Karalliedde Janaka, Gnudi Luigi
Unit for Metabolic Medicine, Department of Diabetes and Endocrinology, Cardiovascular Division, School of Life Science & Medicine, King's College, London, UK.
Nephrol Dial Transplant. 2016 Feb;31(2):206-13. doi: 10.1093/ndt/gfu405. Epub 2014 Dec 30.
Diabetes mellitus (DM) is increasingly recognized as a heterogeneous condition. The individualization of care and treatment necessitates an understanding of the individual patient's pathophysiology of DM that underpins their DM classification and clinical presentation. Classical type-2 diabetes mellitus is due to a combination of insulin resistance and an insulin secretory defect. Type-1 diabetes is characterized by a near-absolute deficiency of insulin secretion. More recently, advances in genetics and a better appreciation of the atypical features of DM has resulted in more categories of diabetes. In the context of kidney disease, patients with DM and microalbuminuria are more insulin resistant, and insulin resistance may be a pathway that results in accelerated progression of diabetic kidney disease. This review summarizes the updated classification of DM, including more rarer categories and their associated renal manifestations that need to be considered in patients who present with atypical features. The benefits and limitations of the tests utilized to make a diagnosis of DM are discussed. We also review the putative pathways and mechanisms by which insulin resistance drives the progression of diabetic kidney disease.
糖尿病（DM）越来越被认为是一种异质性疾病。护理和治疗的个体化需要了解个体患者糖尿病的病理生理学，这是其糖尿病分类和临床表现的基础。经典的2型糖尿病是胰岛素抵抗和胰岛素分泌缺陷共同作用的结果。1型糖尿病的特征是胰岛素分泌近乎绝对缺乏。最近，遗传学的进展以及对糖尿病非典型特征的更好认识导致了更多糖尿病类型的出现。在肾脏疾病方面，糖尿病和微量白蛋白尿患者的胰岛素抵抗更强，胰岛素抵抗可能是导致糖尿病肾病加速进展的一条途径。本综述总结了糖尿病的最新分类，包括更罕见的类型及其相关的肾脏表现，这些在具有非典型特征的患者中需要加以考虑。讨论了用于诊断糖尿病的检测方法的优缺点。我们还综述了胰岛素抵抗驱动糖尿病肾病进展的假定途径和机制。
