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pancreaticoduodenectomy\t(Whipple\tprocedure)\n,\nin\twhich\tdistal\tsegment\t(antrum)\tof\tthe\tstomach,\tthe\tfirst\tand\tsecond\tportions\tof\tthe\tduodenum,\tthe\thead\tof\tthe\npancreas,\tthe\tcommon\tbile\tduct,\tand\tthe\tgallbladder\tare\tremoved.\tThe\tbasic\tconcept\tbehind\tthe
|
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pancreaticoduodenectomy\tis\tthat\tthe\thead\tof\tthe\tpancreas\tand\tthe\tduodenum\tshare\tthe\tsame\tarterial\tblood\tsupply\n(the\tgastroduodenal\tartery).\tThese\tarteries\trun\tthrough\tthe\thead\tof\tthe\tpancreas,\n\tso\tboth\torgans\tmust\tbe\tremoved\tif\nthe\tsingle\tblood\tsupply\tis\tsevered.\tIf\tonly\tthe\thead\tof\tthe\tpancreas\twere\tremoved,\tit\twould\tcompromise\tblood\tflow\tto
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the\tduodenum,\tresulting\tin\ttissue\tnecrosis.\tA\tcholecystectomy,\tvagotomy,\tor\ta\tpartial\tgastrectomy\talso\tmay\tbe\nperformed\tduring\tthe\tsurgery.\tThe\tpancreatic\tduct\tis\treanastomosed\t(reattached)\tto\tthe\tjejunum.\tPartial\tor\tcomplete\npancreatic\tinsufficiency\n\tcan\tresult,\tdepending\ton\tthe\textent\tof\tthe\tpancreatic\tresection.\tMost\tpatients\twho\thave
|
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undergone\tpancreatic\tresection\tare\tat\trisk\tfor\tvitamin\tand\tmineral\tdeficiencies\tand\twill\tbenefit\tfrom\tvitamin\tand\nmineral\tsupplementation.\tNutrition\tcare\tis\tsimilar\tto\tthat\tfor\tCP.\nPancreatic\tand\tislet\tcell\ttransplantation\nThere\thave\tbeen\tsignificant\timprovements\tin\tthe\toutcomes\tof\tpatients\tundergoing\tpancreatic\n\ttransplants\tor
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transplants\tor\npancreatic\ttransplants\tcombined\twith\ta\tkidney\ttransplant\t(\nDean\tet\tal,\t2017\n;\t\nLaftavi\tet\tal,\t2017\n).\tIn\tpatients\twith\nunstable\t(brittle)\tdiabetes\tmellitus\twho\tsuffer\tfrom\tbouts\tof\thyper-\tand\thypoglycemia,\ttransplantation\tcan\trestore
|
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0.035354357212781906,
0.06706076860427856,
0.07948548346757889,
0.010022049769759178
] |
normal\tglucose\thomeostasis\tand\tprevent,\thalt,\tor\treverse\tthe\tprogression\tof\tsecondary\tcomplications\t(\nDunn,\t2014\n;\nGruessner\tand\tGruessner,\t2013\n).\nPancreatic\n\tislet\tallotransplantation\tis\ta\tprocedure\tin\twhich\tislets\tfrom\tthe\tpancreas\tof\ta\tdeceased\torgan\tdonor\tare
|
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] |
purified,\tprocessed,\tand\ttransferred\tinto\ta\trecipient.\tIt\tis\tperformed\tin\tcertain\tpatients\twith\ttype\t1\tdiabetes\tmellitus\nwhose\tblood\tglucose\tlevels\tare\textremely\tlabile\tand\tdifficult\tto\tcontrol.\t\nPancreatic\tislet\tautotransplantation\n\tis\nperformed\tafter\ttotal\tpancreatectomy\tin\tpatients\twith\tsevere
|
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is\nperformed\tafter\ttotal\tpancreatectomy\tin\tpatients\twith\tsevere\n\tand\tchronic,\tor\tlong-lasting,\tpancreatitis\tthat\tcannot\tbe\nmanaged\tby\tother\ttreatments.\tAfter\tpancreatectomy,\tislets\tare\textracted\tand\tpurified\tfrom\tthe\tpancreas.\tThe\tislets
|
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-0.06741014868021011
] |
then\tare\tinfused\tthrough\ta\tcatheter\tinto\tthe\tliver.\tThe\tgoal\tis\tto\tgive\tthe\tbody\tenough\thealthy\tislets\tto\tmake\tinsulin.\nA\tperson\twho\treceives\ta\tpancreatic\tislet\tcell\ttransplant\tshould\tfollow\ta\tmeal\tplan\tdesigned\tfor\ta\tperson\n\twith\ndiabetes\tmellitus\tif\thyperglycemia\tis\tpresent.\tSome\tpatients\tundergoing\tthis\tprocedure\twill\tachieve\tnormoglycemia
|
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] |
without\texogenous\tinsulin\t(see\t\nChapter\t29\n).\tImmunosuppressive\tmedications\tare\trequired\tfor\tallo-\tbut\tnot\nautotransplantation;\tthese\tmedications\tcan\tcontribute\tto\tweight\tgain,\thypertension,\tdyslipidemia,\tand\tlabile\tblood\nglucose\tlevels\t(\nChhabra\tand\tBrayman,\t2014\n).\nAlthough\tpancreas
|
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] |
glucose\tlevels\t(\nChhabra\tand\tBrayman,\t2014\n).\nAlthough\tpancreas\n\ttransplantation\thas\tbeen\tfavored\tfor\tβ-cell\treplacement,\twith\timproved\toutcomes\tfollowing\tislet\ntransplantation,\tthe\tuse\tof\tthis\tminimally\tinvasive\ttherapy\tin\tcarefully\tselected\tpatients\tshould\tbe\tconsidered\t(\nWisel\net\tal,\t2016\n;\t\nHatipoglu,\t2016\n;\t\nMarkmann\tet\tal,\t2016
|
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] |
Wisel\net\tal,\t2016\n;\t\nHatipoglu,\t2016\n;\t\nMarkmann\tet\tal,\t2016\n).\tPancreas\ttransplant\tremains\tthe\tprocedure\tof\tchoice\tfor\tβ-cell\nreplacement\tin\turemic\tpatients.\tIslet\ttransplantation\tshould\tbe\tconsidered\n\tin\tnonuremic\tpatients\twith\tlow\tbody\tmass
|
