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• W2056501443 abstract "Nearly 3.000 years ago, the ancient Hindu physician, Sushruta, recognized that there appeared to be two types of diabetes-one with youth-onset and familial tendency and another ascribed to the use of injudicious diet. Throughout the centuries that have ensued, physicians have come to recognize that the clinical picture, course and severity of diabetes usually follows two general patterns-a juvenile-onset, ketosis-prone type of diabetes and a less severe, maturity-onset, obesityrelated, ketosis-resistant type of diabetes. Yet, many physicians and experts regarded diabetes as a single disease entity, with a more severe clinical course when commencing in children and young adults than when onset was in middle and older age. During the past decade, however, there has been remarkable progress in our understanding of diabetes. It has become clearly established that the two major clinical patterns of the diabetic syndrome are probably distinct entities-in terms of etiology, pathogenesis, clinical presentation and requisite treatment strategies. These have been labeled insulin-dependent diabetes mellitus and noninsulindependent diabetes mellitus in the recent classification of the National Diabetes Group and the Expert Committee on Diabetes of the World Health Organization [W.I. Insulin-dependent diabetes mellitus or type I diabetes, is characterized by severe and pathognomonic changes in the pancreatic islets, by an eventual absolute deficiency of endogenous pancreatic insulin secretion, insulinopenia, proneness to ketosis and a dependency on daily insulin administration for the maintenance of life. This form of diabetes has a clear association with HLA antigens B8/DW3 and B15/DW4 on chromosome 6 [3], a finding which may be indicative that there is a diabetogenic gene on that chromosome. Islet cell destruction occurs in susceptible persons, presumably as a consequence of an abnormal immune response and autoimmunity. Such islet cell destruction is often reflected by circulating antibodies to islet cell cytoplasm or islet cell surface, particularly at the onset of insulindependent diabetes mellitus. It may be triggered by viral infection, noxious chemicals and/or other as yet unidentified environmental factors. It is likely that there is heterogeneity within insulin-dependent diabetes mellitus as well, with a number of separate subtypes now emerging. Noninsulin-dependent diabetes mellitus, or type II diabetes, is characterized by retention of endogenous pancreatic insulin secretion, although with altered secretory dynamics; the absence of ketosis; and insulin resistance due to diminished target cell response to insulin. Patients with noninsulin-dependent diabetes mellitus are usually not dependent on insulin for prevention of ketosis or maintenance of life, although they may require insulin for correction of symptomatic or persistent, fasting hyperglycemia if this cannot be achieved with the use of diet or oral agents. The majority (80 percent) are obese. The whole range of insulin responses to glucose, from low to supranormal, has been reported in patients with noninsulin-dependent diabetes mellitus. Undoubtedly, there is a spectrum of subtypes of noninsulin-dependent diabetes mellitus." @default.
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• W2056501443 date "1981-01-01" @default.
• W2056501443 modified "2023-10-18" @default.
• W2056501443 title "Foreword diabetes mellitus: Progress and directions" @default.
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• W2056501443 doi "https://doi.org/10.1016/0002-9343(81)90416-2" @default.
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