Janka Hans-Uwe, Michaelis Dietrich
Klinikum für Innere Medizin, Zentralkrankenhaus Bremen-Nord.
Z Arztl Fortbild Qualitatssich. 2002 Mar;96(3):159-65.
According to the WHO definition the term diabetes mellitus covers a group of metabolic diseases characterized by elevated blood glucose levels. The two main representatives of this group are type 1 and type 2 diabetes. All forms of diabetes have in common that, due to hyperglycemia, complications (vascular damage in particular) can occur, which are responsible for the high rate of morbidity as well as the excess mortality of the group of persons affected. In all populations--Germany included--the overwhelming majority of diabetics are subjects with type 2 diabetes. Type 2 diabetes is almost 20 times more common than type 1 diabetes, i.e. almost 90% of all diabetic persons can be assigned to the type 2 diabetes category. The rest can be split up into 5-7% type 1 diabetics and 2%-5% of persons suffering from secondary forms of diabetes (pancreatic and hepatic diseases). Positive antibody tests in older diabetic persons suggest that type 2 diabetes may not be a uniform disease and that in almost 10% of cases an autoimmune disease might be the cause of diabetes in old age (LA-DA diabetes). The data of the diabetes register of the former German Democratic Republic (East Germany) together with representative samples obtained from the federal states that comprised West Germany indicate a diabetes prevalence of about 5% in the adult population of Germany. Once the new WHO diagnostic criteria for diabetes mellitus are used and an early-diagnosis procedure (the oral glucose tolerance test) is widely applied the prevalence is expected to be shown to be higher. What is more, the global trend toward higher figures for type 1 and type 2 diabetes can also be observed in Germany. Whereas the pathogenesis of type 1 diabetes results from the autoimmune destruction of beta cells, leading to insulin deficiency, in type 2 diabetes insulin resistance as well as impaired insulin secretion are present; mechanisms that interact closely in the development of glucose intolerance. Strong genetic and environmental factors operate with regard to both types. The reduction of the life expectancies for type 1 and type 2 diabetes is contingent upon the appearance of micro- and/or macrovascular complications. At the top of the mortality statistics are patients suffering from cardiovascular and/or kidney diseases. However, by applying metabolic control and by means of other intervention strategies the prognoses for diabetic patients can be improved significantly.
根据世界卫生组织的定义，糖尿病这一术语涵盖了一组以血糖水平升高为特征的代谢性疾病。该组疾病的两个主要代表是1型糖尿病和2型糖尿病。所有形式的糖尿病都有一个共同点，即由于高血糖，可能会出现并发症（尤其是血管损伤），这些并发症导致了受影响人群的高发病率和额外死亡率。在所有人群中——包括德国——绝大多数糖尿病患者是2型糖尿病患者。2型糖尿病的发病率几乎是1型糖尿病的20倍，也就是说，几乎90%的糖尿病患者可归类为2型糖尿病。其余的可分为5% - 7%的1型糖尿病患者和2% - 5%的继发性糖尿病患者（胰腺和肝脏疾病）。老年糖尿病患者抗体检测呈阳性表明，2型糖尿病可能并非单一疾病，在近10%的病例中，自身免疫性疾病可能是老年糖尿病（成人隐匿性自身免疫糖尿病）的病因。前德意志民主共和国（东德）糖尿病登记数据以及从构成西德的联邦州获取的代表性样本表明，德国成年人口中的糖尿病患病率约为5%。一旦采用世界卫生组织新的糖尿病诊断标准并广泛应用早期诊断程序（口服葡萄糖耐量试验），预计患病率会更高。此外，在德国也能观察到1型和2型糖尿病全球发病率上升的趋势。1型糖尿病的发病机制是β细胞的自身免疫性破坏，导致胰岛素缺乏，而2型糖尿病则存在胰岛素抵抗以及胰岛素分泌受损；这些机制在糖耐量异常的发展过程中密切相互作用。两种类型的糖尿病都受到强大的遗传和环境因素影响。1型和2型糖尿病患者预期寿命的缩短取决于微血管和/或大血管并发症的出现。死亡率统计中居首位的是患有心血管和/或肾脏疾病的患者。然而，通过进行代谢控制和采用其他干预策略，糖尿病患者的预后可以得到显著改善。
