Secondary and other types of Diabetes

According to the classification system developed by the National Diabetes Data Group, the subclass secondary diabetes contains "a variety of types of diabetes, in some of which the etiologic relationship is known (e.g., diabetes secondary to pancreatic disease, endocrine disease, or administration of certain drugs); whereas in others, an etiologic relationship is suspected because of higher frequency of association of diabetes with a syndrome or a condition (e.g., a number of genetic syndromes)."

When diabetes is secondary to pancreatic disorders, particularly when b-cell mass is greatly reduced as in malignancy or pancreatectomy, or when diabetes is due to chemical agents toxic to the b-cell, such as pentamidine or vacor, overt diabetes with or without ketoacidosis will often result depending on the extent of b-cell loss. In contrast, when diabetes is secondary to endocrinopathies leading to counterregulatory hormone production (e.g., acromegaly, Cushing’s syndrome, hyperthyroidism), overt diabetes or ketoacidosis is unusual, mainly owing to the compensatory responsiveness of the normal b-cell mass. The net metabolic outcome in patients with secondary diabetes thus depends on the direct or indirect impact of the underlying disorders on insulin secretion (i.e., inhibition or compensatory hyperinsulinemia), insulin-sensitivity (i.e., glucose utilization), and/or unmasking of genetic diabetes.

classification of various forms of secondary diabetes

Classification of Secondary Forms of Diabetes or Impaired Glucose Tolerance

Pancreatic disorders Pancreatectomy Pancreatitis, pancreatic malignancy Malnutrition-related diabetes Hemochromatosis Endocrinopathies Growth hormone excess (acromegaly) and deficiency states Glucocorticoid excess (Cushing’s syndrome) Catecholamine excess (pheochromocytoma) Primary hyperaldosteronism Hyperthyroidism Tumors of endocrine pancreas or gut Glucagonoma, somatostatinoma, pancreatic cholera syndrome, carcinoid syndrome, multiple endocrine neoplasia syndromes Polyendocrine autoimmunity syndromes Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) syndrome Drugs, chemical agents, and toxins Diuretics and antihypertensive agents Thiazides, chlorthalidone, loop-diuretics (furosemide, ethacrynic acid, metolazone), diazoxide, clonidine, b-adrenergic antagonists Hormones Glucocorticoids, ACTH, a-adrenergic agonists, growth hormone, glucagon, oral contraceptives, progestational agents Psychoactive agents Lithium, opiates, ethanol, phenothiazines Anticonvulsants Diphenylhydantoins (Dilantin) Antineoplastic agents Streptozotocin, L-asparaginase, mithramycin Antiprotozoal Pentamidine Rodenticides Pyriminil (Vacor) Miscellaneous Nicotinic acid, cyclosporine, N-nitrosamines, theophylline Genetic syndromes Pancreatic deficiencies Congenital absence of pancreatic islets Cystic fibrosis Hereditary relapsing pancreatitis Mutant insulin syndromes Severe to extreme insulin resistance syndromes Type A syndrome—classic and variants Type B syndrome—associated with autoantibodies to insulin-receptor Leprechaunism Lipodystrophic syndromes Rabson-Mendenhall syndrome (precocious puberty, dental dysplasia, dystrophic nails) Ataxia-telangiectasia Alström syndrome (obesity, retinitis pigmentosa, deafness) Dystrophia myotonica Glucokinase gene mutations Mitochondrial tRNA gene mutation Obesity-associated insulin resistance Laurence-Moon-Biedl syndrome Bardet-Biedl syndrome Prader-Willi syndrome Achondroplasia Progeroid syndromes Werner’s syndrome Cockayne’s syndrome (microcephaly, dwarfism, deafness, nephropathy) Chromosomal defects Down’s syndrome (Trisomy 21) Klinefelter’s syndrome (47, XXY) Turner’s syndrome (45, XO) Hereditary neuromuscular disorders Muscular dystrophy Huntington’s chorea Friedreich’s ataxia (spinocerebellar ataxia) Machado disease (ataxia, dysarthria, nystagmus) Herrmann’s syndrome (photomyoclonus, dementia, deafness, nephropathy) Stiff-man syndrome DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy, deafness) and variants Kearns-Sayre syndrome (ophthalmoplegia, retinitis pigmentosa, mitochondrial myopathy, heart block)

See Also

• Conditions & Treatments
• Complications
• Attention to Body's Well Being
• Diabetes Medications