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in\tnonuremic\tpatients\twith\tlow\tbody\tmass\nindex\t(BMI)\tand\tlow\tinsulin\trequirements,\tpatients\tlacking\tthe\tcardiovascular\treserve\tto\tundergo\topen\tabdominal\nsurgery,\tor\tpatients\twho\telect\tto\tforego\tthe\trisks\tof\ta\tmajor\toperation\tin\texchange\tfor\tan\tincreased\trisk\tof\tislet\tgraft\nfailure.\nClinical\tCASE\tSTUDY\t1
|
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] |
failure.\nClinical\tCASE\tSTUDY\t1\nA\t62-year-old\twhite\tman\tis\tadmitted\tto\tthe\thospital\tfrom\tthe\tdoctor’s\toffice\twith\taltered\n\tmental\tstatus.\tPast\nmedical\thistory\treveals\tcirrhosis\tresulting\tfrom\thepatitis\tC,\tesophageal\tvarices,\thepatic\tencephalopathy,\tand
|
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] |
ascites.\tThe\tpatient\treports\tmissing\this\tdoses\tof\tlactulose\tthe\ttwo\tprevious\tdays.\tMuscle\twasting\tis\tnoted\tin\tthe\nform\tof\tsquared\tshoulders,\tprominent\tclavicle,\ttemporal\twasting,\tand\tthin\textremities.\tHe\thas\t3+\tpitting\tedema\nin\this\tlower\textremities\tand\ta\tprotuberant\n\tabdomen\tfrom\tascites.\tHis\tabnormal\tlaboratory\tvalues\ton\tadmission
|
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abdomen\tfrom\tascites.\tHis\tabnormal\tlaboratory\tvalues\ton\tadmission\nincluded\televated\tliver\tfunction\tenzymes\tand\ttotal\tbilirubin,\tsodium\t127\tmEq/L,\tglucose\t68\tmg/dL.\tNutritional\ndata\tinclude\theight,\t177.8\tcm;\tweight,\t71.8\tkg;\tdry\tweight,\t75\tkg;\trecent\tbody\tweight\trange\tdue\tto\tfluid\nfluctuations,\t63.6\tkg\tto\t90.9\tkg.\nNutrition\tdiagnostic\tstatements
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0.050380267202854156,
0.05756586417555809,
0.022747410461306572,
0.03367820382118225,
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] |
fluctuations,\t63.6\tkg\tto\t90.9\tkg.\nNutrition\tdiagnostic\tstatements\n•\t\nInvoluntary\tweight\tloss\trelated\tto\tcirrhosis\n\tas\tevidenced\tby\t4.5%\tweight\tloss\t(based\ton\tdry\tweight)\tand\nphysical\tsigns\tof\tmalnutrition.\n•\t\nAltered\tlaboratory\tvalues\trelated\tto\tcirrhosis\tas\tevidenced\tby\thyponatremia\tand\thypoglycemia.\nInterventions\n•
|
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] |
Interventions\n•\t\nInitiate\t2\tg\tsodium\tdiet\twith\tsmall,\tfrequent\tmeals.\n•\t\nEnsure\tadequate\tkcals\tand\tprotein.\n•\t\nFluid\trestriction\t(coordinate\tcare\twith\tmedical\tteam).\n•\t\nInitiate\tcommercial\tbeverage\ttwice\n\tdaily.\nMonitoring\tand\tevaluation\n•\t\nMonitor\tfood\tand\tbeverage\tintake.\n•\t\nAssess\tfood\tand\tnutrition\tknowledge.\n•
|
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] |
•\t\nAssess\tfood\tand\tnutrition\tknowledge.\n•\t\nAssess\tadherence\tto\tprescribed\tdiet.\nCLINICAL\tCASE\tSTUDY\t2\nA\t42-year-old\tHispanic\tfemale\tpresents\twith\ta\thistory\tof\tchronic\tpancreatitis\tresulting\tfrom\tpancreatic\tdivisum\t(a\ncongenital\tabnormality\tin\twhich\tthere\tare\ttwo\tpancreatic\tducts\tinstead\tof\tone).\tThe\tpatient\n\thas\thad\tmultiple
|
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] |
has\thad\tmultiple\nhospitalizations\tfor\tacute\tpancreatitis.\tDespite\tplacement\tof\tpancreatic\tstents,\tshe\thas\tdeveloped\tchronic\npancreatitis\t(confirmed\tby\tabnormal\tendoscopic\tultrasound\tand\tlow\tfecal\telastase)\tand\tdepends\ton\tchronic\tpain\nmedications.\tShe\tpresents\tfor\tevaluation\tof\ttotal\tpancreatectomy\twith\tislet\tautotransplantation.\tThe\tpatient\tis
|
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29\nMedical\tnutrition\ttherapy\tfor\ndiabetes\tmellitus\tand\nhypoglycemia\tof\tnondiabetic\norigin\nJessica\tJones,\tMS,\tRDN,\tCDE\nKEY\tTERMS\nacanthosis\tnigricans\namylin\nautonomic\tsymptoms\nbasal\tor\tbackground\tinsulin\tdose\nC-peptide\ncarbohydrate\tcounting\ncontinuous\tglucose\tmonitoring\t(CGM)\ncorrection\tfactor\t(CF)\ncounterregulatory\t(stress)\thormones\ndawn\tphenomenon
|
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] |
counterregulatory\t(stress)\thormones\ndawn\tphenomenon\ndiabetic\tketoacidosis\n\t(DKA)\nfasting\thypoglycemia\nfasting\tplasma\tglucose\t(FPG)\ngastroparesis\ngestational\tdiabetes\tmellitus\t(GDM)\nglucagon\nglucotoxicity\nglycemic\tindex\t(GI)\nglycemic\tload\t(GL)\nglycosylated\themoglobin\t(A1C)\nhoneymoon\tphase\nhyperglycemia\nhyperglycemic\thyperosmolar\tstate\t(HHS)
|
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] |
honeymoon\tphase\nhyperglycemia\nhyperglycemic\thyperosmolar\tstate\t(HHS)\nhypoglycemia\t(or\tinsulin\treaction)\nhypoglycemia\tof\tnondiabetic\torigin\nimmune-mediated\tdiabetes\tmellitus\nimpaired\n\tfasting\tglucose\t(IFG)\nimpaired\tglucose\ttolerance\t(IGT)\nincretins\ninsulin\ninsulin\tdeficiency\ninsulin\tresistance\ninsulin\tsecretagogues\ninsulin\tto\tcarbohydrate\tratio
|
