Aggiornamento
Uno, cento, mille diabeti
Diabete mellito di tipo 1 e 2 - parte prima
ONE, ONE HUNDRED, ONE THOUSAND DIABETES
Part 1 - Type 1 and type 2 diabetes mellitus
Gianluca Tornese, Laura Rubert, Giorgio Tonini, Elena Faleschini
SS di Endocrinologia, Auxologia e Diabetologia; Clinica Pediatrica, IRCCS “Burlo Garofolo”, Università di Trieste
Giugno 2011 - pagg. 360 -366
Abstract
The term “diabetes mellitus” does not only refer to one disease, but to a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, action, or both. The vast majority of cases of diabetes falls into two broad etiopathogenetic categories, type 1 diabetes (T1DM) and type 2 (T2DM), whose pathological processes are respectively the autoimmune destruction of pancreatic β-cells, resulting in insulin deficit, and abnormalities that result in resistance to insulin as well as in an inadequate compensatory insulin secretory response. This article provides a review of the current information about etiopathogenesis (autoimmunity, genetics, environmental factors), epidemiology and therapy.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. American Diabetes Association. Diagnosis
and classification of diabetes mellitus. Diabe-
tes Care 2011;34:S62-9.
2. WHO. Use of glycated haemoglobin
(HbA1c) in the diagnosis of diabetes mellitus:
abbreviated report of a WHO consultation,
Jan 14, 2011.
3. DCCT Research Group. The effect of inten-
sive treatment of diabetes on the development
and progression of longterm complications in
insulin-dependent diabetes mellitus. N Engl J
Med 1993;329:977-86.
4. UK Prospective Diabetes Study (UKPDS)
Group. Intensive blood glucose control with
sulphonylureas or insulin compared with con-
ventional treatment and risk of complications
in patients with type 2 diabetes (UKPDS 33).
Lancet 1998;352:837-53.
5. International Expert Committee. Interna-
tional Expert Committee report on the role of
the A1C assay in the diagnosis of diabetes.
Diabetes Care 2009;32:1327-34.
6. Kilpatrick ES, Bloomgarden ZT, Zimmet PZ.
Is haemoglobin A1c a step forward for dia-
gnosing diabetes? BMJ 2009;339:b4432.
7. Marchetti F, Tornese G, Faleschini E, Poli F.
Diagnosis of diabetes. What about cystic fi-
brosis? BMJ 2009;339:b5644.
8. Misra S, Hancock M, Meeran K, Dornhost
A, Oliver NS. HbA1c: an old friend in new
clothes. Lancet 2011;377:1476-7.
9. Bottazzo GF, Florin-Christensen A, Doniach
D. Islet-cell antibodies in diabetes mellitus
with autoimmune polyendocrine deficiencies.
Lancet 1974;2:1279-83.
10. Palmer JP, Asplin CM, Clemons P, et al. In-
sulin antibodies in insulin-dependent diabetics
before insulin treatment. Science1983;222:
1337-9.
11. Baekkeskov S, Aanstoot HJ, Christgau S,
et al. Identification of the 64K autoantigen in
insulin-dependent diabetes as the GABA-
synthesizing enzyme glutamic acid decar-
boxylase. Nature1990;347:151-6.
12. Rabin DU, Pleasic SM, Shapiro JA, et al.
Islet cell antigen 512 is a diabetes-specific islet
autoantigen related to protein tyrosine pho-
sphatases. J Immunol1994;152:3183.
13. Wenzlau JM, Juhl K, Yu L, et al. The cation
efflux transporter ZnT8 (Slc30A8) is a major
autoantigen in human type 1 diabetes. Proc
Natl Acad Sci USA2007;104:17040-5.
14. Bingley PJ, Bonifacio E, Williams AJ, Ge-
novese S, Bottazzo GF, Gale EA. Prediction of
IDDM in the general population: strategies
based on combinations of autoantibodiy
markers. Diabetes 1997;46:1701-10.
15. Verge CF, Stenger D, Bonifacio E, et al.
Combined use of autoantibodies (IA-2 autoan-
tibody, GAD autoantibody, insulin autoanti-
body, cytoplasmic islet cell antibodies) in ty-
pe 1 diabetes: Combinatorial Islet Autoanti-
body Workshop. Diabetes 1998;47:1857-66.
