Zhang Zongji Zhang Zongji Department of PathologyDepartment of PathologyKunming Medical CollegeKunming Medical College

OVERVIEWOVERVIEW

Characteristic feature is hyperglycemia and glycosuria. Injury of many organs occur in long-standing diabetes.

Genetic predisposition

Environmental insult

Deficiency in InsulinDeficiency in Insulin

Target-tissue resistanceTarget-tissue resistance

Disorder of metabolism in glucose, protein and fat

Chronic

Disorder Destruction of pancreatic islet

Destruction of pancreatic islet

World health problem

InsulinInsulin

Beta cell of the pancreatic islet

CLACIFICATION

Primary diabetes mellitusPrimary diabetes mellitus

Insulin-dependent diabetes mellitus, Insulin-dependent diabetes mellitus, IDDMIDDM

Secondary diabetes mellitusSecondary diabetes mellitus

Non-Insulin-dependent diabetes Non-Insulin-dependent diabetes mellitus, mellitus, NIDDMNIDDM

Arise from any diseases causing extensive destruction of pancreatic islet

Special types of diabetes mellitusSpecial types of diabetes mellitusGestational diabetes mellitusGestational diabetes mellitus

Insulin-dependent diabetes mellitusInsulin-dependent diabetes mellitus IDIDDMDM TYPEⅠor Juvenile-onset diabetes

HLA genesHLA genes

virusvirus

Beta cellBeta cell

insulininsulin

IDDMIDDM

Genetic Susceptibility ： 6p21— MHC- Ⅱ （ HLA-DP ， DQ ， DR ）

autoimmunityautoimmunity

TypeⅠA and TypeⅠB

Non-Insulin-dependent diabetes mellitusNon-Insulin-dependent diabetes mellitus NIDDMNIDDM TYPEⅡor adult-onset diabetes

90% ～ 95%

环境因素

中国人相关基因中国人相关基因 胰岛素受体基因 载脂蛋白 AI 及 B 基因 葡萄糖激酶 (GCK) 基因

ObesityObesity

多基因变异多基因变异 PPARγ ARNT PTPN1

对胰岛素抵抗

性

胰岛素分泌紊乱

遗传易感性

B

细胞缺

陷

葡萄糖不适当利用

NIDDMNIDDM

Hyperglycemia

两个基本因素 两个基本环节

IDDM NIDDM 基 因 HLA-D相关 多基因缺陷，HLA-D无关

发病机制 自身免疫 胰岛素抵抗

病毒感染 胰岛素分泌紊乱

胰岛细胞 早期胰岛炎 无胰岛炎

显著萎缩和纤维化 局部萎缩和淀粉样变性

严重 B细胞耗竭 中度 B细胞耗竭

临 床 多见儿童 多见成人

正常体重 肥胖

血胰岛素降低 血胰岛素正常或增高

抗胰岛细胞抗体（+） 抗胰岛细胞抗体（—）

常见酮症 罕见酮症

MORPHOLOGY

1. 1. Pancreatic isletPancreatic islet

Leukocytic infiltration( A)ⅠReduction in the number and size of islet（Ⅰ )

Beta-cell degranulation（Ⅰ A) Hyaline（Ⅰ ) and Amyloid （Ⅱ ) replacement of islet

Not specific Ⅰ>Ⅱ

Vascular systemVascular system

Vessels of all sizes are affected

Atherosclerosis

Myocadial Myocadial infarctioninfarction

Gangrene of the lower extremities

World Diabetes Day 2005 focused on diabetes and foot care.

Hyaline arteriolosclerosis：Hypertension

Diabetes microangiopathy:

Diffuse thickening Diffuse thickening of basement of basement membranesmembranes

Diabetic nephropathyDiabetic nephropathy

Glomerular lesionsRenal vascular leisionsPyelonephritis

Renal failure

Diabetic ocular complicationDiabetic ocular complication

Retinopathy

Cararact Glaucoma

nonproliferativeproliferative

BlindnessBlindness

Diabetic neuropathy and other lesions

Chronic ulcer of leg

CLINICAL FEATURES

Hyperglycemia Hyperglycemia andand glycosuria glycosuria““ 三多一少”：三多一少”：

Polyuria Polyphagia Polydipsia Loss of weight

KetoacidosisKetoacidosisLate complicationLate complication

COMPLICATION: Long-Standing Diabetes

AtherosclerosisAtherosclerosis

Susceptibility to infectionsSusceptibility to infections

Myocardial infarctionStroke (cerebrovascular accidents)Gangrene of the legRenal failure Atherosclerotic heart disease

CAUSE OF DEATH:

November 14 ：“ World Diabetes Day

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