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insulin\tsecretagogues\ninsulin\tto\tcarbohydrate\tratio\nlag\ttime\nlatent\tautoimmune\tdiabetes\tof\tthe\tadult\t(LADA)
|
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] |
lipotoxicity\nmacrosomia\nmacrovascular\tdiseases\nmaturity\tonset\tdiabetes\tof\tyouth\t(MODY)\nmetabolic\tsyndrome\nmicrovascular\tdiseases\nneuroglycopenic\tsymptoms\nnormoglycemia\npolydipsia\npolyphagia\npolyuria\npostprandial\t(after\ta\tmeal)\tblood\tglucose\npostprandial\t(reactive)\thypoglycemia\nprediabetes\npreprandial\t(fasting/premeal)\tblood\tglucose
|
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] |
prediabetes\npreprandial\t(fasting/premeal)\tblood\tglucose\nself-monitoring\tof\tblood\tglucose\t(SMBG)\nSomogyi\teffect\ntype\t1\tdiabetes\tmellitus\t(T1DM)\ntype\t2\tdiabetes\tmellitus\t(T2DM)\nWhipple’s\ttriad\nFor\tmost\tpeople,\teating\tcarbohydrate\tfoods\twill\tcause\tblood\tsugar\tlevels\tto\trise.\n\tHowever,\tthe
|
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] |
However,\tthe\ndifference\tbetween\tpeople\twith\tdiabetes\tand\tthose\twithout\tthe\tdisease\tis\thow\thigh\tthe\tblood\tsugar\nrises,\tand\tfor\thow\tlong.\nDiabetes\tmellitus\tis\ta\tgroup\tof\tdiseases\tcharacterized\tby\tprolonged\thigh\tblood\tglucose\nconcentrations.\tThe\tcause\tof\thigh\tblood\tglucose—also\tknown\tas\t\nhyperglycemia\n—is\tthe\tresult\tof
|
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0.007817616686224937
] |
hyperglycemia\n—is\tthe\tresult\tof\ndefects\tin\tinsulin\tsecretion,\tinsulin\taction,\tor\tboth.\t\nInsulin\n,\ta\thormone\tproduced\n\tby\tthe\tbeta-cells\tof\nthe\tpancreas,\tis\tnecessary\tfor\tthe\tuse\tor\tstorage\tof\tmacronutrients\t(think\tcarbohydrate,\tprotein,\tand\nfat).\tSince\tpeople\twith\tdiabetes\tdo\tnot\tproduce\tadequate\tinsulin—and/or\thave\tsome\tdegree\tof
|
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insulin\tresistance—hyperglycemia\toccurs.\nDiabetes\tmellitus\tcontributes\tto\ta\tconsiderable\tincrease\tin\tmorbidity\tand\tmortality,\twhich\tcan\tbe\nreduced\tby\tearly\tdiagnosis\tand\ttreatment.\n\tDirect\tmedical\texpenditures\tsuch\tas\tinpatient\tcare,\noutpatient\tservices,\tand\tnursing\thome\tcare\tare\tastronomical,\tand\tindirect\tcosts\tsuch\tas\tdisability,
|
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] |
work\tloss,\tand\tpremature\tmortality\tare\tequally\thigh.\tResearch\testimates\tthat\tthe\ttotal\tcosts\tof\ndiagnosed\tdiabetes\thave\trisen\tto\t$327\tbillion\tin\t2017\tfrom\t$245\tbillion\tin\t2012\t(\nYang\tet\tal,\t2018\n).\nThus\tproviding\tmedical\tnutrition\ttherapy\t(MNT)\tfor\n\tprevention\tand\ttreatment\tof\tdiabetes\thas
|
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] |
prevention\tand\ttreatment\tof\tdiabetes\thas\ntremendous\tpotential\tto\treduce\tthese\tcosts.\tFortunately,\tpeople\twith\tdiabetes\tcan\ttake\tsteps\tto\ncontrol\tthe\tdisease\tand\tlower\tthe\trisk\tof\tcomplications\tor\tpremature\tdeath.\nIncidence\tand\tprevalence\nIt\tis\testimated\tthat\t9.4%\tof\tthe\tU.S.\tpopulation\tis\tliving\twith\tdiabetes.\tIn\t2017\ttotal\tprevalence\tof
|
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diabetes\tin\tthe\tUnited\tStates\tin\tall\tages\twas\t30.3\tmillion\n\tpeople\t(15.3\tmillion\tadult\tmen\tand\t14.9\nadult\twomen),\tor\t9.4%\tof\tthe\tpopulation.\tOf\tthese,\t23.1\tmillion\tare\tdiagnosed\tand\t7.2\tmillion\tare\nundiagnosed.\tIn\t2015\tan\testimated\t1.5\tmillion\tnew\tcases\tof\tdiabetes\twere\tdiagnosed\tin\tpeople\tage\n18\tyears\tor\tolder\t(
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0.10314980149269104,
0.03260721638798714,
0.0033091742079705,
0.007667202036827803
] |
18\tyears\tor\tolder\t(\nCenters\tfor\tDisease\tControl\tand\tPrevention\t[CDC],\t2017a\n).\tDiabetes\tprevalence\nalso\tincreases\twith\tage,\taffecting\t12\tmillion\tpeople\tage\t65\tyears\n\tand\tolder,\tor\t39.7%\tof\tall\tpeople\tin\nthis\tage\tgroup.\nMuch\tof\tthe\tincrease\tin\tprevalence\tis\tbecause\tthe\tprevalence\tof\ttype\t2\tdiabetes\tis\tincreasing
|
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] |
dramatically\tin\tyounger\tage\tgroups\tin\tthe\tlast\tdecade,\tespecially\tin\tminority\tpopulations.\tAmong\nyouth\twith\tnewly\tdiagnosed\tdiabetes,\tapproximately\t23%\thave\ttype\t2\tdiabetes\t(\nMayer-Davis\tet\tal,\n2017\n).\tThe\tprevalence\tof\ttype\t2\tdiabetes\tis\thighest\tin\n\tethnic\tgroups\tin\tthe\tUnited\tStates.\tData
|
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] |
ethnic\tgroups\tin\tthe\tUnited\tStates.\tData\nindicate\tin\tpeople\taged\t20\tyears\tor\tolder,\t15.1%\tof\tAmerican\tIndians\tand\tAlaska\tNatives,\t12.7%\tof\nnon-Hispanic\tblacks,\t12.1%\tof\tHispanics,\tand\t8.0%\tof\tAsian\tAmericans\thad\tdiagnosed\tdiabetes.\nAmong\tHispanics,\trates\twere\t13.8%\tfor\tMexicans,\t12%\tfor\tPuerto\tRicans,\tand\t9%\tfor\tCubans.\tOf
|
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] |
