Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
- polydipsia
- polyuria
- unintentional weight loss
- polyphagia
- hyperglycemic crisis
Other diagnostic factors
- fatigue
- blurred vision
- nocturia
- candidal infections
- skin infections
- urinary tract infections
- paresthesias
- acanthosis nigricans
Risk factors
- older age
- overweight/obesity
- gestational diabetes
- prediabetes
- first-degree relative with type 2 diabetes
- African, Latino, or American-Indian ancestry
- physical inactivity
- polycystic ovary syndrome (PCOS)
- hypertension
- dyslipidemia
- cardiovascular disease
- stress
Diagnostic investigations
1st investigations to order
- fasting plasma glucose
- HbA1c
- 2-hour plasma glucose
- random plasma glucose
Investigations to consider
- urine ketones
- random C-peptide
- autoantibodies
- urinary albumin excretion
- serum creatinine and estimated GFR
- fasting lipid profile
- ECG
- ankle-brachial index (ABI)
- toe-brachial index (TBI)
- dilated retinal examination
- liver function test (LFT)
Treatment algorithm
at initial diagnosis
marked hyperglycemia nonpregnant: serum glucose ≥300 mg/dL or HbA1c >10% or symptomatic
without marked hyperglycemia nonpregnant asymptomatic: serum glucose <300 mg/dL or HbA1c <10%
pregnant
Contributors
Authors
Gregg Simonson, PhD
Director Professional Training
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
GS declares that his employer, HealthPartners Institute dba International Diabetes Center, has organizational interests that include receiving unrestricted educational grants from Abbott Diabetes Care and Sanofi.
Anders Carlson, MD
Medical Director
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
HealthPartners Institute/International Diabetes Center employs AC and has contracts with Abbott Diabetes Care, Dexcom, Eli Lilly, Insulet, MannKind, Medtronic/Companion Medical, Novo Nordisk, Sanofi US Services, Inc., Tandem Diabetes, and United Health, Inc., for his services as a research investigator and/or consultant. AC receives no personal income from any of these services. AC is an author of a number of references cited in this topic.
Thomas Martens, MD
Medical Director
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
HealthPartners Institute employs TM and has contracts with Abbott Diabetes Care, Dexcom, Insulet, Eli Lilly, Medscape, Medtronic, Novo Nordisk, Sanofi US Services, Inc., and Tandem for his services as a research investigator and/or consultant. No personal income from any of these services goes to TM. TM is an author of a number of references cited in this topic.
Richard Bergenstal, MD
Executive Director
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
RB has received research support, has acted as a consultant, or has been on the scientific advisory board for Abbott Diabetes Care, Ascensia, Bigfoot Biomedical, Inc., CeQur, DexCom, Eli Lilly, Hygieia, Insulet, Medtronic, Novo Nordisk, Onduo, Roche Diabetes Care, Tandem Diabetes Care, Sanofi, United Healthcare, Vertex Pharmaceuticals, and Zealand Pharma. RB's employer, non-profit HealthPartners Institute, contracts for his services and he receives no personal income. RB is the co-author of some references cited in this topic.
Acknowledgements
Dr Gregg Simonson, Dr Anders Carlson, Dr Thomas Martens, and Dr Richard Bergenstal would like to gratefully acknowledge Dr Patrick J. O'Connor and Dr JoAnn M. Sperl-Hillen, previous contributors to this topic.
Disclosures
PJO receives research funding from the National Institutes of Health on multiple projects. JMS-H 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. PJO and JMS-H are authors of a number of references cited in this topic.
Peer reviewers
David K. McCulloch, MD
Medical Director
Clinical Improvement Group Health Cooperative
Seattle
WA
Disclosures
DKM declares that he has no competing interests.
Ashim K. Sinha, MBBS, MD, FRACP, FACE
Associate Professor
Director of Diabetes and Endocrinology
Cairns Base Hospital and Diabetes Centre
Queensland
Australia
Disclosures
AKS declares that he has no competing interests.
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