Free Radical Biomedicine: Principles, Clinical ... - Bentham Science

114 Free Radical Biomedicine: Principles, Clinical Correlations, and Methodologies Y. Robert Li
hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different
organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
The classification of diabetes includes four clinical classes (Table 5.1) [1].
Table 5.1. Classification of diabetes mellitus.
Class Description
Type 1 diabetes Results from -cell destruction, usually leading to absolute insulin deficiency; comprises ~10% of
people with diabetes
Type 2 diabetes Results from a progressive insulin secretory defect on the background of insulin resistance;
comprises ~90% of people with diabetes
Other specific
types of diabetes
Gestational
diabetes
Due to other causes, e.g., genetic defects in cell function, genetic defects in insulin action,
diseases of the exocrine pancreas (such as cystic fibrosis), and drug or chemical-induced diabetes
(such as in the treatment of AIDS or after organ transplantation)
Diabetes diagnosed during pregnancy
The current diagnostic criteria for diabetes are summarized in Table 5.2 [1].
Table 5.2. Criteria for the diagnosis of diabetes mellitus.
Criteria Description
1 A1C >6.5%. The test should be performed in a laboratory using a method that is NGSP certified
and standardized to the DCCT assay
OR
2 FPG >126 mg/dl (7.0 mM). Fasting is defined as no caloric intake for at least 8 hours
OR
3 2-h plasma glucose >200 mg/dl (11.1 mM) during an OGTT. The test should be performed as
described by the World Health Organization, using a glucose load containing the equivalent of 75 g
anhydrous glucose dissolved in water
OR
4 In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma
glucose >200 mg/dl (11.1 mM)
Note to Table 5.2: In the absence of unequaivocal hyperglycemia, criteria 1-3 should be confirmed by repeated testing; The
glycosylated hemoglobin A1C (or HbA1C) is a widely used marker of chronic glycemia, reflecting average blood glucose levels over
a 2- to 3-month period of time. NGSP, National Glycohemoglobin Standardization Program; DCCT, Diabetes Control and
Complications Trial; FPG, fasting plasma glucose; OGTT stands for oral glucose tolerance test.
Table 5.3. Categories of increased risk for diabetes mellitus.
Categories Description
Fasting plasma glucose (FPG): 100-125 mg/dl (5.6-6.9 mM) This condition is referred to as impaired fasting
glucose (IFG)
2-h plasma glucose on the 75-g OGTT: 140-199 mg/dl (7.8-
11.0 mM)
A1C: 5.7–6.4%
This condition is referred to as impaired glucose
tolerance (IGT)
Note to Table 5.3: For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately
greater at higher ends of the range; Individuals with IFG and/or IGT have been referred to as having pre-diabetes.
In the 2010 Clinical Practice Recommendations of the American Diabetes Association, categories of
increased risk for diabetes have been included to refer to an intermediate group of individuals whose