Diabetes mellitus: Difference between revisions

Latest revision as of 13:41, 25 December 2021

Background

Disorder of glucose metabolism resulting in chronically elevated serum glucose levels

Causes and Classification

Type 1: absolute insulin deficiency from beta-islet cell destruction
- Type 1a: autoimmune beta-islet destruction
- Type 1b: beta-islet destruction without known cause
- Latent autoimmune diabetes in adults (LADA) (type 1.5): insulin resistance that progresses to autoimmune diabetes and insulin dependency over several years
Type 2: insulin resistance and varying degrees of insulin deficiency
Genetic conditions
- Maturity-onsent diabetes of the young (MODY): autosomal dominant condition that causes type 2 diabetes in those under 25
- Wolfram syndrome: diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD)
Exocrine pancreas disorders
Drug-induced
- Steroids
- Many others
Stiff-person syndrome
Anti-insulin receptor antibodies

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

@@ Line 1: / Line 1: @@
-== Definition ==
+==Background==
-* Disorder of glucose metabolism resulting in chronically elevated serum glucose levels
+*Disorder of glucose metabolism resulting in chronically elevated serum glucose levels
-== Causes and Classification ==
+===Causes and Classification===
-* '''Type 1:''' absolute insulin deficiency from beta-islet cell destruction
+*'''[[Type 1 diabetes mellitus|Type 1]]:''' absolute insulin deficiency from beta-islet cell destruction
-** '''Type 1a:''' autoimmune beta-islet destruction
+**'''Type 1a:''' autoimmune beta-islet destruction
-** '''Type 1b:''' beta-islet destruction without known cause
+**'''Type 1b:''' beta-islet destruction without known cause
-** '''Latent autoimmune diabetes in adults (LADA):''' insulin resistance that progresses to autoimmune diabetes and insulin dependency over several years
+**'''Latent autoimmune diabetes in adults (LADA) (type 1.5):''' insulin resistance that progresses to autoimmune diabetes and insulin dependency over several years
-* '''Type 2:''' insulin resistance and varying degrees of insulin deficiency
+*'''[[Type 2 diabetes mellitus|Type 2]]:''' insulin resistance and varying degrees of insulin deficiency
-* Genetic conditions
+*Genetic conditions
-** '''Maturity-onsent diabetes of the young (MODY):''' autosomal dominant condition that causes type 2 diabetes in those under 25
+**'''[[Maturity-onsent diabetes of the young]] (MODY):''' autosomal dominant condition that causes type 2 diabetes in those under 25
-** '''Wolfram syndrome:''' diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD)
+**'''[[Wolfram syndrome]]:''' [[diabetes insipidus]], [[diabetes mellitus]], [[optic atrophy]], and [[deafness]] (DIDMOAD)
-* Exocrine pancreas disorders
+*Exocrine pancreas disorders
-** Cystic fibrosis
+**[[Cystic fibrosis]]
-** Hereditary hemochronatosis
+**[[Hereditary hemochromatosis]]
-** Chronic pancreatitis
+**[[Chronic pancreatitis]]
-** Fibrocalculous pancreatic diabetes
+**[[Fibrocalculous pancreatic diabetes]]
-* Drug-induced
+*Drug-induced
-** Steroids
+**[[Steroids]]
-** Many others
+**Many others
-* Stiff-person syndrome
+*[[Stiff-person syndrome]]
-* Anti-insulin receptor antibodies
+*Anti-insulin receptor antibodies
+== 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
 [[Category:Endocrinology]]