Browse
Topics & Collections
Search for a specific
disease or term
—  or  —
Learn more about ACP Smart Medicine

Dynamed

X
This content was provided by DynaMed (dynamed.ebscohost.com). For more information click here.
Last Updated: 4/21/2014  

Diabetes Mellitus, Type 2

Prevention
  • Recommend healthy lifestyle changes in patients with impaired glucose tolerance or who are at high risk for type 2 diabetes based on obesity, the presence of polycystic ovarian disease, metabolic syndrome, or strong family history.

Screening
  • Obtain a fasting plasma glucose level or HbA1C to screen for type 2 diabetes in patients with selected comorbidities or risk factors for the disease including obesity, family history, hypertension, and polycystic ovarian disease.

Diagnosis
  • Establish the diagnosis of diabetes using a glucose tolerance test, a fasting plasma glucose level >126 mg/dL, a random glucose level >200 mg/dL, or an HbA1c >6.5%.

  • Confirm the diagnosis of type 2 diabetes in any patient with a random plasma glucose level above the normal range, symptoms of hyperglycemia, or possible complications of diabetes.

  • Order laboratory tests to establish baselines and to screen for complications of diabetes, checking HbA1c, urine microalbumin, lipid profile, creatinine and electrolytes.

Therapy
  • Use patient characteristics and preferences to set treatment goals, generally with a goal HbA1c <7%.

  • Recommend diet and exercise programs as the cornerstones of therapy for diabetes.

  • Begin oral hypoglycemic agents in patients in whom diet and exercise do not adequately control diabetes and adjust as needed to achieve target level of glycemic control. Use metformin as the first-line oral agent in most patients with diabetes.

  • Consider using a combination of insulin and oral agents if oral agents do not achieve the desired level of glycemic control.

  • Treat hypertension preferentially with an ACE inhibitor or ARB, to reduce the risk for adverse microvascular (e.g., retinopathy, nephropathy) and macrovascular (e.g., MI, stroke) outcomes, with a goal blood pressure <140/90 mm Hg.

  • Treat hyperlipidemia with moderate- or high-intensity statin therapy to reduce the risk for macrovascular complications.

  • Use aspirin for secondary prevention of cardiovascular disease in patients with diabetes and consider its use for primary prevention in select patients.

  • Prevent and treat diabetic nephropathy, preferentially with ACE inhibitors, to reduce the risk for progression to end-stage renal failure in patients with type 2 diabetes.

  • Institute foot-care strategies to prevent ulceration and amputation in patients with documented diabetic neuropathy.

  • Consider treating painful neuropathy preferentially with pregabalin or tricyclic antidepressants.

DOI: 10.7326/d296
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Sandeep Vijan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Rajesh K. Garg, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Related Content
Annals of Internal Medicine