Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- asymptomatic
- polydipsia
- polyuria
Other diagnostic factors
- candidal infections
- skin infections
- urinary tract infections
- fatigue
- blurred vision
- polyphagia
- unintentional weight loss
- paraesthesias
- acanthosis nigricans
Risk factors
- older age
- overweight/obesity
- gestational diabetes
- non-diabetic hyperglycaemia
- family history of type 2 diabetes
- non-white ancestry
- polycystic ovary syndrome
- hypertension
- dyslipidaemia
- cardiovascular disease
- stress
Diagnostic investigations
1st investigations to order
- fasting plasma glucose
- HbA1c
- 2-hour post-load glucose after 75 g oral glucose
- random plasma glucose
Investigations to consider
- fasting lipid profile
- urine ketones
- albumin to creatinine ratio (ACR)
- serum creatinine and estimated GFR
- ECG
- ankle-brachial pressure index (ABPI)
- random C-peptide
- autoantibody testing
- liver function tests
Treatment algorithm
at initial diagnosis
metformin tolerated and not contraindicated: non-pregnant
metformin contraindicated or not tolerated: non-pregnant
pregnant
Contributors
Authors
Amar Puttanna, MBChB, MRCP
Diabetes and Endocrinology Consultant
Good Hope Hospital
University Hospitals Birmingham NHS Trust
UK
Disclosures
AP has received honoraria from Napp, Novo Nordisk, Sanofi, Lilly-Boehringer Ingelheim, Daiichi-Sankyo, and AstraZeneca for presentation at meetings, conference registration or participating in advisory boards.
Partha Kar, OBE, MBBS MD, FRCP
Consultant Endocrinologist
Portsmouth Hospitals University NHS Trust
National Specialty Advisor, Diabetes, NHS England
UK
Disclosures
PK has sat on advisory boards and attended events reimbursed by Novo Nordisk, Eli Lilly, and Sanofi.
Acknowledgements
Dr Amar Puttanna and Dr Partha Kar would like to gratefully acknowledge Dr Patrick J. O'Connor and Dr JoAnn M. Sperl-Hillen, the previous contributors to this topic.
Disclosures
PJO receives research funding from the National Institutes of Health on multiple projects and is an author of a number of references cited in this topic. JMS-H is an author of a number of references cited in this topic and is an inventor on a US patent for Disease Treatment Simulation, a simulation-based technology developed without commercial support to educate health providers on chronic disease management in a virtual environment.
Peer reviewers
Vinod Patel, MD, FRCP, FHEA, MRCGP, DRCOG, MBChB, BSc (Hons), RCPathME
Professor, Diabetes and Clinical Skills
Warwick Medical School
University of Warwick
Hon Consultant in Endocrinology and Diabetes, Acute Medicine, Medical Obstetrics
Diabetes and Endocrinology Centre
George Eliot Hospital NHS Trust
Nuneaton
Clinical Director for Diabetes West Midlands Clinical Networks & Clinical Senate
NHS England and NHS Improvement - Midlands
UK
Disclosures
VP declares he has worked with most of the large pharmaceutical industry groups over the years with the majority of the work being in education of healthcare professionals in diabetes care. This includes Novo Nordisk, Eli Lily, MSD, BI, Sanofi, Napp, Internis, Takeda, and AZ. VP has been part of advisory board work on occasions. VP has received conference arrangements and lecture fees. VP is a trustee of the charity South Asian Health Foundation.
Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA
Price-Evans Professor of Cardiovascular Medicine
University of Liverpool
Senior Investigator
National Institute for Health Research
UK
Distinguished Professor
Faculty of Medicine
Aalborg University
Denmark
Adjunct Professor
Yonsei University
Seoul
South Korea
Disclosures
GL has acted as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo.
Differentials
- Non-diabetic hyperglycaemia (pre-diabetes)
- Diabetes mellitus, type 1
- Latent autoimmune diabetes in adults (LADA)
More DifferentialsGuidelines
- Type 2 diabetes in adults: management
- Guidelines on diabetes, pre-diabetes, and cardiovascular diseases
More GuidelinesPatient leaflets
Pre-diabetes
Diabetes: what is it?
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer