Type 2 Diabetes - Basics
Heidi James, MD, and Vanessa Cardy, MD
Background
- Type 2 diabetes is common
- Often asymptomatic and found on screening
- Screen overweight, obese, and sedentary adults age 40-70 y
- Symptoms include
- Weight loss
- Blurry vision
- Polyuria
- Polydipsia
- Polyphagia
- Associated with poor health outcomes
- Genetically linked
Clinical Findings
- Diagnosis is made by lab testing
- Random glucose: >200 mg/dL (11.1 mmol/L)
- 8-h fasting glucose: >126 mg/dL (7.0 mmol/L)
- 2-h oral glucose challenge test: >200 mg/dL (11.11 mmol/L)
- Hemoglobin A1C: >6.5%
- *Tests other than symptomatically elevated random glucose in symptomatic must be confirmed by repeat testing
Management
- Lifestyle management is key
- Exercise
- Weight loss
- Healthy diet
- Target A1C is <7.0 for most patients
- Medication options include
- Biguanides
- Sulfonylureas
- Glucagon-like peptide 1 (GLP-1) receptor agonists
- Dipeptidyl peptidase 4 (DPP-4) inhibitors
- Sodium-glucose cotransporter-2 (SGLT-2) inhibitors
- Insulin
- Ultra-short acting
- Short acting
- Intermediate acting
- Long acting
