29-01: Diabetes Mellitus

Key Clinical Updates in Diabetes Mellitus

For all patients with type 1 diabetes who are no longer in partial clinical remission, insulin delivery systems (eg, MiniMed 7870 G, Tandem Control-IQ, Omnipod 5) should be considered. Patients with other types of diabetes who have labile glucose levels and are on intensive insulin therapy are also candidates (eg, after total pancreatectomy).

V-go (MannKind) is a mechanical patch pump designed specifically for patients with type 2 diabetes who use a basal/bolus insulin regimen. CeQur Simplicity (CeQur) is a 3-day mechanical patch device that holds 200 units of rapid-acting insulin and delivers two units per press of a button to cover meals and to lower high-glucose excursions.

ESSENTIALS OF DIAGNOSIS

Type 1 diabetes

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

• Plasma glucose ≥ 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.

• Generally progresses from stage 1 (autoantibodies but normal glucose tolerance) to stage 2 (autoantibodies with glucose intolerance) to stage 3 (symptomatic disease).

Type 2 diabetes

• Many patients are > 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 ≥ 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).

• HbA_1c ≥ 6.5%.

• Hypertension, dyslipidemia, and atherosclerosis are often associated.