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糖尿病英文文章

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2021-01-26 05:15
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Diabetes mellitus type 2
(formerly noninsulin-dependent diabetes mellitus
(NIDDM) or adult-onset diabetes) is a metabolic disorderthat is characterized by high blooglucose
in the context of insulin resistance and relative insulin deficiency.[2] This is in contrast todiabetes
mellitus type 1, in which there is an absolute insulin deficiency due to destruction of islet cells in t
he pancreas.[3]
The classic symptoms
are excess thirst, frequent urination, and constant hunger. T
ype 2 diabetes makes up about 90% of cases of diabetes with the other 10% due primarily to diabe
tes mellitus type 1 and gestational diabetes. Obesity is thought to be the primary cause of type 2 di
abetes in people who are genetically predisposed to the disease.
Type 2 diabetes
is initially managed by increasing exercise and dietary modification. If blood glu
cose levels are not adequately lowered by these measures, medications such
as metformin or insulin may be needed. In those on insulin, there is typically the requirement to ro
utinely check blood sugar levels.
Rates of type 2 diabetes have increased markedly over the last 50 years in parallel with obesity: As
of 2010 there are approximately 285 million people with the disease compared to around 30 milli
on in 1985.[4][5]
Long-term complications
from high blood sugar can include heart
disease,strokes, diabetic retinopathy where eyesight is affected, kidney failurewhich may require d
ialysis, and poor circulation of limbs leading toamputations. The acute complication of ketoacidosi
s, a feature of type 1 diabetes, is uncommon.[6] However, nonketotic hyperosmolar coma may occ
ur.




Signs and symptoms


Overview of the most significant symptoms of diabetes.
The classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), p
olyphagia (increased hunger), and weight loss.[7] Other symptoms that are commonly present at d
iagnosis include: a history of blurred vision,itchiness, peripheral neuropathy,
recurrent vaginal infections, and fatigue. Many people, however, have no symptoms during the firs
t few years and are diagnosed on routine testing. People with type 2 diabetes mellitus may rarely p
resent with nonketotic hyperosmolar coma (a condition of very high blood sugar associated with a
decreased level of consciousness and low blood pressure).



10 References
11 External links
Signs and symptoms


Overview of the most significant symptoms of diabetes.
The classic symptoms of diabetes are polyuria (frequent
Complications
Main article: Complications of diabetes mellitus
Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life
expectancy.[4] This is partly due to a number of complications with which it is associated, includi
ng: two to four times the risk of cardiovascular disease, includingischemic heart disease and stroke
; a 20-fold increase in lower limb amputations, and increased rates of hospitalizations.[4] In the de
veloped world, and increasingly elsewhere, type 2 diabetes is the largest cause of
nontraumatic blindnessand kidney failure.[8] It has also been associated with an increased risk of
cognitive dysfunction and dementiathrough disease processes such as Alzheimer'disease and vascu
lar dementia.[9] Other complications include:acanthosis nigricans, sexual dysfunction, and freque
nt infections.[7]
cause
The development of type 2 diabetes is caused by a combination of lifestyle and genetic factors.[8][
10] While some are under personal control, such as diet and obesity, others, such as increasing age
, female gender, and genetics, are not.[4] A lack of sleep has been linked to type 2 diabetes.[11] Th
is is believed to act through its effect on metabolism.[11] The nutritional status of a mother during
fetal development may also play a role, with one proposed mechanism being that of altered DNA
methylation

genetic
There are a number of rare cases of diabetes that arise due to an abnormality in a single gen
e (known asmonogenic forms of diabetes or
clude maturity onset diabetes of the young (MODY), Donohue syndrome,
and Rabson-Mendenhall syndrome, among others.[4] Maturity onset diabetes of the young c
onstitute 1

5% of all cases of diabetes in young people.[18]
Medical conditions
There are a number of medications and other health problems that can predispose to
diabetes.[19] Some of the medications include: glucocorticoids, thiazides, beta blockers, atyp
ical antipsychotics,[20] andstatins.[21]Those who have previously had gestational diabetes ar
e at a higher risk of developing type 2 diabetes.[7] Other health problems that are associated
include: acromegaly, Cushing's syndrome, hyperthyroidism,pheochromocytoma, and
certain cancers such as glucagonomas.[19] Testosterone deficiency is also associated with typ
e 2 diabetes.[22][23]
Pathophysiology
Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insuli
n resistance.[3] Insulin resistance, which is the inability of cells to respond adequately to nor
mal levels of insulin, occurs primarily within the muscles, liver, and fat tissue.[24] In the liver
, insulin normally suppresses glucose release. However, in the setting of insulin resistance, th
e liver inappropriately releases glucose into the blood.[4] The proportion of insulin resistance
versus beta cell dysfunction differs among individuals, with some having primarily insulin r
esistance and only a minor defect in insulin secretion and others with slight insulin resistance
and primarily a lack of insulin secretion.[3] Other potentially important mechanisms associ
ated with type 2 diabetes and insulin resistance include: increased breakdown of lipids withi
n fat cells, resistance to and lack of incretin, high glucagon levels in the blood, increased rete
ntion of salt and water by the kidneys, and inappropriate regulation of metabolism by thecen
tral nervous system.[4] However, not all people with insulin resistance develop diabetes, sinc
e an impairment of insulin secretion by pancreatic beta cells is also required.[3]
Diagnosis
The World Health Organizationdefinition of diabetes (both type 1 and type 2) is for a single
raised glucose reading with symptoms, otherwise raised values on two occasions, of either:[2
7]