16. Bingley PJ, Bonifacio E, Ziegler AG,
Schatz DA, Atkinson MA, Eisenbarth GS. Pro-
posed guidelines on screening for risk of type
I diabetes. Diabetes Care2001;24:398.
17. Achenbach P, Ziegler AG. Diabetes-related
antibodies in euglycemic subjects. Best Pract
Res Clin Endocrinol Metab2005;19:101-17.
18. Verge CF, Gianani R, Kawasaki E, et al.
Prediction of type I diabetes in first-degree re-
latives using a combination of insulin, GAD,
and ICA512bdc/IA-2 autoantibodies. Diabetes
1996;45:926-33.
19. Wang J, Miao D, Babu S, et al. Prevalence
of autoantibody-negative diabetes is not rare at
all ages and increases with older age and obe-
sity. J Clin Endocrinol Metab2007;92:88-92.
20. DIAMOND Project Group. Incidence and
trends of childhood Type 1 diabetes worldwi-
de 1990-1999. Diabet Med 2006;23:857-66.
21. Bruno G, Maule M, Merletti F, et al; RIDI
Study Group. Age-period-cohort analysis of
1990-2003 incidence time trends of childhood
diabetes in Italy: the RIDI study. Diabetes
2010;59:2281-7.
22. Patterson CC, Dahlquist GG, Gyürüs E,
Green A, Soltész G; EURODIAB Study Group.
Incidence trends for childhood type 1 diabe-
tes in Europe during 1989-2003 and predicted
new cases 2005-20: a multicentre prospective
registration study. Lancet2009;373:2027-33.
23. Harjutsalo V, Sjöberg L, Tuomilehto J. Ti-
me trends in the incidence of type 1 diabetes
in Finnish children: a cohort study. Lancet
2008;371:1777-82.
24. Atkinson MA, Maclaren NK. The patho-
genesis of insulin dependent diabetes. N Engl
J Med1994;33:1428-36.
25. Bartolozzi G, Guglielminelli M. Pediatria.
Principi e pratica clinica. Elsevier Masson,
2008:389.
26. Barrett JC, Clayton DG, Concannon P, et al.
Genome-wide association study and meta-
analysis find that over 40 loci affect risk of ty-
pe 1 diabetes. Nat Genet2009;41:703-7.
27. Buzzetti R, Quattrocchi CC,Nisticò L. Dis-
secting the genetics of type I diabetes: rele-
vance for familial clustering and differences in
incidence. Diabetes Metab Rev 1998;14:111-28.
28. Gepts W. Pathologic anatomy of the pan-
creas in juvenile diabetes mellitus. Diabetes
1965;14:619-33.
29. Atkinson MA, Eisenbarth GS. Type 1 dia-
betes: new perspectives on disease pathoge-
nesis and treatment. Lancet 2001;358:221-9.
30. Dahlquist GG, Patterson C, Soltesz G. Pe-
rinatal risk factors for childhood type 1 diabe-
tes in Europe. The EURODIAB Substudy 2
Study Group. Diabetes Care 1999;22:1698-702.
31. Lombardo F, Valenzise M, Wasniewska M,
et al. Two year prospective evaluation of the
factors affecting honeymoon frequency and
duration in children with insulin dependent
diabetes mellitus: the key-role of age at dia-
gnosis. Diabetes Nutr Metab2002;15:246-51.
32. The Diabetes Control Complication Trial
(DCCT) Research Group. The effect of inten-
sive treatment of diabetes on the development
and progression of long-term complications in
insulin-dependent diabetes mellitus. N Engl J
Med 1993;329:977-86.
33. Pickup J, Mattock M, Kerry S. Glycaemic
control with continuous subcutaneous insulin
infusion compared with intensive insulin injec-
tions in patients with type 1 diabetes: meta-
analysis of randomised controlled trials. BMJ
2002;324:705.
34. American Diabetes Association. Nutrition
principles and recommendations in diabetes
(Position Statement). Diabetes Care 2003;26
(Suppl. 1):S51-S61.
35. Scavone G, Manto A, Pitocco D, et al. Ef-
fect of carbohydrate counting and medical nu-
tritional therapy on glycaemic control in type 1
diabetic subjects: a pilot study. Diabet Med
2010;27:477-9.
