糖尿病的英文文章.docx
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糖尿病的英文文章.docx
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糖尿病的英文文章
糖尿病的英文文章
第一篇Diabetesmellitustype2FromWikipedia,thefreeencyclopediaDiabetesmellitustype2ClassificationandexternalresourcesUniversalbluecirclesymbolfordiabetes.[1]ICD-10E11ICD-9250.00,250.02OMIM125853DiseasesDB3661MedlinePlus000313eMedicinearticle/117853MeSHD003924Diabetesmellitustype2(formerlynoninsulin-dependentdiabetesmellitus(NIDDM)oradult-onsetdiabetes)isametabolicdisorderthatischaracterizedbyhighbloodglucoseinthecontextofinsulinresistanceandrelativeinsulindeficiency.[2]Thisisincontrasttodiabetesmellitustype1,inwhichthereisanabsoluteinsulindeficiencyduetodestructionofisletcellsinthepancreas.[3]Theclassicsymptomsareexcessthirst,frequenturination,andconstanthunger.Type2diabetesmakesupabout90%ofcasesofdiabeteswiththeother10%dueprimarilytodiabetesmellitustype1andgestationaldiabetes.Obesityisthoughttobetheprimarycauseoftype2diabetesinpeoplewhoaregeneticallypredisposedtothedisease.Type2diabetesisinitiallymanagedbyincreasingexerciseanddietarymodification.Ifbloodglucoselevelsarenotadequatelyloweredbythesemeasures,medicationssuchasmetforminorinsulinmaybeneeded.Inthoseoninsulin,thereistypicallytherequirementtoroutinelycheckbloodsugarlevels.Ratesoftype2diabeteshaveincreasedmarkedlyoverthelast50yearsinparallelwithobesity:
Asof2010thereareapproximately285millionpeoplewiththediseasecomparedtoaround30millionin1985.[4][5]Long-termcomplicationsfromhighbloodsugarcanincludeheartdisease,strokes,diabeticretinopathywhereeyesightisaffected,kidneyfailurewhichmayrequiredialysis,andpoorcirculationoflimbsleadingtoamputations.Theacutecomplicationofketoacidosis,afeatureoftype1diabetes,isuncommon.[6]However,nonketotichyperosmolarcomamayoccur.Contents[hide]1Signsandsymptomso1.1Complications2Causeo2.1Lifestyleo2.2Geneticso2.3Medicalconditions3Pathophysiology4Diagnosis5Screening6Prevention7Managemento7.1Lifestyleo7.2Medicationso7.3Surgery8Epidemiology9History10References11ExternallinksSignsandsymptomsOverviewofthemostsignificantsymptomsofdiabetes.Theclassicsymptomsofdiabetesarepolyuria(frequenturination),polydipsia(increasedthirst),polyphagia(increasedhunger),andweightloss.[7]Othersymptomsthatarecommonlypresentatdiagnosisinclude:
ahistoryofblurredvision,itchiness,peripheralneuropathy,recurrentvaginalinfections,andfatigue.Manypeople,however,havenosymptomsduringthefirstfewyearsandarediagnosedonroutinetesting.Peoplewithtype2diabetesmellitusmayrarelypresentwithnonketotichyperosmolarcoma(aconditionofveryhighbloodsugarassociatedwithadecreasedlevelofconsciousnessandlowbloodpressure).[3]ComplicationsMainarticle:
ComplicationsofdiabetesmellitusType2diabetesistypicallyachronicdiseaseassociatedwithaten-year-shorterlifeexpectancy.[4]Thisispartlyduetoanumberofcomplicationswithwhichitisassociated,including:
twotofourtimestheriskofcardiovasculardisease,includingischemicheartdiseaseandstroke;a20-foldincreaseinlowerlimbamputations,andincreasedratesofhospitalizations.[4]Inthedevelopedworld,andincreasinglyelsewhere,type2diabetesisthelargestcauseofnontraumaticblindnessandkidneyfailure.[8]IthasalsobeenassociatedwithanincreasedriskofcognitivedysfunctionanddementiathroughdiseaseprocessessuchasAlzheimer’sdiseaseandvasculardementia.[9]Othercomplicationsinclude:
acanthosisnigricans,sexualdysfunction,andfrequentinfections.[7]CauseThedevelopmentoftype2diabetesiscausedbyacombinationoflifestyleandgeneticfactors.[8][10]Whilesomeareunderpersonalcontrol,suchasdietandobesity,others,suchasincreasingage,femalegender,andgenetics,arenot.[4]Alackofsleephasbeenlinkedtotype2diabetes.[11]Thisisbelievedtoactthroughitseffectonmetabolism.[11]Thenutritionalstatusofamotherduringfetaldevelopmentmayalsoplayarole,withoneproposedmechanismbeingthatofalteredDNAmethylation.[12]LifestyleMainarticle:
Lifestylecausesofdiabetesmellitustype2Anumberoflifestylefactorsareknowntobeimportanttothedevelopmentoftype2diabetes,including:
obesity(definedbyabodymassindexofgreaterthanthirty),lackofphysicalactivity,poordiet,stress,andurbanization.[4]Excessbodyfatisassociatedwith30%ofcasesinthoseofChineseandJapanesedescent,60-80%ofcasesinthoseofEuropeanandAfricandescent,and100%ofPimaIndiansandPacificIslanders.[3]Thosewhoarenotobeseoftenhaveahighwaisthipratio.[3]Dietaryfactorsalsoinfluencetheriskofdevelopingtype2diabetes.Consumptionofsugar-sweeteneddrinksinexcessisassociatedwithanincreasedrisk.[13][14]Thetypeoffatsinthedietarealsoimportant,withsaturatedfatsandtransfattyacidsincreasingtheriskandpolyunsaturatedandmonounsaturatedfatdecreasingtherisk.[10]Eatinglotsofwhitericeappearstoalsoplayaroleinincreasingrisk.[15]Alackofexerciseisbelievedtocause7%ofcases.[16]GeneticsMainarticle:
Geneticcausesofdiabetesmellitustype2Mostcasesofdiabetesinvolvemanygenes,witheachbeingasmallcontributortoanincreasedprobabilityofbecomingatype2diabetic.[4]Ifoneidenticaltwinhasdiabetes,thechanceoftheotherdevelopingdiabeteswithinhislifetimeisgreaterthan90%whiletheratefornonidenticalsiblingsis25-50%.[3]Asof2019,morethan36geneshavebeenfoundthatcontributetotheriskoftype2diabetes.[17]Allofthesegenestogetherstillonlyaccountfor10%ofthetotalheritablecomponentofthedisease.TheTCF7L2allele,forexample,increasestheriskofdevelopingdiabetesby1.5timesandisthegreatestriskofthecommongeneticvariants.Mostofthegeneslinkedtodiabetesareinvolvedinbetacellfunctions.[3]Thereareanumberofrarecasesofdiabetesthatariseduetoanabnormalityinasinglegene(knownasmonogenicformsofdiabetesorotherspecifictypesofdiabetes).[3][4]Theseincludematurityonsetdiabetesoftheyoung(MODY),Donohuesyndrome,andRabson-Mendenhallsyndrome,amongothers.[4]Maturityonsetdiabetesoftheyoungconstitute15%ofallcasesofdiabetesinyoungpeople.[18]MedicalconditionsThereareanumberofmedicationsandotherhealthproblemsthatcanpredisposetodiabetes.[19]Someofthemedicationsinclude:
glucocorticoids,thiazides,betablockers,atypicalantipsychotics,[20]andstatins.[21]Thosewhohavepreviouslyhadgestationaldiabetesareatahigherriskofdevelopingtype2diabetes.[7]Otherhealthproblemsthatareassociatedinclude:
acromegaly,Cushing’ssyndrome,hyperthyroidism,pheochromocytoma,andcertaincancerssuchasglucagonomas.[19]Testosteronedeficiencyisalsoassociatedwithtype2diabetes.[22][23]PathophysiologyType2diabetesisduetoinsufficientinsulinproductionfrombetacellsinthesettingofinsulinresistance.[3]Insulinresistance,whichistheinabilityofcellstorespondadequatelytonormallevelsofinsulin,occursprimarilywithinthemuscles,liver,andfattissue.[24]Intheliver,insulinnormallysuppressesglucoserelease.However,inthesettingofinsulinresistance,theliverinappropriatelyreleasesglucoseintotheblood.[4]Theproportionofinsulinresistanceversusbetacelldysfunctiondiffersamongindividuals,withsomehavingprimarilyinsulinresistanceandonlyaminordefectininsulinsecretionandotherswithslightinsulinresistanceandprimarilyalackofinsulinsecretion.[3]Otherpotentiallyimportantmechanismsassociatedwithtype2diabetesandinsulinresistanceinclude:
increasedbreakdownoflipidswithinfatcells,resistancetoandlackofincretin,highglucagonlevelsintheblood,increasedretentionofsaltandwaterbythekidneys,andinappropriateregulationofmetabolismbythecentralnervoussystem.[4]However,notallpeoplewithinsulinresistancedevelopdiabetes,sinceanimpairmentofinsulinsecretionbypancreaticbetacellsisalsorequired.[3]DiagnosisTheWorldHealthOrganizationdefinitionofdiabetes(bothtype1andtype2)isforasingleraisedglucosereadingwithsymptoms,otherwiseraisedvaluesontwooccasions,ofeither:
[27]fastingplasmaglucose7.0mmol/l(126mg/dl)orwithaglucosetolerancetest,twohoursaftertheoraldoseaplasmaglucose11.1mmol/l(200mg/dl)Arandombloodsugarofgreaterthan11.1mmol/l(200mg/dL)inassociationwithtypicalsymptoms[7]oraglycatedhemoglobin(HbA1c)ofgreaterthan6.5%isanothermethodofdiagnosingdiabetes.[4]In2009anInternationalExpertCommitteethatincludedrepresentativesoftheAmericanDiabetesAssociation(ADA),theInternationalDiabetesFederation(IDF),andtheEuropeanAssociationfortheStudyofDiabetes(EASD)recommendedthatathresholdof6.5%HbA1cshouldbeusedtodiagnosediabetes.ThisrecommendationwasadoptedbytheAmericanDiabetesAssociationin2010.[28]Positivetestsshouldberepeatedunlessthepersonpresentswithtypicalsymptomsandbloodsugars11.1mmol/l(200mg/dl).[29]Thresholdfordiagnosisofdiabetesisbasedontherelationshipbetweenresultsofglucosetolerancetests,fastingglucoseorHbA1candcomplicationssuchasretinalproblems.[4]Afastingorrandombloodsugarispreferredovertheglucosetolerancetest,astheyaremoreconvenientforpeople.[4]HbA1chastheadvantagesthatfastingisnotrequiredandresultsaremorestablebuthasthedisadvantagethatthetestismorecostlythanmeasurementofbloodglucose.[30]Itisestimatedthat20%ofpeoplewithdiabetesintheUnitedStatesdonotrealize
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