Diabetes Mellitus Type 2 - Treatment, Screening & Management PDF

Diabetes Mellitus Type 2  Diabetes mellitus  Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose.  *Cardinal Signs of DM – Polydipsia, Polyuria, Polyphagia  There are many subtypes with the main ones being  Type 1 DM—low or absent insulin ,C-peptid...

Diabetes Mellitus Type 2  Diabetes mellitus  Diabetes mellitus (DM) is a disease of inadequate control of blood levels of glucose.  *Cardinal Signs of DM – Polydipsia, Polyuria, Polyphagia  There are many subtypes with the main ones being  Type 1 DM—low or absent insulin ,C-peptide, positive β-cell autoantibodies, ketosis.  Type 2 DM is due to a progressive insulin secretory defect in the setting of insulin resistance.  *SIMPLY STATED – Type 1 is no insulin, Type 2 is insulin that doesn’t work properly.   The American Association of Clinical Screening Endocrinologists, American Academy of Family Physicians, Diabetes Australia, Guidelines Diabetes UK, and the Canadian Task Force on Preventive Health Care recommend screening for diabetes in persons with risk factors only.  Classic Presentation Majority of patients are asymptomatic and hyperglycemia is found on routine lab evaluation. Polydipsia, polyuria, nocturia, blurred vision, and infrequently weight loss, fatigue, slowly healing wounds, frequent infections, and sometimes numbness and tingling of hands and feet. Polyuria commonly presents when serum glucose concentrations rise significantly above 180mg/dL which is the renal threshold for glucose. Patients with type 2 diabetes may have no symptoms or only subtle symptoms that may persist for weeks, months, or years before detection.  Type 2 DM Insufficient insulin secretion Increased insulin resistance  Type 2 DM  previously referred to as “non–insulin-dependent diabetes” or “adult- onset diabetes”  accounts for 90–95% of all diabetes  This form encompasses individuals who have insulin resistance and usually relative (rather than absolute) insulin deficiency DM Screening in Asymptomatic Adult – Risk Factors overweight or obese (BMI >25 or >23 in Asian Americans) and who have one or more additional risk factors for diabetes:  physical inactivity  HDL cholesterol level 35 mg/dL and/or a  first-degree relative with diabetes triglyceride level 250 mg/dL (2.82  high-risk race/ethnicity (e.g., African mmol/L)  women with polycystic ovary syndrome American, Latino, Native American,  A1C 5.7%, IGT, or IFG on previous Asian American, Pacific Islander) testing  women who delivered a baby  other clinical conditions associated with weighing 9 lbs or were diagnosed insulin resistance (e.g., severe obesity, with GDM acanthosis nigricans)  history of CVD  hypertension (>140/90 mmHg or on therapy for hypertension)   For all patients, testing should begin at age 45 years.  If results are normal, testing should be repeated at a minimum of 3-year Criteria for intervals, with consideration of more Screening frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status. Diagnostics Serum Glucose (random or fasting)  Urinalysis 126 mg/dl diabetes or higher on 2  C peptide separate occasions  0.51–2.72 ng/dl normal  2.72 ng/dl T2DM 6.5% diabetes  Fasting lipid profile  Liver function tests Oral Glucose Tolerance Test  Spot urinary albumin-to-creatinine 200mg/dl diabetes or higher after 2  Serum Creatinine and estimated GFR hours  TSH in patients with dyslipidemia or women aged >50  Comprehensive Medical Evaluation Eating patterns, nutritional status, Presence of common weight history, and Age and comorbidities, Screen for depression physical activity characteristics of psychosocial using PHQ-2 (PHQ-9 if habits; nutrition onset of diabetes problems, and dental PHQ-2 is positive) education and disease behavioral support history and needs Diabetes education, Screen for diabetes History of smoking, self-management, and distress using DDS or alcohol consumption, support history and PAID-1 and substance use needs   Height, weight and BMI (growth and pubertal development in children and adolescents)  Blood pressure (including orthostatic if indicated)  Eyes (fundoscopy) Physical  Oral cavity (gum disease, fungal infections, or lesions)  Neck (palpate thyroid) Examination  Cardiac: HR, rate, rhythm, murmurs, clicks or extra heart sounds  Skin: irritation, infection, redness, ulcers, dryness, acanthosis nigrans  Feet: pulses, reflexes, sensation, overall skin condition  Glycemic Targets  HgbA1C