Diabetes Mellitus

Background

  • Diabetes mellitus type 2 is a common endocrine disorder characterized by variable degrees of insulin resistance and deficiency, resulting in hyperglycemia.
  • Potential complications of diabetes mellitus include cardiovascular disease, neuropathy, nephropathy, retinopathy, and increased mortality.
  • Assess HbA1c (or another glycemic measurement) to determine glycemic control.
    • For patients who have stable glycemic control and who are meeting treatment goals, consider testing at least 2 times per year (Weak recommendation).
    • For patients not meeting treatment goals or if therapy changes, consider testing at least every 3 months (quarterly) and as needed (Weak recommendation).
  • It is often identified through routine screening beginning in middle age, or through targeted screening of adults of any age with overweight or obesity and with risk factors such as metabolic syndrome, polycystic ovary syndrome, a history of gestational diabetes, or other concerning familial, clinical, or demographic characteristics.

    Evaluation

    • Type 2 diabetes is frequently asymptomatic but may present with symptoms typical of hyperglycemia such as polyuria, polydipsia, and polyphagia.
    • Perform blood testing to diagnose diabetes (Strong recommendation).
      • Diagnostic criteria for diabetes is any of:
        • random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) with symptoms of hyperglycemia (such as polyuria or polydipsia) or hyperglycemic crisis
        • no unequivocal hyperglycemia, but 2 abnormal test results from either 2 separate test samples or the same sample; abnormal test results include:
          • fasting plasma glucose ≥ 126 mg/dL (7 mmol/L) (no caloric intake for ≥ 8 hours)
          • 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during 75-g oral glucose tolerance test
          • HbA1c ≥ 6.5% (HbA1c may not be accurate for diagnosis with pregnancy, hemoglobinopathy, certain anemias, or abnormal erythrocyte loss or replacement
    Assess HbA1c (or another glycemic measurement) to determine glycemic control.
    • For patients who have stable glycemic control and who are meeting treatment goals, consider testing at least 2 times per year (Weak recommendation).
    • For patients not meeting treatment goals or if therapy changes, consider testing at least every 3 months (quarterly) and as needed (Weak recommendation)