19951 - UPDATE ON CHILDHOOD DIABETES MELLITUS Abdelaziz...

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UPDATE ON  UPDATE ON  CHILDHOOD DIABETES  CHILDHOOD DIABETES  MELLITUS MELLITUS Abdelaziz Elamin  MD, PhD, FRCPCH  Professor of Child Health Sultan Qaboos University
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DEFINITION   The term diabetes mellitus describes      a metabolic disorder of multiple      etiologies characterized by chronic       hyperglycemia with disturbances of      carbohydrate, fat and protein      metabolism resulting from defects of      insulin secretion, insulin action or      both.
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DIABETES EPIDEMIOLOGY Diabetes is the most common endocrine  worldwide. Incidence of diabetes is alarmingly  increasing all over the globe. Incidence of childhood diabetes range  between 3-50/100,000 worldwide; in Oman  it is estimated as 4/100000 per year.
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OLD CLASSIFICATION (1985) Type 1, Insulin-dependent (IDDM) Type 2, Non Insulin-dependent (NIDDM) obese non-obese MODY  IGT Gestational Diabetes
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WHO CLASSIFICATION 2000 Is based on etiology not on type of  treatment or age of the patient. Type 1 Diabetes    (idiopathic or autoimmune  β -cell  destruction) Type 2 Diabetes  (defects in insulin secretion or action) Other specific types
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WHO CLASSIFICATION/2 subdivided into: Not insulin requiring Insulin requiring for control Insulin requiring for survival Gestational diabetes is a separate entity Impaired Glucose Tolerance (IGT)  indicates blood glucose levels between  glucose tolerance test.
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DIAGNOSTIC CRITERIA Fasting blood  glucose level Diabetic Plasma >7.0 mmol Capillary >6.0 mmol IGT Plasma 6.0-6.9 mmol Capillary 5.6-6.0 mmol 2 hours after  glucose load (Plasma or capillary BS) IGT 7.8-11.0 Diabetic level > 11.1 (200 mg)
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Types of Diabetes in Children Type 1 diabetes mellitus accounts for  >90% of cases. Type 2 diabetes is increasingly  recognized in children with presentation  like in adults. Permanent neonatal diabetes Transient neonatal diabetes Maturity-onset diabetes of the young Secondary diabetes e.g. in cystic fibrosis  or Cushing syndrome.
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MODY adolescents Not rare as previously considered 5 subclasses are identified, one  subclass has specific mode of  inheritance (AD)  Not associated with immunologic or  genetic markers Insulin resistance is present
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TRANSIENT NEONATAL DIABETES but more common in preterm  Caused by immaturity of islet  β -cells Highly sensitive to insulin Disappears in 4-6 weeks
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This note was uploaded on 03/08/2012 for the course PHARM 300 taught by Professor Staff during the Fall '11 term at Rutgers.

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19951 - UPDATE ON CHILDHOOD DIABETES MELLITUS Abdelaziz...

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