Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- assintomático
- polidipsia
- poliúria
Other diagnostic factors
- infecções por cândida
- infecções cutâneas
- infecções do trato urinário
- fadiga
- visão turva
- polifagia
- perda de peso não intencional
- parestesias
- acantose nigricans
Risk factors
- idade avançada
- sobrepeso/obesidade
- diabetes gestacional
- hiperglicemia não diabética
- história familiar de diabetes do tipo 2
- ascendência não branca
- síndrome do ovário policístico
- hipertensão
- dislipidemia
- doença cardiovascular
- estresse
Diagnostic investigations
1st investigations to order
- glicemia de jejum
- HbA1c
- glicemia 2 horas após sobrecarga com ingesta de 75 g de glicose
- glicemia plasmática aleatória
Investigations to consider
- perfil lipídico em jejum
- cetonúria
- relação entre albumina e creatinina (RAC)
- creatinina sérica e taxa de filtração glomerular (TFG) estimada
- eletrocardiograma (ECG)
- índice de pressão tornozelo-braquial (ITB)
- peptídeo C aleatório
- testagem de autoanticorpos
- testes da função hepática
Treatment algorithm
no diagnóstico inicial
HbA1C acima da meta: não gestante
HbA1C acima do limite acordado na farmacoterapia inicial ou alterações de risco cardiovascular: não gestante
gestante
Contributors
Authors
Surya Rajeev, MBBS, MRCP, MD
Consultant Physician and Clinical Director
Department of Diabetes and Endocrinology
Liverpool University Hospital NHS Foundation Trust
UK
Disclosures
SR has received reimbursement from Novo Nordisk for conferences, and has presented paid lectures.
Acknowledgements
Dr Surya Rajeev would like to gratefully acknowledge Dr Partha Kar, Dr Amar Puttanna, Dr Patrick J. O'Connor and Dr JoAnn M. Sperl-Hillen, the previous contributors to this topic.
Disclosures
PK has sat on advisory boards and attended events reimbursed by Novo Nordisk, Eli Lilly, and Sanofi. 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. 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. Jun 2022 [internet publication].Full text
Marx N, Federici M, Schütt K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.Full text Abstract
National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication].Full text
Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-86.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hiperglicemia não diabética (pré-diabetes)
- Diabetes mellitus, tipo 1
- Diabetes autoimune latente do adulto (LADA)
More DifferentialsGuidelines
- 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes
- Management of hyperglycaemia in type 2 diabetes, 2022
More GuidelinesPatient information
Diabetes do tipo 2: devo tomar insulina?
Diabetes: o que posso fazer para me manter saudável?
More Patient informationCalculators
Probabilidade de cirrose na hepatite C (FIB-4)
Taxa de filtração glomerular estimada pela equação CKD-EPI
More Calculators
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