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 post-load glucose after 75 g oral 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
Treatment algorithm
Contributors
Authors
Director Professional Training
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
GS is a member of the Merck scientific advisory board. He receives no personal income from Merck and all honorarium goes to his employer, the non-profit International Diabetes Center. GS has received unrestricted educational grants from Abbott Diabetes Care to conduct continuing medical education programs.
Medical Director
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
AC reports grants from Insulet, grants from Dexcom, grants and consulting/advisory board from Medtronic, grants from Abbott Diabetes, grants and consulting from Sanofi, grants and consulting from Eli Lilly, consulting from Bigfoot, consulting from Sensionics. AC's employer, the Health Partners Institute/International Diabetes Center receives all payments; no direct payments go to AC. AC is also the co-author of some references cited in this topic.
Medical Director
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
TM has been a site principal investigator and subprincipal investigator for research with funding from Abbott Diabetes Care, Dexcom, Medtronic, Insulet, Lilly, and Novo-Nordisk, without being personally reimbursed. TM has participated speaking engagements arranged and managed by his employer, International Diabetes Center and funded by Abbott Diabetes Care, Lilly, Novo-Nordisk, Medtronic, Medscape, American Diabetes Association, American Medical Group Association and American College of Physicians. All financial payments for the research activities and the speaking and medical education activities were to HealthPartners Institute DBA International Diabetes Center. TM is paid on a salary and does not receive direct payments for any of these activities. TM has co-authored an article with individuals employed by Lilly and Dexcom. He is also the co-author of some references cited in this topic.
Executive Director
International Diabetes Center at Park Nicollet
Minneapolis
MN
Disclosures
RB has received research or grant support, has acted as a consultant, or has been on the scientific advisory board for Abbott Diabetes Care, DexCom, Eli Lilly, Helmsley Charitable Trust, Insulet, Medtronic, NIH/NIDDK, Novo Nordisk, and Sanofi. RB served as a consultant for Ascencia, Bigfoot Biomedical, Inc., CeQur, Hygieia, Onduo, and United Healthcare. RB's employer, non-profit HealthPartners Institute, contracts for his services and he receives no personal income. He is the co-author of one reference cited in this topic.
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
Medical Director
Clinical Improvement Group Health Cooperative
Seattle
WA
Disclosures
DKM declares that he has no competing interests.
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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