great\tconcern\tare\tthe\t84.1\tmillion\tpeople\t(34%\tof\tadults\t18\tyears\tor\tolder\n\tand\t48.3%\tof\tadults\t65\nyears\tor\tolder)\twith\tprediabetes,\twhich\tincludes\timpaired\tglucose\ttolerance\t(IGT)\tand\timpaired\nfasting\tglucose\t(IFG)\t(\nCDC,\t2017a\n).\tAll\tare\ta\thigh\trisk\tfor\tconversion\tto\ttype\t2\tdiabetes\tand
|
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] |
the\tcircumstances\tpresent\tat\tthe\ttime\nof\tdiagnosis,\tand\tmany\tindividuals\tdo\tnot\teasily\tfit\tinto\ta\tsingle\tcategory.\tWhat\tis\tessential\tis\tthe\nneed\tto\tintercede\tearly\twith\tlifestyle\tinterventions,\tbeginning\twith\tprediabetes\tand\tcontinuing\nthrough\tthe\tdisease\tprocess.\nPrediabetes
|
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] |
Individuals\twith\ta\tstage\tof\timpaired\tglucose\thomeostasis\tthat\tincludes\t\nimpaired\tfasting\tglucose\n(IFG)\n\tand\t\nimpaired\tglucose\ttolerance\t(IGT)\n\tare\treferred\tto\tas\thaving\tprediabetes,\tindicating\ntheir\trelatively\thigh\trisk\tfor\tthe\tdevelopment\tof\tdiabetes\tand\tCVD.\t\nPrediabetes\n\tis\tdiagnosed\twith\tat
|
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Prediabetes\n\tis\tdiagnosed\twith\tat\nleast\tone\tof\tthe\tfollowing:\tIFG\t(fasting\tplasma\tglucose\t100\tto\t125\tmg/dL),\tIGT\t(2-hour\tpostchallenge\nglucose\tof\t140\tto\t199\tmg/dL),\tboth,\tor\ta\themoglobin\tA1C\tof\t5.7%\tto\t6.4%.\tIndividuals\tdiagnosed\nwith\tprediabetes\tand\tshould\tbe\tcounseled\tabout\teffective\n\tdiabetes\tprevention\tstrategies,\tsuch\tas
|
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] |
diabetes\tprevention\tstrategies,\tsuch\tas\neating\ta\tbalanced\tdiet\tand\tincreasing\tphysical\tactivity,\tto\tlower\ttheir\trisks\t(\nAmerican\tDiabetes\nAssociation\t[ADA],\t2018\n).\nType\t1\tdiabetes\nThe\tADA\testimates\tthat\tabout\t1.25\tmillion\tAmericans\thave\ttype\t1\tdiabetes\t(\nADA,\t2018\n).\tAt\ndiagnosis,\tpeople\twith\t\ntype\t1\tdiabetes\tmellitus\t(T1DM)
|
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] |
).\tAt\ndiagnosis,\tpeople\twith\t\ntype\t1\tdiabetes\tmellitus\t(T1DM)\n\toften\texperience\texcessive\tthirst,\nfrequent\turination,\tand\tsignificant\n\tweight\tloss.\tThe\tprimary\tdefect\tis\tpancreatic\tbeta-cell\ndestruction,\tusually\tleading\tto\tabsolute\t\ninsulin\tdeficiency\n\tand\tresulting\tin\thyperglycemia,\npolyuria\n\t(excessive\turination),\t\npolydipsia
|
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] |
polyuria\n\t(excessive\turination),\t\npolydipsia\n\t(excessive\tthirst),\t\npolyphagia\n\t(excessive\thunger),\nunexpected\tweight\tloss,\tdehydration,\telectrolyte\tdisturbance,\tand\t\ndiabetic\tketoacidosis\t(DKA)\n—a\nserious\tcomplication\tof\tdiabetes\tcharacterized\tby\textreme\n\thyperglycemia\tand\ta\tbuildup\tof\tketones\tin
|
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] |
hyperglycemia\tand\ta\tbuildup\tof\tketones\tin\nthe\tblood\tand\turine.\tThe\trate\tof\tbeta-cell\tdestruction\tis\tvariable,\tproceeding\trapidly\tin\tinfants\tand\nchildren\tand\tslowly\tin\tothers\t(mainly\tadults.)\tThe\tcapacity\tof\ta\thealthy\tpancreas\tto\tsecrete\tinsulin\tis
|
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far\tin\texcess\tof\twhat\tis\tneeded\tnormally.\tTherefore\tthe\tclinical\tonset\tof\tdiabetes\tmay\tbe\tpreceded\tby\nan\textensive\tasymptomatic\tperiod\tof\tmonths\tto\tyears,\n\tduring\twhich\tbeta-cells\tare\tundergoing\ngradual\tdestruction.\nT1DM\taccounts\tfor\t5%\tof\tall\tdiagnosed\tcases\tof\tdiabetes\t(\nCDC,\t2017a\n).\tPeople\twith\tT1DM\tare
|
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] |
CDC,\t2017a\n).\tPeople\twith\tT1DM\tare\ndependent\ton\texogenous\tinsulin—meaning\tinsulin\tproduced\toutside\tof\tthe\tbody—to\tprevent\nketoacidosis\tand\tdeath.\tT1DM\tcan\tdevelop\tat\tany\tage.\tAlthough\tmore\tcases\tare\tdiagnosed\tin\tpeople\nbefore\tthe\tage\tof\t30\tyears,\tit\talso\toccurs\tin\tolder\tindividuals.\n\tMost\tindividuals\tare\tlean\tbut\tsome\tare
|
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] |
Most\tindividuals\tare\tlean\tbut\tsome\tare\ndiagnosed\twithout\tany\t(or\twith\tmore\tsubtle)\tsymptoms\tand\tmay\tbe\tat\ta\thigher\tweight.\nT1DM\thas\ttwo\tforms:\timmune-mediated\tand\tidiopathic\t(\nADA,\t2018\n).\t\nImmune-mediated\tdiabetes\nmellitus\n\tresults\tfrom\tan\tautoimmune\tdestruction\tof\tthe\tbeta-cells\tof\tthe\tpancreas,\tthe\tonly\tcells\tin
|
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the\tbody\tthat\tmake\tthe\thormone\tinsulin.\tIdiopathic\tT1DM\trefers\tto\tforms\tof\tthe\tdisease\n\tthat\thave\tno\nknown\tetiology.\tAlthough\tonly\ta\tminority\tof\tindividuals\twith\tT1DM\tfall\tinto\tthis\tcategory,\tof\tthose\nwho\tdo,\tmost\tare\tof\tAfrican\tor\tAsian\tancestry\t(\nADA,\t2018\n).\tAt\tthis\ttime\tthere\tis\tno\tknown\tcure\tfor\nT1DM.
