Public - Diabetes Mellitus, Type 2

Diabetes Mellitus, Type 2

Author: Sandeep Vijan, MD
Editorial changes - 2009-11-06
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

	Tables
	Figures
	References
	Glossary
	What's New
	Patient Information
	Additional Resources
	Tools

	Quality Measures

Diagnosis
Confirm the diagnosis in patients with symptoms of hyperglycemia and symptoms suggestive of known complications of the disease. Confirm the diagnosis in patients with physical findings suggestive of known complications and epiphenomena of the disease. Confirm the diagnosis of type 2 diabetes in any patient with a random plasma glucose level above the normal range. Perform a careful history and physical examination in all patients with hyperglycemia to evaluate for the complications of diabetes. Order laboratory tests to establish baselines and to screen for complications of diabetes. Consider the limited differential diagnosis for type 2 diabetes.
Key History and Physical Examination Items for Initial Evaluation of Diabetes Mellitus, Type 2 (table)
Laboratory Test Items for Initial Evaluation of Diabetes Mellitus, Type 2 (table)
Differential Diagnosis of Diabetes Mellitus, Type 2 (table)


Confirm the diagnosis in patients with symptoms of hyperglycemia and symptoms suggestive of known complications of the disease.
Use diagnostic testing in patients with symptoms consistent with diabetes. Other symptoms include: Unexplained weight loss Frequent infections Impotence See table Screening and Diagnostic Tests for Diabetes Mellitus.
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Confirm the diagnosis in patients with physical findings suggestive of known complications and epiphenomena of the disease.
Confirm the diagnosis in patients with signs of diabetic retinopathy, acanthosis nigricans, or peripheral neuropathy, looking for the following signs: Diabetic retinopathy (retinal microaneurysms, dot-blot hemorrhages, macular edema). Acanthosis nigricans (velvety, hyperpigmented skin, often in the axilla or at the base of the neck). Peripheral neuropathy (typically symmetric, sensory, stocking-glove distribution). See figure Acanthosis nigrans. See figure Diabetic retinopathy, left eye. See figure Diabetic retinopathy, right eye.
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Confirm the diagnosis of type 2 diabetes in any patient with a random plasma glucose level above the normal range.
Confirm the diagnosis of type 2 diabetes in all patients who are incidentally found to have a random plasma glucose level above the normal range using available diagnostic tests. See table Screening and Diagnostic Tests for Diabetes Mellitus.
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Perform a careful history and physical examination in all patients with hyperglycemia to evaluate for the complications of diabetes.
Document key items from the patient history and physical examination that are manifestations of diabetes or its complications. See table Key History and Physical Examination Items for Initial Evaluation of Diabetes Mellitus, Type 2.
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Order laboratory tests to establish baselines and to screen for complications of diabetes.
Order the following tests to establish baselines and screen for complications of diabetes: Fasting blood sugar level Glycosylated hemoglobin level Fasting lipid profile Serum electrolyte, blood urea nitrogen, and creatinine levels Urinalysis Electrocardiogram See table Laboratory Test Items for Initial Evaluation of Diabetes Mellitus, Type 2.
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Consider the limited differential diagnosis for type 2 diabetes.
Consider type 1 diabetes in younger patients who are prone to ketoacidosis. Consider diabetes insipidus in normoglycemic patients who have polyuria and polydipsia. See table Differential Diagnosis of Diabetes Mellitus, Type 2.
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FAQs

Allan J. Garber, MD, PhD, FACE, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sandeep Vijan, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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