fasting plasma glucose

7.0 mmol/l (126 mg/dl) or








with a glucose tolerance test, two hours after the oral dose a plasma glucose

11.1 mmol/
l
(200 mg/dl)
A random blood sugar of greater than 11.1 mmol/l (200 mg/dL) in association with typical sy
mptoms[7] or aglycated hemoglobin (HbA1c) of greater than 6.5% is another method of diag
nosing diabetes.[4] In 2009 an International Expert Committee that included representatives
of the American Diabetes Association (ADA), the International Diabetes Federation (IDF), a
nd the European Association for the Study of Diabetes (EASD) recommended that a threshol
d of

6.5% HbA1c should be used to diagnose diabetes. This recommendation was adopted by the
American Diabetes Association in 2010.[28] Positive tests should be repeated unless the perso
n presents with typical symptoms and blood sugars >11.1 mmol/l (>200 mg/dl).[29]
Threshold for diagnosis of diabetes is based on the relationship between results of glucose tol
erance tests, fasting glucose or HbA1c and complications such as retinal problems.[4] A fasti
ng or random blood sugar is preferred over the glucose tolerance test, as they are more conv
enient for people.[4] HbA1c has the advantages that fasting is not required and results are m
ore stable but has the disadvantage that the test is more costly than measurement of blood gl
ucose.[30] It is estimated that 20% of people with diabetes in the United States do not realize
that they have the disease.[4]
Diabetes mellitus type 2 is characterized by high blood glucose in the context of insulin resist
ance and relative insulin deficiency.[2] This is in contrast to diabetes mellitus type 1 in which
there is an absolute insulin deficiency due to destruction of islet cells in
the pancreas and gestational diabetes mellitus that is a new onset of high blood sugars in ass
ociated with pregnancy.[3] Type 1 and type 2 diabetes can typically be distinguished based o
n the presenting circumstances.[29] If the diagnosis is in doubt antibody testing may be usefu
l to confirm type 1 diabetes and C-peptide levels may be useful to confirm type 2
diabetes,[31] with C-peptide levels normal or high in type 2 diabetes, but low in type 1 diabet
es.
Screening
No major organization recommends universal screening for diabetes as there is no evidence t
hat such a program would improve outcomes.[32] Screening is recommended by the United
States Preventive Services Task Force in adults without symptoms whose blood pressure is gr
eater than 135/80 mmHg.[33] For those whose blood pressure is less, the evidence is insuffici
ent to recommend for or against screening.[33] The World Health
Organizationrecommends only testing those groups at high risk.[32] High-risk groups in the
United States include: those over 45 years old; those with a first degree relative with diabetes
; some ethnic groups, including Hispanics, African-Americans, and Native- Americans; a hist
ory








of gestational diabetes; polycystic ovary syndrome; excess weight; and conditions associated
with metabolic syndrome.[7]
Prevention
Main article: Prevention of diabetes mellitus type 2
Onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular e
xercise.[34][35]Intensive lifestyle measures may reduce the risk by over half.[8] The benefit o
f exercise occurs regardless of the person's initial weight or subsequent weight loss.[36] Evid
ence for the benefit of dietary changes alone, however, is limited,[37] with some evidence for
a diet high in green leafy vegetables[38] and some for limiting the intake of sugary drinks.[13
] In those with impaired glucose tolerance, diet and exercise either alone or in combination w
ith metformin or acarbose may decrease the risk of developing diabetes.[8][39] Lifestyle inte
rventions are more effective than metformin.[8]ention
Main article: Prevention of diabetes mellitus type 2
Onset of type 2 diabetes can be delayed or prevented through proper nutrition and regular exercise
.[34][35]Intensive lifestyle measures may reduce the risk by over half.[8] The benefit of exercise o
ccurs regardless of the person's initial weight or subsequent weight loss.[36] Evidence for the bene
fit of dietary changes alone, however, is limited,[37] with some evidence for a diet high in green le
afy vegetables[38] and some for limiting the intake of sugary drinks.[13] In those with impaired gl
ucose tolerance, diet and exercise either alone or in combination with metformin or acarbose may
decrease the risk of developing diabetes.[8][39] Lifestyle interventions are more effective than met
formin.[8]
Management
Further information: Diabetes management
Management of type 2 diabetes
focuses on lifestyle interventions, lowering other cardiovascular

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