Translated version of http://bvs.sld.cu/revistas/end/vol11_1_00/end08100.htm

Translated version of http://bvs.sld.cu/revistas/end/vol11_1_00/end08100.htm

New criteria to classify diebetes mellitus

Lic. Eduardo Rode Goatherd, ¹ Dr Leonel Suárez Fonseca, ² Lic. Oscar Diaz ^Horta3 and Dr. Oscar Diaz ^Díaz4

The diabetes mellitus is a heterogenous syndrome that it has, like chronic common element, one hiperglucemia by an insulin deficiency or an insufficient effectiveness of their action.

The glucorregulación is a complex physiological process in which faults at different levels lead finally to one hiperglucemia. At the moment new knowledge are had accumulated where defects at level of cells, weaves have been identified or functions that are related to the expression of the disease. This has given rise to the appearance of new proposals to classify the diabetes mellitus. Recently, the Committee of Experts of the American Association of Diabetes (IT ACCEPTS) ¹ and of the World-wide Organization of Health (the WHO) ² has proposed a new classification that contemplates 4 groups:

• Diabetes mellitus type 1.
• Diabetes mellitus type 2.
• Other specific types of diabetes.
• Gestacional diabetes mellitus.

In the diabetes type 1 the forms of diabetes by destruction of the cell ß caused by immunological alterations or of unknown cause are included (idiopática). They describe as to diabetes type 2 those forms with predominant insulínica resistance and, possibly, insulin a relative secretion deficiency, in which it includes the cases whose cause is essentially desconocida.3

A third group is created, call “Other specific types of diabetes” where the cases are included whose basic defect is known and can be identified. Paradoxicalally, in this group are diabetics type 1 and type 2 of well-known causes. For example types of diabetes that have insulin deficit by destruction of the cells ß, although not of cause are included autoinmune, or cases of diabetes type 2 by resistance to the insulin, by known genetic defects.

The gestacional diabetes simply defines it by the fact to appear during the pregnancy; and it does not establish a etiológica entailment, nevertheless, in the present time knows his heterogeneity, as we see next. ^4-8

Frequency of different causes from hiperglucemia in cases grouped like “gestacional diabetes”

Genetic defects of the function of the cells ß

Frequencies

MODY1 (HNF4 to chromosome 20q) 2.0%

MODY 2 (glucoquinasa chromosome 7p) 3.0%

MODY3 (HNF1 to chromosome 12q) 15.0%

MODY 4 (IPF1 chromosome 13q) 0.0%

MODY 5 (HNF 1ß chromosome 17p) 2.0%

Mutations in mitocondrial DNA (3243) 8.3%

Diabetes type 1 1,7- 3.7%

Diabetes type 2 30.0%

The gestacional diabetes is in fact the waiting room of different types from diabetes, despite we preferred to maintain the one of independent form by its importance in the morbidity and infantile and maternal mortality.

The initial proposal of classification published by nosotros3 has been modified as we suggested next, and where it considers, not only the state of the secretion or insulínica action, but also the causes that originates it, including the existence or not of autoimmunity.