[Diabetes mellitus as a primary and secondary metabolic disease]

Already in the preface of his book "Alimentary and Metabolic Diseases" Max Bürger writes: "I see a difficulty in the definition in the field of metabolic diseases. Since all life processes are finally based on a change of the substances, the accentuation of individual diseases as metabolic diseases is more or less arbitrary." The diabetes mellitus belongs to the classical metabolic diseases. But here only the symptoms are taken into consideration which phenotypically are standing in the foreground. The further clarification of the etiopathogenesis shows that the diabetes mellitus has heterogeneous causes and an existing insulin deficiency is etiologically to be classified as a primary immunological or endocrinological disease and thus one should speak of a secondary metabolic disease, while in normal insulin secretion it should be regarded as a primary metabolic disease.