|
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] |
ADA,\t2018\n).\tAt\tthis\ttime\tthere\tis\tno\tknown\tcure\tfor\nT1DM.\nSince\tautoimmune\tthyroid\tdisease\tand\tceliac\tdisease\toccur\twith\tincreased\tfrequency\tin\tpeople\nwith\tT1DM,\tthe\tADA\tsuggests\tscreening\tfor\tthyroid\tdisease\tin\tpeople\tdiagnosed\twith\tT1DM.\n\tOther\nautoimmune\tconditions,\tsuch\tas\tceliac\tdisease,\tAddison’s\tdisease,\tautoimmune\thepatitis,
|
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] |
autoimmune\tgastritis,\tdermatomyositis,\tand\tmyasthenia\tgravis,\talso\toccur\tmore\tcommonly\tin\tpeople\nwith\tT1DM\tcompared\twith\tthe\tgeneral\tpediatric\tpopulation.\tIndividuals\twith\tceliac\tdisease\tthat\thas\nbeen\tconfirmed\tby\ta\tbiopsy\tshould\tbe\tplaced\ton\ta\tgluten-free\tdiet\tby\ta\tregistered\tdietitian\nnutritionist
|
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nutritionist\n\t(RDN)\texperienced\tin\tmanaging\tdiabetes\tand\tceliac\tdisease\t(\nADA,\t2018\n).\nPathophysiology\nAs\tmentioned\tpreviously,\tpeople\twith\tT1DM\texperience\tdestruction\tof\tthe\tpancreatic\tbeta\tcells,\nwhich\tresults\tin\tdecreased\tinsulin\tproduction\tand\tprolonged\televation\tof\tblood\tglucose\tlevels.
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Markers\tof\tthe\timmune\tdestruction\tof\tthe\tbeta-cells\tinclude\tislet\tcells\tautoantibodies;\tautoantibodies\nto\tinsulin;\tautoantibodies\n\tto\tglutamic\tacid\tdecarboxylase\t(GAD65)\t(a\tprotein\ton\tthe\tsurface\tof\tthe\nbeta-cells);\tand\tautoantibodies\tto\tthe\ttyrosine\tphosphatases\tIA-2,\tIA-2beta,\tand\tZnT8.\tT1DM\tis
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] |
defined\tby\tthe\tpresence\tof\tone\tor\tmore\tof\tthese\tautoimmune\tmarkers.\tIt\tis\timportant\tto\tnote\tthat\nT1DM\talso\thas\tstrong\tgenetic\tfactors,\twhich\tinvolve\tthe\tassociation\tbetween\tT1DM\tand\nhistocompatibility\tlocus\tantigen\t(HLA)\n\twith\tlinkage\tto\tthe\tDQA\tand\tDQB\tand\tthe\tDRB\tgenes.\tThese\nHLA-DR/DQ\talleles\tcan\tbe\teither\tpredisposing\tor\tprotective\t(\nADA,\t2018
|
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] |
ADA,\t2018\n).\tIn\tT1DM,\tthe\trate\tof\nclinical\tbeta-cell\tdestruction\tis\tvariable,\tbeing\trapid\tin\tsome\tindividuals\t(mainly\tinfants\tand\tchildren)\nand\tslow\tin\tothers\t(mainly\tadults).\tChildren\tand\tadolescents,\tfor\texample,\tmay\tpresent\twith\tDKA\tas\nthe\tfirst\tmanifestation\tof\tthe\tdisease.\tAdults\n\tcan\toften\tretain\tsufficient\tb-cell\tfunction\tto\tprevent
|
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] |
can\toften\tretain\tsufficient\tb-cell\tfunction\tto\tprevent\nDKA\tfor\tmany\tyears.\tNote\tthat\talthough\tT1DM\tcommonly\toccurs\tin\tchildhood\tand\tadolescence,\tit\ncan\toccur\tat\tany\tage\t(\nADA,\t2018\n).\nFrequently\tafter\tdiagnosis\tand\tthe\tcorrection\tof\thyperglycemia,\tmetabolic\tacidosis,\tand
|
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] |
ketoacidosis,\tendogenous\tinsulin\tsecretion—or\tinsulin\tsecreted\tinside\tthe\tbody—recovers.\tDuring\nthis\t\nhoneymoon\tphase\n,\texogenous\n\t(outside\tthe\tbody)\tinsulin\trequirements\tdecrease\tdramatically\nfor\tup\tto\t1\tyear\tor\tlonger,\tand\tgood\tmetabolic\tcontrol\tmay\tbe\teasily\tachieved\t(\nFonolleda\tet\tal,\t2017\n).
|
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Fonolleda\tet\tal,\t2017\n).\nHowever,\tthe\tneed\tfor\tincreasing\texogenous\tinsulin\treplacement\tis\tinevitable\tand\talways\tshould\tbe\nanticipated.\tIntensive\tinsulin\ttherapy\talong\twith\tattention\tto\tMNT\tand\tself-monitoring\tof\tglucose\nfrom\tearly\tdiagnosis\thas\tbeen\tshown\n\tto\tprolong\tinsulin\tsecretion.\tOne\tstudy\tfound\tthat\tchildren\twho
|
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] |
to\tprolong\tinsulin\tsecretion.\tOne\tstudy\tfound\tthat\tchildren\twho\nwere\tdiagnosed\twith\tT1DM\tearly\tin\tlife—specifically\tbefore\tthe\tage\tof\t7\tyears—had\ta\tmuch\tgreater\nloss\tof\tβ-cells\tcompared\twith\tthose\twho\tare\tdiagnosed\twith\tthe\tillness\tin\ttheir\tteenage\tyears\tor\nbeyond\t(\nLeete\tet\tal,\t2016\n).\nLatent\tautoimmune\tdiabetes\tof\tthe\tadult\t(LADA)
|
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Leete\tet\tal,\t2016\n).\nLatent\tautoimmune\tdiabetes\tof\tthe\tadult\t(LADA)\n—also\tknown\tas\ttype\t1.5\tdiabetes—is\tan\nautoimmune\tdiabetes\tthat\n\toccurs\tin\tadulthood.\tIt\tis\tdefined\tby\tadult-onset,\tpresence\tof\tdiabetes\nassociated\tautoantibodies,\tand\tno\tinsulin\ttreatment\trequirement\tfor\ta\tperiod\tafter\tdiagnosis.\tWith
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genetic\tfeatures\tof\tboth\ttype\t1\tand\ttype\t2\tdiabetes,\tLADA\tis\tthe\tmost\tprevalent\tform\tof\tadult-onset\nautoimmune\tdiabetes\t(and\tpossibly\tthe\tmost\tcommon\tform\tof\tautoimmune\tdiabetes\tin\tgeneral).\nLADA\tmay\tbe\tcontrolled\tinitially\twith\n\tnutrition\ttherapy,\tbut\twithin\ta\trelatively\tshort\tperiod\tof\ttime
|
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] |
nutrition\ttherapy,\tbut\twithin\ta\trelatively\tshort\tperiod\tof\ttime\nglucose-lowering\tmedication\tand\tprogression\tto\tinsulin\ttreatment\tare\trequired\t(\nLaugesen\tet\tal,\n2015\n).
