© Borgis - Medycyna Rodzinna 1, p. 11-18
*Ewa Otto-Buczkowska, Przemysława Jarosz-Chobot
Zaburzenia metabolizmu glukozy w populacji wieku rozwojowego – co nowego w diagnostyce i leczeniu? Część I
Alterations of blood glucose homeostasis in children and adolescents – what news in diagnostics and therapy? Part I
Górnośląskie Centrum Zdrowia Dziecka i Matki, Poradnia Diabetologiczna, Katowice
Summary
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia that results from defects in insulin secretion, insulin action, or both. Pathogenic processes involved in the development of diabetes mellitus range from autoimmune destruction of the pancreatic β cells with consequent insulin deficiency (i.e. T1DM) to relative insulin deficiency, which occurs as a result of target tissue resistance to insulin action combined with inadequate compensatory insulin secretion (i.e. T2DM). Impairment of insulin secretion and defects in insulin action frequently coexist in the same patient and it can be unclear which abnormality is the primary cause of hyperglycemia.
An increase in the number of children and adolescents with a mixture of the types of diabetes Under the current classification, it is difficult to define the type of diabetes affecting these young subjects, who might be classified as T2D because they are obese and insulin resistant but also as T1D because of the presence of autoantibodies to β cells. These subjects show an overlapping diabetes phenotype typical of both T1D and T2D, suggesting that the current classification of diabetes should be revised.
Monogenic diabetes, associated with severe β cell dysfunction or with severe resistance to insulin action, is diagnosed with increasing frequency by genetic testing. A molecular genetic diagnosis is now possible for> 80% of patients with monogenic diabetes.
Neonatal diabetes diagnosed within the first 3 months of life is usually a single gene disorder associated with altered β-cell number or function. Some children with monogenic diabetes present in the neonatal period with ketoacidosis.
Insulin resistance (with hyperinsulinaemia and various degrees of hyperglycaemia) is associated with several rare syndromes, including acantosis nigricans, leprechaunism and lipodystrophy.
Key words: glucose homeostasis, impaired glucose tolerance, hyperglycemia, deficient insulin secretion, insulin resistance, type 1 diabetes, type 2 diabetes, monogenic diabetes
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otrzymano/received: 2007-12-14
zaakceptowano/accepted: 2007-12-27
Adres/address:
*Ewa Otto-Buczkowska
Jasnogorska 16/21, 44-100 Gliwice
e-mail: em.buczkowski@pro.onet.pl
