糖尿病の治療 : 総論(シリーズ「糖尿病の治療」(1))

概要

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Diabetes mellitus is a disease characterized by chronic hyperglycemia with its etiology involving both genetic and environmental factors. In 1999, the Japan Diabetes Society proposed a new classification and diagnostic criteria for diabetes. Diabetes and related disorders of glycemia are now classified into 4 types: 1) Type 1,2) Type2, 3) hyperglycemia due to other specific mechanism or diseases, and 4) gestational diabetes mellitus (GDM). Type 1 diabetes is characterized by a destruction of the pancreatic β cells resulting in severe insulin deficiency. Type 2 diabetes is characterized by various degrees of insulin deficiency or/and insulin resistance. Staging of diabetes mellitus according to the severity of hyperglycemia or insulin dependency is also useful when determining a therapeutic approach. Diabetic type is defined as fasting plasma glucose≧126mg/dl, and/or plasma glucose 2 hours after a 75g glucose load≧200mg/dl, and/or casual plasma glucose≧200mg/dl. Diabetes mellitus is diagnosed when diabetic type glucose abnormality is reconfirmed on separate occasions. Basic therapeutic approaches for diabetes mellitus are diet and exercise therapies. The goal of diabetes care is to prevent microvascular and macrovascular complications. Favorable body weight, blood pressure, lipid metabolism, and long-term glycemic control are important.