36. Zinman B, Ruderman N, Campaigne BN,
Devlin JT, Schneider SH, the American Dia-
betes Association. Physical activity/exercise
and diabetes (Position Statement). Diabetes
Care 2004;27(Suppl. 1):S58-S62.
37. Robertson K, Adolfsson P, Riddell M,
Scheiner G, Hanas R. Exercise in children and
adolescents with diabetes. Pediatr Diabetes
2009;10(Suppl. 12):154-68.
38. Berger M, Assai JP, Jorgens V. Physical
exercise in the diabetic. The importance of un-
derstanding endocrine and metabolic respon-
ses. Diabetes Metab 1998;6:59-69.
39. Rosenbloom AL, Silverstein JH, Amemiya
S, Zeitler P, Klingensmith G. Type 2 diabetes
in the child and adolescent. Pediatr Diabetes
2009;10:17-32.
40. Pinhas-Hamiel O, Zeitler P. The global
spread of type 2 diabetes mellitus in children
and adolescents. J Pediatr2005;146:693-700.
41. Kiess W, Böttner A, Blüher S, Raile K, Gal-
ler A, Kapellen TM. Type 2 diabetes mellitus
in children and adolescents-the beginning of a
renal catastrophe? Nephrol Dial Transplant
2004;19:2693-6.
42. Cerutti F, Iughetti L. Sindrome metabolica
e diabete di tipo 2 nell’età evolutiva. Roche
Diagnostic2005;38-39.
43. Druet C, Tubiana-Rufi N, Chevenne D, Ri-
gal O, Polak M, Levy-Marchal C. Characteri-
zation of insulin secretion and resistance in ty-
pe 2 diabetes of adolescents. J Clin Endocri-
nol Metab 2006;91:401-4.
44. The Writing Group for the SEARCH for
Diabetes in Youth Study Group. Incidence ofdiabetes in youth in the United States. JAMA
2007;297:2716-24.
45. Whincup PH, Kaye SJ, Owen CG, et al.
Birth weight and risk of type 2 diabetes: a sy-
stematic review. JAMA 2008;300:2886-97.
46. Morales A,Rosenbloom AL. Death caused
by hyperglycemic hyperosmolar state at the
onset of type 2 diabetes. J Pediatr 2004;144:
270-3.
47. Pinhas-Hamiel O, Zeitler P. Acute and ch-
ronic complications of type 2 diabetes melli-
tus in children and adolescents. Lancet 2007;
369:1823-31.
48. Rosembloom AL. Obesity, insulin resi-
stance, beta cell autoimmunity, and the chan-
ging clinical epidemiology of childhood dia-
betes. Diabetes Care 2003;26:2954-6.
49. Turner R, Stratton I, Horton V, et al; for
the UK Prospective Diabetes Study (UKPDS)
Group. UKPDS 25: Autoantibodies to islet cell
cytoplasm and glutamic acid decarboxylase
for prediction of insulin requirement in type 2
diabetes. Lancet1997;350:1288-93.
50. Aslander-van Vliet E, Smart C, Waldron S.
Nutritional management in childhood and
adolescent diabetes. ISPAD Clinical Practice
Consensus Guidelines 2006-2007. Pediatr Dia-
betes 2007;8:323-39.
51. Miller J, Silverstein JH, Rosembloom AL.
Type 2 diabetes in the child and adolescent.
In: Lifshitz F (Ed). Pediatric Endocrinology,
5th edition, Volume 1. New York: Marcel
Dekker, 2007:169-88.
52. Wei JN, Sung FC, Li CY, et al. Low birth
weight and high birth weight infants are both
at an increased risk to have type 2 diabetes
among schoolchildren in Taiwan. Diabetes
Care 2003;26:343-8.
53. Jeffery RW. Community programs for obe-
sity prevention: The Minnesota Heart Health
Program. Obes Res 1995;3(Suppl. 2):283s-288s.
54. Craig M, Hattersley A, Donaghue K. Defi-
nition, epidemiology, diagnosis and classifica-
tion. ISPAD Clinical Practice Consensus Gui-
delines 2006-2007. Pediatr Diabetes 2006;7:
343-51.
Corrispondenza: tornese@burlo.trieste.it
