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1. In the name of God

2. Essentials of Type 2
Diabetes Mellitus
Presented by H. Chehrehgosha
Endocrinologist
Assistant professor
Iran, Tehran, Iran University of Medical Science, Rasoul Akram Hospital
October, 2021.

3. Basic principles
Diagnosis and classification
Management
3
Agenda

4. Types of diabetes

5. Diabetes classification
according to the obesity
epidemic
5
Before obesity epidemic During obesity epidemic

6. Diabetes
classification
6

7. Summary of important
types of DM
7
Summary of T1DM Summary of T2DM

8. Stages of T1DM
and T2DM
8
Development of T1DM and
“honeymoon” phase
Insulin secretory capacity of
the β-cell

9. Ketosis prone diabetes type 2
Intermediate features between type 1 and type 2 diabetes
Usually present with diabetic ketoacidosis but do not have the typical
phenotype of patients with type 1 diabetes
Almost always obese and usually have a family history of type 2 diabetes
After recovery from the episode of ketoacidosis and resolution of glucose
toxicity, beta-cell function improves in most but not all patients.
9

10. Aβ system of classification of patients with ketosis-prone
diabetes
A+β- A+β+ A-β- A-β+ *
10

11. 14. What are the monogenic forms of diabetes?
11

12. 22. When to suspect MODY (maturity-onset diabetes in the young) ?
12

13. 23. Types of MODY?
13

14. 24. Why is it important to diagnose MODY?
14

15. Latent autoimmune diabetes in adults (LADA)
Type 1.5 diabetes = non-insulin-
requiring autoimmune diabetes
Diagnosed with type 2 diabetes but
for whom antibodies typically found
in patients with type 1 diabetes
were present.
Criteria: age at diagnosis older
than 30 years, presence of any
islet autoantibody, and at least 6
months of no insulin treatment
after diagnosis.
15

16. Diagnosis

17. 20. Who should be screened for diabetes?
17

18. 15. How to diagnose diabetes?
18

19. 15. How to diagnose diabetes according to symptom?
19

20. 16. Which test is considered as the reference standard for the diagnosis of diabetes?
20

21. 17. What is the rationale for specific cut-offs of blood glucose to diagnose diabetes?
21

22. 19. What is the utility of HbA1c in the diagnosis of diabetes?
22

23. Correlation of HbA1c and
mean plasma glucose levels
23

24. 18. Why is retina believed to be “mirror of diabetes”?
24

25. Summary
Diabetes classification
Correlation of HbA1c and mean plasma glucose levels
Stages of T1DM and T2DM
Criteria for testing for diabetes or prediabetes in asymptomatic adults
Monogenic forms of diabetes
25

26. References
26