|
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] |
Type\t2\tdiabetes\nType\t2\tdiabetes\tmellitus\t(T2DM)\n\taccounts\tfor\t90%\tto\t95%\tof\tall\tdiagnosed\tcases\tof\tdiabetes\tand\nis\ta\tprogressive\tdisease\tthat,\tin\tmany\tcases,\tis\tpresent\tlong\tbefore\tit\tis\tdiagnosed\t(\nADA,\t2018\n).\nHyperglycemia\tdevelops\n\tgradually\tand\tis\toften\tnot\tsevere\tenough\tin\tthe\tearly\tstages\tfor\tthe\tperson
|
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] |
to\tnotice\tany\tof\tthe\tclassic\tsymptoms\tof\tdiabetes.\tAlthough\tundiagnosed,\tthese\tindividuals\tare\tat\nincreased\trisk\tof\tdeveloping\tmacrovascular\tand\tmicrovascular\tcomplications\t(\nCDC,\t2017a\n).\nMost\tpeople\twith\tT2DM\tare\tobese\t(defined\tas\tbody\tmass\tindex\t[BMI]\t>30\tkg/m\n2\n),\tyet\tmost\tobese
|
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2\n),\tyet\tmost\tobese\nindividuals\tdo\tnot\tdevelop\tT2DM.\tBeing\tat\ta\thigher\tweight\tmay\tincrease\tinsulin\tresistance\tand\tcan\ncontribute\tto\tthe\tdestruction\tof\tthe\tpancreatic\tbeta-cells;\thowever\tthe\texact\tmechanism\tof\taction\nremains\tunclear.\tTherefore\tobesity\tcombined\twith\ta\tgenetic\tpredisposition\tmay\tbe\tnecessary\tfor\nT2DM\tto
|
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] |
T2DM\tto\n\toccur.\tOther\trisk\tfactors\tinclude\tgenetic\tand\tenvironmental\tfactors,\tincluding\ta\tfamily\nhistory\tof\tdiabetes,\tolder\tage,\tphysical\tinactivity,\ta\tprior\thistory\tof\tgestational\tdiabetes,\tprediabetes,\nhypertension\tor\tdyslipidemia,\tand\trace\tor\tethnicity\t(\nEckel\tet\tal,\t2011\n).\nPathophysiology\nT2DM\tis\tcharacterized\tby\ta\tcombination\tof
|
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] |
).\nPathophysiology\nT2DM\tis\tcharacterized\tby\ta\tcombination\tof\t\ninsulin\tresistance\n\t(decreased\ttissue\tsensitivity\tor\nresponsiveness\n\tto\tinsulin)\tand\tbeta-cell\tfailure.\tEndogenous\tinsulin\tlevels\tmay\tbe\tnormal,\tdepressed,\nor\televated,\tbut\tthey\tare\tinadequate\tto\tovercome\tconcomitant\tinsulin\tresistance.\tAs\ta\tresult,
|
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] |
hyperglycemia\tensues.\tAt\tthe\ttime\tT2DM\tis\tdiagnosed,\tthere\tis\tan\testimated\t24%\tto\t65%\treduction\nin\tbeta-cell\tfunction\t(\nChen\tet\tal,\t2017\n).\nInsulin\tresistance\tis\tdemonstrated\tfirst\tin\ttarget\ttissues,\tmainly\tmuscle,\tliver,\n\tand\tadipose\tcells.\nInitially\tthere\tis\ta\tcompensatory\tincrease\tin\tinsulin\tsecretion\t(hyperinsulinemia),\twhich\tmaintains
|
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-0.018462102860212326
] |
glucose\tconcentrations\tin\tthe\tnormal\tor\tprediabetic\trange.\tHowever,\tin\tmany\tpeople,\tthe\tpancreas\tis\nunable\tto\tcontinue\tto\tproduce\tadequate\tinsulin,\twhich\tresults\tin\tchronic\thyperglycemia\tfollowed\tby\na\tdiabetes\tdiagnosis.\nHyperglycemia\tis\tfirst\texhibited\tas\tan\televation\tof\t\npostprandial\t(after\ta\tmeal)\tblood\tglucose
|
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] |
postprandial\t(after\ta\tmeal)\tblood\tglucose\ncaused\tby\tinsulin\tresistance\tat\tthe\tcellular\tlevel\tand\tis\tfollowed\tby\tan\televation\tin\tfasting\tglucose\nconcentrations.\tAs\tinsulin\tsecretion\tdecreases,\thepatic\tglucose\tproduction\tincreases,\tcausing\tthe\nincrease\tin\t\npreprandial\t(fasting/premeal)\tblood\tglucose\tlevels\n.\tThe\tinsulin\tresponse\tis\talso
|
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.\tThe\tinsulin\tresponse\tis\talso\ninadequate\tin\tsuppressing\talpha-cell\t\nglucagon\n\tsecretion,\tresulting\tin\tglucagon\thypersecretion\tand\nincreased\n\thepatic\tglucose\tproduction.\tCompounding\tthe\tproblem\tis\t\nglucotoxicity\n,\tthe\tdeleterious\neffect\tof\thyperglycemia\ton\tinsulin\tsensitivity\tand\tinsulin\tsecretion;\thence\tthe\timportance\tof
|
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achieving\tnear-euglycemia\tin\tpeople\twith\tT2DM\t(\nHædersdal\tet\tal,\t2018\n).\nInsulin\tresistance\talso\tis\tdemonstrated\tat\tthe\tadipocyte\tlevel,\tleading\tto\tlipolysis\tand\tan\televation\nin\tcirculating\tfree\tfatty\tacids.\tIn\tparticular,\n\texcess\tintraabdominal\tobesity,\tcharacterized\tby\tan
|
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excess\tintraabdominal\tobesity,\tcharacterized\tby\tan\nexcess\taccumulation\tof\tvisceral\tfat\taround\tand\tinside\tabdominal\torgans,\tresults\tin\tan\tincreased\tflux\nof\tfree\tfatty\tacids\tto\tthe\tliver,\tleading\tto\tan\tincrease\tin\tinsulin\tresistance.\tIncreased\tfatty\tacid\tlevels
|
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(\nlipotoxicity\n)\talso\tcause\ta\tfurther\tdecrease\tin\tinsulin\tsensitivity\tat\tthe\tcellular\tlevel,\timpair\npancreatic\tinsulin\tsecretion,\tand\tdisrupt\n\thepatic\tglucose\tproduction.\tThe\tabove\tdefects\tcontribute\tto\nthe\tdevelopment\tand\tprogression\tof\tT2DM\tand\tare\talso\tprimary\ttargets\tfor\tpharmacologic\ttherapy.
