. Contributions of insulin-resistance and insulin- secretory defects to the pathogenesis of type 2 diabetes. Mayo Clin Proc . 2003;78:447–456. 16. DeFronzo RA. Banting lecture. From the triumvirate to ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes . 2009;32:1327–1334. 17. Matthews DR, Cull CA, Stratton IM, et al. for the United Kingdom Prospective Diabetes Study (UKPDS) Group. UKPDS 26: Sulfonylurea failure in non-insulin-dependent diabetic patients over six years. Diabetes Med. 1998;15:297–303. 18. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature . 2006;444:840–846. 19. Matfin G. Developing therapies for the metabolic syndrome: Challenges. opportunities, and the unknown. Ther Adv Endocrinol Metabol. 2010;4(2):89–94. 20. Grundy SM, Panel Chair . Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). NIH publication no. 01–3670. Bethesda, MD: National Institutes of Health; 2001. 21. Guven S, El-Bershawi A, Sonnenberg GE, et al. Persistent elevation in plasma leptin level in ex-obese with normal body mass index: relation to body composition and insulin sensitivity. Diabetes . 1999;48:347–352. 22. Bays H, Mandarino L, DeFronzo RA. Role of adipocyte, free fatty acid, and ectopic fat in pathogenesis of type 2 diabetes: peroxisomal proliferator-activated receptor agonists provide a rationale therapeutic approach. J Clin Endocrinol Metab . 2004;89:463–478. 23. Kadowaki T, Yamauchi T, Kubota N, et al. Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. J Clin Invest . 2006;116:1784–1792. 24. Gallagher EJ, LeRoith D, Karnieli E. The metabolic syndrome— From insulin resistance to obesity and diabetes. Endocrinol Metab Clin North Am . 2008;37:559–579. 25. Kuritzkes DR, Currier J. Cardiovascular risk factors and antiretroviral therapy. N Engl J Med . 2003;348:679–680. 26. Landon MB, Gabbe SG. Gestational diabetes mellitus. Obstet Gynecol . 2011;118:1379–1393. 27. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop— Conference on Gestational Diabetes. Diabetes Care. 2007;30(Suppl 2):S251–S260. 28. American Diabetes Association. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011;34:e61–e99. 29. Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutritional recommendations and interventions for diabetes—2006: a position statement of the American Diabetes Association. Diabetes Care . 2006;29:2140–2157. 30. American Diabetes Association. Physical activity/exercise and diabetes mellitus. Diabetes Care . 2004;27(Suppl 1):S55–S59. 31. Inzucchi SE, Bergenstal RM, Buse JB, et al.; for the American Diabetes Association, European Association for the Study of Diabetes. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–1379. 32. Fonseca V. Diabetes mellitus in the next decade: novel pipeline medications to treat hyperglycemia. Clin Ther . 2013;35:714–72333. 33. Erdmann E, Wilcox RG. Weighing up cardiovascular benefits of thiazolidinedione therapy: the impact of increased risk of heart failure. Eur Heart J . 2008;29:12–20. 34. Meier BM, Kraenzlin ME, Meier CR. Risk of fractures with glitazones: a critical review of evidence to date. Drug Saf. 2009;32(7):539–547.