[내과]5 stage of beta cell dysfunction in DM

소개

당뇨의 병인으로 베타세포의 dysfunction에 따른 당뇨병의 진행 과정을 정리한
파워포인트 파일입니다.

제가 내과 morning conference 발표를 위해 만들었고, 발표 이후 환자 진료 및
실습생 교육 때 사용한 파워포인트 자료 입니다.
내과, 가정의학과 레지던트 및 전문의의 진료 시 참조 자료,
conference 자료로 이용할 수 있습니다.
의대생, 의학대학원생, 간호대생, 약대생의 시험 자료 및
레포트 자료, conference 자료로 그대로 사용할 수 있습니다.

논문들을 분석하여 정리한 최신 지견입니다.

목차

Progression to diabetes
1) Very beginning
2) IFG or IGT range
3) Frank diabetes

5 stage during development of DM by the authors
Stage 1 (compensation)
Stage 2 (stable period of b cell adaptation)
Stage 3
Stage 4
Stage 5

Stage 1; compensation
Signal leading to increased b cell mass
Glucokinase in b cell
The importance of b cell differentiation
Glut2
aerobic glycolysis
To maintain specialization
Some enzyme to be supressed
Include
Maintenance of b cell differentiation during stage 1 compensation

Stage 2; stable adaptation
Loss of GSIS in stage 2; glucotoxicity hypothesis
Changes in b cell differentiation in stage 2

why is stage 3 unstable?
Stage 3; unstable early decompensation

stage 4; stable decompensation
Change in b cell mass, function, and differentiation in stage 4

stage 5; severe decompensation

본문내용

Progression to diabetes
1) Very beginning
- fasting plasma glucose
; 80mg/dL -> 89 mg/dL
- cannot be recognized as clinically
2) IFG or IGT range
3) Frank diabetes
very similar change can occur as type 1 dM unfold, or as pancreatic islet cell transplantations fail
5 stage during development of DM by the authors
5 stage can be distinguished by change in b cell mass, phenotype, function
Stage 1 (compensation)
; insulin secretion increase to maintain normal glucose level during insulin resistance
2) Stage 2 (stable period of b cell adaptation)
; when glucose level rise to levels of 89 ~ 116mg/dl
Stage 3 ; unstable period of early decompensation
Stage 4; stable decompensation
Stage 5; severe decompensation
- profound b cell failure with to progression to ketosis
Stage 1; compensation
In case of insulin resistance due to obesity
-> accompanied by higher overall rate of insulin secretion
-> increased acute glucose stimulated insulin secretion (GSIS) following an intravenous glucose challenge
Increase in insulin secretion -> result from increase in b cell mass (because not only increased b cell number, but also b cell hypertrophy)
As case of insulin resistance, there are compensation in early stage of autoimmune destruction

참고자료

· Diabetes; dec 2004; 53, suppl.3; s16 – s21