Diabetes mellitus type 2

From IDWiki

Definition

  • A disease of glucose processing caused by a combination of insulin resistance and decreased insulin production that is characterized by elevated serum glucose, decreased glucose tolerance, and elevated glycosylated products, and that greatly increases the risk of cardiovascular disease

Etiology

Pathophysiology

Differential Diagnosis

Epidemiology

Risk Factors

  • Family history
  • Metabolic syndrome

Clinical Manifestations

  • History
  • Signs & Symptoms

Investigations

  • Labs
  • Imaging
  • Other

Diagnosis

  • If asymptomatic, need to repeat the same test on a different day, and also needs another of below; if symptomatic, only need one criteria
  • Fasting plasma glucose ≥7.0 (normal ≤6.0)
  • Hemoglobin A1c ≥6.5% (normal <6%)
  • Random plasma glucose ≥11.1
  • 2h 75g oral glucose tolerance test ≥11.1 (normal ≤7.7)

Chronic Management

  • ABCDEs: A1c, BP, Cholesterol, Drugs (ACEi/Statin/ASA), Exercise/Eating, Stop smoking
  • Smoking cessation
  • Targets
    • Hemoglobin A1c ≤7% for most people, ≤6.5% for some, and ≤8.5% for elderly or significant comorbidities that complicate management
    • BP ≤130/80
    • LDL-C ≤2.0
  • Monitoring
    • A1c
    • Urine microalbumin
    • Lipid panel
    • Eye exam
  • Driving if on a hypoglycemic agent
    • CBG ≥5 before driving (snack or dex tabs if lower, then recheck)
  • Exercise 150 minutes per week of moderate exercise
  • Statins
    • ≥40 yrs, or age >30 yrs with diabetes >15 years
    • Macro or microvascular disease
  • ACEi/ARBs
    • ≥55 years
    • Micro or macrovascular disease
    • Agents:
      • perindopril 8mg (EUROPA)
      • ramipril 10mg (HOPE)
      • telmisartan 80mg daily (ONTARGET)
  • ASA: insufficient evidence
  • CKD: ACR≥2.0 or eGFR < 60
  • Retinopathy: screen probably q2y if no or mild retinopathy, and q6mo. in severe
  • Neuropathy: screen with monofilament or tuning fork
  • Treat pain with
    • Anticonsulsants gabapentin, valproate
    • Antidepressents: amitriptyline, duloxetine, venlafaxin
    • Opioids
  • Sick day management (what to do if unable to eat and drink)
    • Counsel patient on which medications to hold

Further Reading