Diabetes mellitus: Difference between revisions
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==Background== |
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*Disorder of glucose metabolism resulting in chronically elevated serum glucose levels |
*Disorder of glucose metabolism resulting in chronically elevated serum glucose levels |
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==Causes and Classification== |
===Causes and Classification=== |
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*'''[[Type 1 diabetes mellitus|Type 1]]:''' absolute insulin deficiency from beta-islet cell destruction |
*'''[[Type 1 diabetes mellitus|Type 1]]:''' absolute insulin deficiency from beta-islet cell destruction |
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**'''Type 1a:''' autoimmune beta-islet destruction |
**'''Type 1a:''' autoimmune beta-islet destruction |
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**'''Type 1b:''' beta-islet destruction without known cause |
**'''Type 1b:''' beta-islet destruction without known cause |
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**'''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 |
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*'''[[Type 2 diabetes mellitus|Type 2]]:''' insulin resistance and varying degrees of insulin deficiency |
*'''[[Type 2 diabetes mellitus|Type 2]]:''' insulin resistance and varying degrees of insulin deficiency |
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*Genetic conditions |
*Genetic conditions |
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*[[Stiff-person syndrome]] |
*[[Stiff-person syndrome]] |
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*Anti-insulin receptor antibodies |
*Anti-insulin receptor antibodies |
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== Management == |
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=== ABCDESSS === |
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* A1c targets: ≤7% (or ≤6.5 to decrease disk of CKD and retinopathy) |
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* BP targets: <130/80 mmHg |
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* Cholesterol targets: LDL <2 mmol/L or >50% reduction from baseline |
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* Drugs for CVD risk reduction |
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** ACEi/ARB if CVD, age ≥55 with risk factors, or diabetes complications |
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** Statin if CVD, age ≥40 (for type 2), or diabetes complications |
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** ASA if CVD |
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** SGLT2i/GLP1ra if type 2 with CVD and A1c not at target |
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* Exercise goals and healthy eating |
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** 150 minutes of moderate-to-vigorous aerobic activity weekly, with resistance exercise 2-3 times weekly |
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** Health dietary pattern such as Mediterranean diet or low glycemic index diet |
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* Screening for complications |
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** Cardiac: ECG every 3-5 years if age >40 or diabetes complications |
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** Foot: monofilament or vibration testing yearly, or more often if abnormal |
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** Kidney: creatinine and ACR yearly, or more often if abnormal |
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** Retinopathy: yearly for type 1, every 1-2 years for type 2 |
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* Smoking cessation: ask permission to give advice, refer for therapy, and provide support |
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* Self-management, stress, and other barriers |
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** Set personalized goals |
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** Assess for stress, mental health, and financial concerns that might be barriers to achieving goals |
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[[Category:Endocrinology]] |
[[Category:Endocrinology]] |
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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
