THE NEW ASPECT AND MANAGEMENT OF DIABETES MELLITUS

Abstract

The majority of diabetes mellitus in Japan are non-insulin dependent diabetes mellitus ( NIDDM) .
The prognosis of NIDDM is largely determined by macroangiopathy and microangiopathy. The new diagnostic level was proposed by a Working Group of the American Diabetes Association.
A significant proportion of people with IGT also have risk factors that increase their likelihood of developing coronary heart disease and many will develop diabetes.
Insulin resistance and compensatory hyperinsulinemia are strongly related to metabolic risk factors for coronary heart disease and the clustering syndrome of multiple risk factors is called syndrome X.
In the pathogenesis of NIDDM, The two fundamental defects which are insulin resistance and glucose desensitization of B cell are caused by a combination of genetic and environmental factors that lead to the progression from normal glucose tolerance to diabetes.
At present, a few genes were proven potential for causing some form of NIDDM, but the gene or genes causing the common NIDDM remained unknown.
In the treatment of NIDDM, current recommendations based on results of DCCT emphasize the aim of achieving HbAlc values of <7.0 % and action should be taken when levels are >8.0 %. Hyperglycemia-diabetic microangiopatly hypothesis was proven one and for all. Now, new orally active hypoglycemic agents (α-glucosidase inhibitor and insulin sensitizer) are frequently used to help manage the glucose intolerance of NIDDM. A non-sulfonylurea, hypoglycemic agent which evoke a more rapid and short lived insulin release than sulfonylurea hypoglycemic agent will be able to use to improve post prandial hyperglycemia. We have to select the medicine according to the clinical course of NIDDM.