Management of Type 2 Diabetes Mellitus

Objectives: Improve adherence to important, morbidity-reducing recommendations for preventing, detecting, and managing diabetic complications.

Key points:

Screening: Although little evidence is available on screening for diabetes, one may consider beginning screening at age 45 at 3–year intervals, earlier particularly if BMI ≥ 25 kg/m2 [evidence: D].

Prevention: In individuals at risk for diabetes (see Table 1), diet, exercise, and pharmacologic interventions can delay or prevent type 2 diabetes [A].

Diagnosis: Either two separate fasting glucoses ≥ 126 mg/dL, or if symptoms, a glucose ≥ 200 mg/dL confirmed on a separate day by a fasting glucose ≥ 126 mg/dL, or 2-hour postload glucose ≥ 200 mg/dl during an oral glucose tolerance test [B]. (See Table 1.) HbA1c has low sensitivity, but high specificity, for the diagnosis of diabetes, and most experts feel that is should not be used as a primary diagnostic test.

Treatment: Diet, exercise, and pharmacologic interventions should be initiated for:
• Hypertension control [A]
• Glycemic control [A]
• Lipid control [A]
• Cardiovascular risk reduction [A]
Source: University of Michigan

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