Diabetes mellitus

From IDWiki

Background

  • Disorder of glucose metabolism resulting in chronically elevated serum glucose levels

Causes and Classification

Management

ABCDESSS

  • A1c targets: ≤7% (or ≤6.5 to decrease disk of CKD and retinopathy)
  • BP targets: <130/80 mmHg
  • Cholesterol targets: LDL <2 mmol/L or >50% reduction from baseline
  • Drugs for CVD risk reduction
    • ACEi/ARB if CVD, age ≥55 with risk factors, or diabetes complications
    • Statin if CVD, age ≥40 (for type 2), or diabetes complications
    • ASA if CVD
    • SGLT2i/GLP1ra if type 2 with CVD and A1c not at target
  • Exercise goals and healthy eating
    • 150 minutes of moderate-to-vigorous aerobic activity weekly, with resistance exercise 2-3 times weekly
    • Health dietary pattern such as Mediterranean diet or low glycemic index diet
  • Screening for complications
    • Cardiac: ECG every 3-5 years if age >40 or diabetes complications
    • Foot: monofilament or vibration testing yearly, or more often if abnormal
    • Kidney: creatinine and ACR yearly, or more often if abnormal
    • Retinopathy: yearly for type 1, every 1-2 years for type 2
  • Smoking cessation: ask permission to give advice, refer for therapy, and provide support
  • Self-management, stress, and other barriers
    • Set personalized goals
    • Assess for stress, mental health, and financial concerns that might be barriers to achieving goals