This page compiles our content related to diabetes. For further information on diagnosis and treatment, follow the links below to our full BMJ Best Practice topics on the relevant conditions and symptoms.
Introduction
Relevant conditions
Type 2 diabetes mellitus in adults | go to our full topic on Type 2 diabetes mellitus in adults Common disorder characterized by insulin resistance and relative insulin deficiency. Often people with type 2 diabetes mellitus are asymptomatic and it is detected on screening. Symptoms, when present, may indicate overt hyperglycemia. Strong risk factors include older age, smoking, overweight/obesity, physical inactivity, prior gestational diabetes mellitus, prediabetes, nonwhite ancestry, family history of diabetes, or polycystic ovary syndrome.[1][2] |
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Type 1 diabetes mellitus | go to our full topic on Type 1 diabetes mellitus Characterized by absolute insulin deficiency. Usually develops as a result of autoimmune pancreatic beta-cell destruction in genetically susceptible individuals.[3] Type 1 diabetes can be diagnosed at any age, but the highest incidence is in children aged 10-14 years.[3] Patients most often present with a few days or weeks of polyuria, polydipsia, weight loss, and weakness. Some patients may present with diabetic ketoacidosis. |
Type 2 diabetes in children | go to our full topic on Type 2 diabetes in children Obesity, leading to insulin resistance, is the primary cause of type 2 diabetes in children. The incidence of type 2 diabetes in youths (age 10 to 19 years) is increasing.[4] Commonly accompanied by acanthosis nigricans (90% to 95% of patients).[5] |
Gestational diabetes mellitus (GDM) | go to our full topic on Gestational diabetes mellitus (GDM) GDM develops during pregnancy and is diagnosed on the basis of elevated plasma glucose levels, although the precise diagnostic criteria remain controversial. Risk factors for GDM include advanced maternal age (>40 years), obesity, personal history of gestational diabetes or macrosomia of previous child, polycystic ovary syndrome, nonwhite ancestry, and family history of type 2 diabetes mellitus.[6][7] The risk for recurrence of GDM in subsequent pregnancies or progression to type 2 diabetes is high. |
Diabetic ketoacidosis (DKA) | go to our full topic on Diabetic ketoacidosis (DKA) DKA and hyperosmolar hyperglycemic states are acute metabolic emergencies. DKA is characterized by the triad of hyperglycemia, increased ketone concentration in the blood and/or urine, and metabolic acidosis.[8] DKA is more common in young people with type 1 diabetes but can occur at any age and with any type of diabetes.[8] Successful treatment includes correction of volume depletion, hyperglycemia, electrolyte imbalances, and comorbid precipitating events (e.g., infection), with frequent monitoring. |
Hyperosmolar hyperglycemic state | go to our full topic on Hyperosmolar hyperglycemic state Severe hyperglycemia, hyperosmolality, and volume depletion, in the absence of severe ketoacidosis or acidosis.[8] Occurs most commonly in older patients with type 2 diabetes with high mortality, but can occur at any age and with any type of diabetes.[8] Treatment includes correction of fluid deficit and electrolyte abnormalities, and intravenous insulin. |
Diabetic cardiovascular disease | go to our full topic on Diabetic cardiovascular disease Cardiovascular disease (CVD) is the leading cause of death in people with diabetes. People with diabetes have up to a fourfold increased risk of stroke and are twice as likely to die after myocardial infarction than people without diabetes.[9][10] Regular physical activity, medical nutrition therapy, and smoking cessation or noninitiation are important lifestyle changes for the primary prevention of CVD. Strong risk factors include poor glycemic control, cigarette smoking, hypertension, dyslipidemia, physical inactivity, albuminuria, C-reactive protein, and family history of CVD. |
Diabetic kidney disease | go to our full topic on Diabetic kidney disease Defined by albuminuria (increased urinary albumin excretion is defined as 30 mg/g) and progressive reduction in estimated glomerular filtration rate (eGFR) in the setting of a long duration of diabetes (>10 years' duration of type 1 diabetes; may be present at diagnosis in type 2 diabetes), and is typically associated with retinopathy. Symptoms may be absent until the disease is advanced. |
Diabetic neuropathy | go to our full topic on Diabetic neuropathy Diabetic neuropathy is a highly prevalent complication of diabetes (type 1 or type 2) and is characterized by the presence of symptoms and/or signs of peripheral nerve dysfunction and/or autonomic nerve dysfunction. Peripheral neuropathy may present as pain, loss of sensation, or painless ulcers on pressure points, although many patients are asymptomatic. In addition to symptoms associated with orthostatic hypotension, patients with autonomic neuropathy may present with nausea, vomiting, and early satiety (gastroparesis); difficulty in emptying the bladder (cystopathy); or erectile dysfunction. |
Diabetes-related foot disease | go to our full topic on Diabetes-related foot disease Diabetes-related foot disease, including ulcers and infections, is a common and costly complication of diabetes mellitus. Most diabetic foot ulcers are caused by repetitive trauma sustained during activity on a structurally abnormal, insensate foot. Ulcers act as a portal of entry for bacterial infections. Preventing and/or healing ulcers helps prevent infections and thereby minimizes risk of limb loss. Primary care physician and primary care nurses are generally on the front line of care for patients with diabetes. As such, they have a key role in preventing and identifying active diabetic foot problems. |
Diabetic retinopathy | go to our full topic on Diabetic retinopathy The chronic progressive retinal manifestation of hyperglycemic vascular damage and neurodegenerative change. It increases in prevalence with duration of diabetes. Sight-threatening signs include macular edema, retinal or optic disc new vessels, and vitreous hemorrhage. |
Inpatient glycemic management | go to our full topic on Inpatient glycemic management Refers to identification and treatment of hyperglycemia in the setting of acute illness in hospitalized patients with either preexisting diabetes or new-onset hyperglycemia. The development of hyperglycemia during acute medical or surgical illness is not be a physiologic or benign condition but rather a marker of poor clinical outcomes and increased mortality.[11] |
Metabolic syndrome | go to our full topic on Metabolic syndrome Cluster of common abnormalities, including insulin resistance, impaired glucose tolerance, abdominal obesity, reduced high-density lipoprotein-cholesterol levels, elevated triglycerides, and hypertension.[12][13] The main utility of diagnosing metabolic syndrome is the identification of people at high risk of cardiovascular disease beyond low-density lipoprotein-cholesterol levels. However, whether a diagnosis of metabolic syndrome provides more useful information than its individual components regarding cardiovascular risk is greatly controversial. |
Diabetes insipidus (DI) | go to our full topic on Diabetes insipidus (DI) Characterized by polydipsia, polyuria, and formation of inappropriately hypotonic (dilute) urine. Central DI is due to defective synthesis or release of arginine vasopressin (AVP).[14] Nephrogenic DI is due to renal insensitivity to AVP.[15] |
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Disclosures
This overview has been compiled using the information in existing sub-topics.
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Pre-diabetes
Diabetes type 2: should I take insulin?
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