|
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People\twith\tT2DM\tmay\tor\tmay\tnot\texperience\tthe\tclassic\tsymptoms\tof\tuncontrolled\tdiabetes\n(polydipsia,\tpolyuria,\tpolyphagia,\tweight\tloss)\tand\tthey\tare\tnot\tprone\tto\tdevelop\tketoacidosis\texcept\nduring\ttimes\tof\tsevere\tstress.\tThe\tprogressive\tloss\n\tof\tbeta-cell\tsecretory\tfunction\tmeans\tthat\tpeople
|
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0.0198921337723732,
0.09317874908447266,
0.119118832051754,
-0.022942034527659416
] |
If\tat\tdiagnosis\tit\tis\tnot\tclear\twhether\tT1DM\tor\tT2DM\tis\tpresent,\t\nC-peptide\n\tmay\n\tbe\tmeasured.\nWhen\tthe\tpancreas\tproduces\tinsulin,\tit\tbegins\tas\ta\tlarge\tmolecule—proinsulin.\tThis\tmolecule\tsplits\ninto\ttwo\tequal-sized\tpieces:\tinsulin\tand\tC-peptide.\tA\tperson\twith\tT1DM\thas\ta\tlow\tlevel\tof\tC-peptide,
|
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] |
whereas\tas\ta\tperson\twith\tT2DM\tcan\thave\ta\tnormal\tor\thigh\tlevel\tof\tC-peptide.\tAs\tT2DM\tprogresses,\nC-peptide\talso\tmay\tbe\tmeasured\tto\tsee\tif\tendogenous\tinsulin\tis\tstill\tbeing\tproduced\tby\tthe\n\tpancreas.\nIf\tit\tis\tnot,\texogenous\tinsulin\tis\tneeded\t(\nLeighton\tet\tal,\t2017\n).\nGestational\tdiabetes\tmellitus\nGestational\tdiabetes\tmellitus\t(GDM)
|
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).\nGestational\tdiabetes\tmellitus\nGestational\tdiabetes\tmellitus\t(GDM)\n\tis\ta\ttype\tof\tdiabetes\tthat\toccurs\tduring\tpregnancy.\tAbout\n2%\tto\t10%\tof\tall\tpregnancies\tin\tthe\tUnited\tStates\tare\taffected\tby\tthis\tcondition\t(\nCDC,\t2017b\n).\nGestational\tdiabetes\tincreases\ta\tmother’s\trisk\tof\tboth\thypertension\tduring\tpregnancy\tand\thaving\n\ta
|
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] |
a\nlarge\tbaby\trequiring\ta\tcesarean\tsection\t(C-section).\tGestational\tdiabetes\talso\tincreases\tthe\tbaby’s\nrisk\tof\tpremature\tlabor\t(causing\tbreathing\tand\tother\tproblems),\thaving\tlow\tblood\tsugar,\tand\ndeveloping\tdiabetes\tlater\tin\tlife.\tWomen\tof\tlow\tsocioeconomic\tstatus\tand\tthose\tof\tHispanic,\tNative
|
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American,\tAsian,\tand\tAfrican\tAmerican\tdescent\tare\tmore\tlikely\tto\texperience\tGDM\t(\nPhelan,\t2016\n).\nFor\tmany\n\twomen,\tblood\tsugar\tlevels\twill\trevert\tback\tto\tnormal\tafter\tpregnancy.\tOthers\twill\tend\tup\ndeveloping\tdiabetes.\tIt\tis\testimated\tthat\t15%\tto\t25%\tof\twomen\twith\tprior\tGDM\twill\tdevelop\tT2DM
|
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T2DM\tin\tpregnancy\n\tbecause\tit\tdoes\tnot\tcross\tthe\tplacenta.\tFurthermore,\toral\tagents,\tsuch\tas\nmetformin,\tare\ttypically\tnot\tsufficient\tin\tovercoming\tthe\tinsulin\tresistance\tin\tT2DM\tand\tare\nineffective\tin\tT1DM\t(\nADA,\t2018\n).\tPreviously\tGDM\twas\tdefined\tas\tany\tdegree\tof\tglucose\tintolerance
|
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] |
).\tPreviously\tGDM\twas\tdefined\tas\tany\tdegree\tof\tglucose\tintolerance\nwith\tonset\tor\tfirst\trecognition\tduring\tpregnancy.\tHowever,\tthe\tnumber\tof\tpregnant\twomen\twith\nundiagnosed\tdiabetes\thas\tincreased,\tand\n\ttherefore\tit\thas\tnow\tbeen\trecommended\tthat\twomen\twith
|
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] |
therefore\tit\thas\tnow\tbeen\trecommended\tthat\twomen\twith\nrisk\tfactors\tfor\tdiabetes\tshould\tbe\tscreened\tfor\tundiagnosed\tT2DM\tat\tthe\tfirst\tprenatal\tvisit,\tusing\nstandard\tdiagnostic\tcriteria.\tWomen\tfound\tto\thave\tdiabetes\tin\tthe\tfirst\ttrimester\tshould\treceive\ta\ndiagnosis\tof\tovert,\tnot\tgestational,\tdiabetes\t(\nADA,\t2018\n).
|
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diagnosis\tof\tovert,\tnot\tgestational,\tdiabetes\t(\nADA,\t2018\n).\nAll\twomen\tnot\tpreviously\tknown\tto\thave\tdiabetes\tshould\tbe\tscreened\tfor\tGDM\tat\t24\tto\n\t28\tweeks\tof\ngestation.\tGDM\tis\tdiagnosed\tmost\toften\tduring\tthe\tsecond\tor\tthird\ttrimester\tof\tpregnancy\tbecause
|
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] |
(GTT).\tGDM\tscreening\tcan\tbe\taccomplished\twith\teither\tof\ttwo\tstrategies\t(for\tmore\tdetails,\tsee\t\nTable\n14.5\n\tin\t\nChapter\t14\n):\n1.\t\n“One-step”\t75-g\toral\tglucose\ttolerance\ttest\t(OGTT)\tor\n2.\t\n“Two-step”\tapproach\twith\ta\t50-g\t(nonfasting)\tscreen\tfollowed\tby\ta\t100-g\tOGTT\tfor\tthose\nwho\tscreen\tpositive.
|
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] |
who\tscreen\tpositive.\nFor\ta\tcomprehensive\tmultisystem\tchecklist\tfor\tpeople\twith\tdiabetes,\tplease\trefer\tto\tthe\tdocument\nAmerican\n\tDiabetes\tAssociation\tStandards\tof\tMedical\tCare\tin\tDiabetes\n,\twhich\tis\tpublished\tyearly\nonline\tfor\tfree.
|
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During\tpregnancy,\ttreatment\tto\tnormalize\tmaternal\tblood\tglucose\tlevels\treduces\tthe\trisk\tof\nadverse\tmaternal,\tfetal,\tand\tneonatal\toutcomes.\tExtra\tglucose\tfrom\tthe\tmother\tcrosses\tthe\tfetal\nplacenta\tand\tthe\tfetus’\tpancreas\tresponds\tby\treleasing\textra\tinsulin\tto\tcope\twith\tthe\texcess\tglucose.\nThe\texcess\tglucose\tis\tconverted\tto\tfat,\twhich\tresults\tin
|
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The\texcess\tglucose\tis\tconverted\tto\tfat,\twhich\tresults\tin\t\nmacrosomia\n\t(a\tlarger\tthan\tnormal\tbaby).\nThe\tfetus\n\tmay\tbecome\ttoo\tlarge\tfor\ta\tnormal\tbirth\tresulting\tin\tthe\tneed\tfor\tC-section.\tNeonatal\nhypoglycemia\tat\tbirth\tis\tanother\tcommon\tproblem.\tThe\tabove-normal\tlevels\tof\tmaternal\tglucose
|
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] |
pregnancy,\tthe\tfetal\torgans\twere\tformed\tbefore\thyperglycemia\n\tbecame\ta\tproblem.\nWhen\toptimal\tblood\tglucose\tlevels\tare\tnot\tbeing\tmaintained\twith\tMNT\tor\tthe\trate\tof\tfetal\tgrowth\nis\texcessive,\tpharmacologic\ttherapy\tis\tneeded\t(\nADA,\t2018\n).\tResearch\tsupports\tthe\tuse\tof\tinsulin,
|
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] |
ADA,\t2018\n).\tResearch\tsupports\tthe\tuse\tof\tinsulin,\ninsulin\tanalogs,\tmetformin,\tand\tglyburide\tduring\tpregnancy.\tWomen\twith\tGDM\tshould\tbe\tscreened\nfor\tdiabetes\t4\tto\t12\tweeks\tpostpartum\tand\tshould\thave\tlifelong\tscreening\tfor\tthe\tdevelopment\n\tof\ndiabetes\tor\tprediabetes\tat\tleast\tevery\t3\tyears\t(\nADA,\t2018\n).\tSee\t\nTable\t29.1\n\tfor\ta\tcriteria\tfor\tthe
|
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] |
ADA,\t2018\n).\tSee\t\nTable\t29.1\n\tfor\ta\tcriteria\tfor\tthe\ndiagnosis\tof\tdiabetes\tand\tprediabetes.
|
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0.06905288994312286,
0.005780459847301245,
-0.06405036151409149,
0.1081392765045166,
-0.03819749504327774,
-0.05945386365056038,
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0.020749304443597794,
-0.04813715070486069,
-0.02478737197816372,
0.02679509110748768,
0.014564014971256256,
-0.060307055711746216,
0.011735239997506142,
0.04110423102974892,
0.022318053990602493,
-0.08175357431173325,
-0.029419563710689545,
0.04466106742620468,
0.002349457936361432,
-0.022617684677243233,
-0.052770283073186874,
0.026006435975432396,
-0.007183227688074112,
-0.05293719097971916,
-0.04367503523826599,
-0.033482979983091354,
0.14552797377109528,
0.03227284923195839,
0.03950332850217819,
0.007556161377578974
] |
TABLE\t29.1\nCriteria\tfor\tthe\tDiagnosis\tof\tDiabetes\tMellitus\tand\tIncreased\tRisk\tfor\tDiabetes\t(Prediabetes)\nDiagnosis\nCriteria\nDiabetes\nA1C\t≥6.5%\t(≥48\tmmol/mol).\tThe\ttest\tshould\tbe\tperformed\tin\ta\tlaboratory\tusing\ta\tmethod\nthat\tis\tNGSP\tcertified\tand\n\tstandardized\tto\tthe\tDCCT\tassay.\n*\nOR
|
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0.11174046993255615,
0.04363801330327988,
0.04990508034825325,
0.01452074758708477
] |
that\tis\tNGSP\tcertified\tand\n\tstandardized\tto\tthe\tDCCT\tassay.\n*\nOR\nFPG\t≥126\tmg/dL\t(≥7.0\tmmol/L).\tFasting\tis\tdefined\tas\tno\tcaloric\tintake\tfor\tat\tleast\t8\thr.\n*\nOR\n2-h\tPG\t≥200\tmg/dL\t(≥11.1\tmmol/L)\tduring\tan\tOGTT.\tThe\ttest\tshould\tbe\tperformed\tas\ndescribed\tby\tthe\tWHO,\tusing\ta\tglucose\tload\tcontaining\tthe\tequivalent\tof\t75-g
|
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] |
anhydrous\tglucose\tdissolved\tin\twater.\n*\nOR\nIn\tpatients\twith\tclassic\tsymptoms\tof\thyperglycemia\tor\thyperglycemic\n\tcrisis,\ta\trandom\nPG\t≥200\tmg/dL\t(≥11.1\tmmol/L)\nPrediabetes\n*\nFPG\t100-125\tmg/dL\t(5.6-6.9\tmmol/L)\t(impaired\tfasting\tglucose)\nOR\n2-h\tPG\tduring\t75-g\tOGTT\t140-199\tmg/dL\t(7.8-11.0\tmmol/L)\t(impaired\tglucose\ttolerance)\nOR
|
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] |
OR\nA1C\t5.7%-6.4%\t(39-47\tmmol/mol)\n*\nIn\tthe\tabsence\tof\tunequivocal\thyperglycemia,\tresults\tshould\tbe\tconfirmed\tby\trepeat\ttesting.\n*\nFor\tall\tthree\ttests,\trisk\tis\tcontinuous,\textending\n\tbelow\tthe\tlower\tlimit\tof\tthe\trange\tand\tbecoming\tdisproportionately\tgreater\tat\tthe\thigher\tend\tof\tthe\nrange.\nDCCT\n,\tDiabetes\tControl\tand\tComplications\tTrial;\t\nFPG
|
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] |
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