الفهرس 
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Abstract
Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030.
Diabetes was classified into four broad categories: type 1, type 2, gestational diabetes and ”other specific types”. The ”other specific types” are a collection of a few dozen individual causes. The term ”diabetes”, without qualification, usually refers to diabetes mellitus. The rare disease diabetes insipidus has similar symptoms as diabetes mellitus, but without disturbances in the sugar metabolism (insipidus means ”without taste” in Latin).
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated autoimmune attack.
Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 diabetes is the most common type.
The diagnosis of diabetes was based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h value in the 75-g oral glucose tolerance test (OGTT). In 2009, an International Expert Committee that included representatives of the ADA, the International Diabetes Federation (IDF), and the European Association for the Study of Diabetes (EASD) recommended the use of the A1C test to diagnose diabetes, with a threshold of ≥ 6.5%, and the ADA adopted this criterion in 2010.
Testing to detect type 2 diabetes and prediabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥ 25 kg/m2) and who have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45. If tests are normal, repeat testing at least at 3-year intervals is reasonable.
The ADA recognizes the anticipated significant increase in the incidence of GDM diagnosed by these criteria and is sensitive to concerns about the “medicalization” of pregnancies previously categorized as normal.
These diagnostic criteria changes are being made in the context of worrisome worldwide increases in obesity and diabetes rates, with the intent of optimizing gestational outcomes for women and their babies. The diagnosis of GDM is made when any of the following plasma glucose values are exceeded:Fasting: ≥ 92 mg/dL (5.1 mmol/L), 1 h: ≥ 180 mg/dL (10.0 mmol/L), 2 h:≥ 153 mg/dL (8.5 mmol/L).
The accumulated results suggest that not everyone benefits from aggressive glucose management. It follows that it is important to individualize treatment targets. or patient centered approach.
The ADA’s “Standards of Medical Care in Diabetes” recommends lowering HbA1c to < 7.0% in most patients to reduce the incidence of microvascular disease. This can be achieved with a mean plasma glucose of about 150–160 mg/dL; ideally, fasting and premeal glucose should be main tained at < 130 mg/dL and the postprandial glucose at <180 mg/dL.
More stringent HbA1c targets (e.g., 6.0– 6.5%) might be considered in selected patients (with short disease duration, long life expectancy, no significant CVD) if this can be achieved without significant hypoglycemia or other adverse effects of treatment.
Conversely, less stringent HbA1c goal e.g., 7.5–8.0% or even slightly higher dare appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced complications, extensive co-morbid conditions and those in whom the target is difficult to attain despite intensive self-management education, repeated counseling, and effective doses of multiple glucose-lowering agents, including insulin.
Ultimately, the aims of controlling glycemia are to avoid acute osmotic symptoms of hyperglycemia, to avoid instability in blood glucose over time, and to prevent/delay the development of diabetes complications without adversely affecting quality of life.
The glucose-lowering effectiveness of noninsulin pharmacological agents was said to be high for metformin, sulfonylureas, TZDs, and GLP-1 agonists (expected HbA1c reduction about 1.0–1.5%), and generally lower for meglitinides, DPP-4 inhibitors, AGIs, colesevelam, and bromocriptine (about 0.5–1.0%).
The major implication of is that individuals with diabetes seem to use CAM as a complement rather than as an alternative to conventional treatment. 57% of individuals with diabetes who used CAM discussed it with their regular physician and 43% were actually referred to CAM users by a physician.
Coenzyme Q10 is a cofactor used in oxidative respira¬tion and is produced endogenously. Supplementation of coenzyme Q10 is especially popular for cardiovascular diseases. Two RCTs of patients with type 2 diabetes and a single RCT of patients with type 1 diabetes pro¬duced no strong evidence for glycemic control with coenzyme Q10 supple-mentation.
There is strong evidence that 200 to 1000 μg of chromium picolinate daily improve glycemic control. Based on its safety and potential cost-effectiveness, a definitive clinical trial is urgently needed. Biotin might enhance its effects, but this combination requires further study.
Cinnamon has been used for thousands of years to treat diabetes and other conditions. The aqueous extract appears to activate the insulin receptor by multiple mechanisms, and also increases glycogen synthesis activity.
Prospective and retrospective population studies suggest that green tea consumption reduces the risk of type 2 DM by up to 48%. Surprisingly, only 1 small RCT (N = 49) has evaluated green tea in the context of diabetes. In this study, patients with baseline HbA1c levels of 6.5% to 9.1% were randomized to receive either an extract containing green tea catchiness and black tea theaflavins or placebo for 3 months. No improvements in HbA1c levels were seen and FBG values were not measured.
One trial, which used a higher dose (100 g) of defatted seed powder in 15 patients for 10 days, did report improvements in FBG values. None of the trials investigated HbA1c levels. No adverse effects were reported. There is very limited evidence to support the use of fenugreek in diabetes management.
In one trial, patients with type 2 DM were given either 200 mg of an ethanolic extract daily or their usual treatment for 18 to 20 months. Significant improvements in FBG and HbA1c levels (P < .001 for both) were noted in the test group.
Two controlled, nonrandomized trials in patients with type 2 dia-betes who were given aloe gel juice reported decreases in fasting blood glucose during 6 weeks. Clinical trials of oral garlic in patients with type 2 diabe¬tes have not demonstrated significant changes in blood glucose or insulin levels.
This systematic review of 23 trials and 2,774 patients found that prayer and distant healing yielded statistically significant treatment effects in 13 patients (57%), no effect over control interventions in 9 patients (39%), and a negative effect in 1 patient (4%).
Public health nurses and community outreach workers in high-risk communities are also helpful through their efforts to screen, identify cases, refer and track follow-up appointments, and educate patients. All health care professionals must be committed to enhancing DM control through reinforcing messages about the risks of DM, education about effective lifestyle interventions, pharmacologic therapies, and adherence to treatment. Patient attitudes are greatly influenced by cultural differences, beliefs, and previous experiences with the health system.