C h a p t e r 3 3
Diabetes Mellitus and the Metabolic Syndrome
819
BMI of 32 kg/m
2
, and waist circumference of
45 inches (114 cm). Complete blood count
(CBC), thyroid-stimulating hormone (TSH),
and alanine aminotransferase (ALT) are within
normal limits. The lipid panel shows that his HDL
cholesterol (30 mg/dL [0.8 mmol/L]) and LDL
cholesterol (136 mg/dL [3.5 mmol/L]) are within
the normal range, and triglycerides are elevated
(290 mg/dL [2.3 mmol/L]; normal is <165 mg/dL
[1.9 mmol/L]).
A.
What is this man’s probable diagnosis?
B.
Based on this man’s blood glucose level and
the ADA diabetes classification system, what
glucose intolerance status would you place this
man in? Does he need a 75-g OGTT for further
assessment of his IFG?
C.
His OGTT test result reveals a 2-hour glucose
value of 175 mg/dL (9.6 mmol/L). What is the
diagnosis? What type of treatment would be
appropriate for this man?
R E F E R E N C E S
1. American Diabetes Association.
Diabetes statistics
. 2013.
Available at:
-
statistics/. Accessed September 10, 2013.
2. Hall JE.
Guyton and Hall’s Medical Physiology
. 12th ed.
Philadelphia, PA: Elsevier Saunders; 2011:939–954.
3. Masharani U, German MS. Pancreatic hormones and diabetes
mellitus. In: Gardner DG, Shoback D, eds.
Greenspan’s Basic and
Clinical Endocrinology
. 9th ed. New York, NY: Lange Medical
Books/McGraw-Hill; 2007:573–656.
4. Shepard PR, Kahn B. Glucose transporters and insulin action.
N
Engl J Med
. 1999;341:248–256.
5. DeFronzo RA, Eldor R, Abdul-Ghani M. Pathophysiologic
approach to therapy in patients with newly diagnosed type 2
diabetes.
Diabetes Care.
2013;36(Suppl 2):S127–S138.
6. Drucker DJ. The biology of incretin hormones.
Cell Metab
.
2006;3:153–165.
7. Goldfine IR, Youngren JF. Contributions of the American
Journal of Physiology to the discovery of insulin.
Am J Physiol
.
1998;274:E207–E209.
8. Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Report of the Expert Committee on the
Diagnosis and Classification of Diabetes Mellitus.
Diabetes Care.
1997;10:1183–1197.
9. Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Follow-up report on the diagnosis of diabetes
mellitus.
Diabetes Care.
2003;26(11):3160–3167.
10. American Diabetes Association. Diagnosis and classification of
diabetes mellitus.
Diabetes Care
. 2013;36(Suppl 1):S62–S69.
11. American Diabetes Association. Standards of medical care in
diabetes—2013.
Diabetes Care
. 2013;36(Suppl 1):S11–S61.
12. Jones KL. Role of obesity in complicating and confusing the
diagnosis and treatment of diabetes in children.
Pediatrics.
2008;121(2):361–368.
13. The International Diabetes Federation Consensus Workshop.
Type 2 diabetes in the young: The evolving epidemic.
Diabetes
Care.
2004;27:1798–1811.
14. Nolan CJ, Damm P, Prentki M. Type 2 diabetes across
the generations: from pathophysiology to prevention and
management.
Lancet
. 2011;378:169–181.
15. Gerich JE. Contributions of insulin-resistance and insulin-
secretory defects to the pathogenesis of type 2 diabetes.
Mayo
Clin Proc
. 2003;78:447–456.
16. DeFronzo RA. Banting lecture. From the triumvirate to ominous
octet: a new paradigm for the treatment of type 2 diabetes
mellitus.
Diabetes
. 2009;32:1327–1334.
17. Matthews DR, Cull CA, Stratton IM, et al. for the United
Kingdom Prospective Diabetes Study (UKPDS) Group. UKPDS
26: Sulfonylurea failure in non-insulin-dependent diabetic
patients over six years.
Diabetes Med.
1998;15:297–303.
18. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking
obesity to insulin resistance and type 2 diabetes.
Nature
.
2006;444:840–846.
19. Matfin G. Developing therapies for the metabolic syndrome:
Challenges. opportunities, and the unknown.
Ther Adv
Endocrinol Metabol.
2010;4(2):89–94.
20. Grundy SM, Panel Chair
.
Third Report of the National
Cholesterol Education Program (NCEP) Expert Panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol
in Adults (Adult Treatment Panel III). NIH publication no.
01–3670. Bethesda, MD: National Institutes of Health; 2001.
21. Guven S, El-Bershawi A, Sonnenberg GE, et al. Persistent
elevation in plasma leptin level in ex-obese with normal body
mass index: relation to body composition and insulin sensitivity.
Diabetes
. 1999;48:347–352.
22. Bays H, Mandarino L, DeFronzo RA. Role of adipocyte, free
fatty acid, and ectopic fat in pathogenesis of type 2 diabetes:
peroxisomal proliferator-activated receptor agonists provide
a rationale therapeutic approach.
J Clin Endocrinol Metab
.
2004;89:463–478.
23. Kadowaki T, Yamauchi T, Kubota N, et al. Adiponectin and
adiponectin receptors in insulin resistance, diabetes, and the
metabolic syndrome.
J Clin Invest
. 2006;116:1784–1792.
24. Gallagher EJ, LeRoith D, Karnieli E. The metabolic syndrome—
From insulin resistance to obesity and diabetes.
Endocrinol
Metab Clin North Am
. 2008;37:559–579.
25. Kuritzkes DR, Currier J. Cardiovascular risk factors and
antiretroviral therapy.
N Engl J Med
. 2003;348:679–680.
26. Landon MB, Gabbe SG. Gestational diabetes mellitus.
Obstet
Gynecol
. 2011;118:1379–1393.
27. Metzger BE, Buchanan TA, Coustan DR, et al. Summary
and recommendations of the Fifth International Workshop—
Conference on Gestational Diabetes.
Diabetes Care.
2007;30(Suppl 2):S251–S260.
28. American Diabetes Association. Guidelines and recommendations
for laboratory analysis in the diagnosis and management of
diabetes mellitus.
Diabetes Care.
2011;34:e61–e99.
29. Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutritional
recommendations and interventions for diabetes—2006: a
position statement of the American Diabetes Association.
Diabetes Care
. 2006;29:2140–2157.
30. American Diabetes Association. Physical activity/exercise and
diabetes mellitus.
Diabetes Care
. 2004;27(Suppl 1):S55–S59.
31. Inzucchi SE, Bergenstal RM, Buse JB, et al.; for the American
Diabetes Association, European Association for the Study of
Diabetes. Management of hyperglycemia in type 2 diabetes: a
patient-centered approach: Position statement of the American
Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD).
Diabetes Care.
2012;35:1364–1379.
32. Fonseca V. Diabetes mellitus in the next decade: novel
pipeline medications to treat hyperglycemia.
Clin Ther
.
2013;35:714–72333.
33. Erdmann E, Wilcox RG. Weighing up cardiovascular benefits of
thiazolidinedione therapy: the impact of increased risk of heart
failure.
Eur Heart J
. 2008;29:12–20.
34. Meier BM, Kraenzlin ME, Meier CR. Risk of fractures with
glitazones: a critical review of evidence to date.
Drug Saf.
2009;32(7):539–547.
