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Key Clinical Updates in Diabetes Mellitus

Teplizumab mzwv is approved for use in individuals 8 years and older who are at high risk for type 1 diabetes (two positive antibodies and impaired glucose tolerance). Common adverse reactions include transient decreases in white cell and lymphocyte counts, rash, and headache.

The TNF-alpha blocker infliximab has been reported to reverse beta cell dysfunction and induce remission of diabetes in patients with checkpoint inhibitor–induced diabetes.

LeFevre JD et al. Am J Health Syst Pharm. [PMID: 36056809]


Type 1 diabetes

  • Polyuria, polydipsia, and weight loss with random plasma glucose of ≥ 200 mg/dL (11.1 mmol/L).

  • Plasma glucose of ≥ 126 mg/dL (7.0 mmol/L) after an overnight fast, documented on more than one occasion.

  • Ketonemia, ketonuria, or both.

  • Islet autoantibodies are frequently present.

Type 2 diabetes

  • Many patients are over 40 years of age and have obesity.

  • Polyuria and polydipsia. Ketonuria and weight loss are uncommon at time of diagnosis. Candidal vaginitis may be an initial manifestation.

  • Plasma glucose of ≥ 126 mg/dL after an overnight fast on more than one occasion. Two hours after 75 g oral glucose, diagnostic values are ≥ 200 mg/dL (11.1 mmol).

  • HbA1c ≥ 6.5%.

  • Hypertension, dyslipidemia, and atherosclerosis are often associated.


An estimated 37.3 million people (10.5%) in the United States have diabetes mellitus, of whom approximately 5–10% have type 1 diabetes and most of the rest have type 2 diabetes. A third group designated as “other specific types” by the American Diabetes Association (ADA) (Table 29–1) number in the thousands.

Table 29–1.Other specific types of diabetes mellitus.


Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate for the resistance.

A. Type 1 Diabetes Mellitus

This form of diabetes is due to autoimmune destruction of pancreatic islet B cell. The rate of pancreatic B cell destruction is variable, being rapid in some individuals and slow in others. It occurs at any age but most commonly arises in ...

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