Type 2 diabetes mellitus in adults

Blood pressure control, lipid management, and glycemic management are important to reduce the risk of macrovascular complications such as heart attack and stroke. Glycemic control and blood pressure management reduce the risk of microvascular complications (neuropathy, nephropathy, retinopathy).

A primary goal of care is treatment of cardiovascular risk factors to achieve individualized targets with antihypertensive agents, lipid medications, aspirin for patients with known coronary heart disease or those at high risk; ACE inhibitors for patients with proteinuria; and smoking cessation.

Lifestyle changes plus metformin are initial antihyperglycemic therapy for most patients. Glycemic goals and treatment choices are individualized.

Selected glucose-lowering drugs may reduce cardiovascular risk and mortality.

Type 2 diabetes mellitus is a progressive disorder defined by deficits in insulin secretion and action that lead to abnormal glucose metabolism and related metabolic derangements. [1] Meigs JB, Muller DC, Nathan DM, et al. The natural history of progression from normal glucose tolerance to type 2 diabetes in the Baltimore Longitudinal Study of Aging. Diabetes. 2003;52:1475-1484. http://diabetes.diabetesjournals.org/content/52/6/1475.full http://www.ncbi.nlm.nih.gov/pubmed/12765960?tool=bestpractice.com Although the etiologies of type 1 and type 2 diabetes differ dramatically, both lead to hyperglycemic states, and both share common macrovascular (coronary heart, cerebrovascular, and peripheral vascular disease) and microvascular (retinopathy, nephropathy, and neuropathy) complications. Type 2 diabetes is usually diagnosed based on screening. It is preceded by a state of prediabetes, which is defined by a single fasting plasma glucose of 100-125 mg/dL or an HbA1c of 5.7% to 6.5% in the absence of diabetes. Diabetes diagnosis is based on 2 confirmed values of: fasting plasma glucose >125 mg/dL; HbA1c of 6.5% or greater; or (less commonly) glucose tolerance test results, or a random plasma glucose of ≥200 mg/dL plus symptoms of hyperglycemia. [2] American Diabetes Association. Standards of medical care in diabetes - 2017. Diabetes Care. 2017;40(suppl 1):S1-S135. http://care.diabetesjournals.org/content/40/Supplement_1/