- Two separate measurements of any combination of the following:
- Random plasma glucose ≥200 mg/dL with polydipsia, polyuria, polyphagia, and/or weight loss
- Fasting plasma glucose ≥126 mg/dL
- Two-hour oral glucose tolerance test ≥200 mg/dL after a 75-g glucose load
- A1C ≥6.5%. (by lab using a method that is NGSPcertified and standardized to the DCCT assay.
The increasing acquisition of processed food combined with decreasing physical activity has led to an explosion in worldwide obesity and type 2 diabetes mellitus, with the greatest rate of increase in the young. Diabetes is now the sixth (www.cdc.gov/diabetes) leading cause of death in the United States, and its treatment consumes one in every seven health care dollars, with 63% spent on inpatient care. It is a major cause of blindness, renal failure, lower extremity amputations, cardiovascular disease, and congenital malformations. With 90% of patients receiving their care from primary care physicians, diabetes is the epitome of a chronic disease requiring a multidisciplinary management approach.
National Diabetes Information Clearinghouse. National diabetes statistics, 2007. National Institute of Diabetes and Digestive and Kidney Diseases at http://diabetes.niddk.nih.gov
. Accessed June 5, 2009.
Diabetes develops from a complex interaction of genetic and environmental factors. In type 1 diabetes this leads to destruction of the pancreatic β cells and loss of the body's ability to produce insulin. Type 2 diabetes is the result of increasing cellular resistance to insulin, a process accelerated by obesity and inactivity. A very small percentage of diabetic patients may have latent autoimmune diabetes with an onset similar to type 2, but with destruction of the β cells, and a more rapid progression to insulin dependence.
Leahy JL: Pathogenesis of type 2 diabetes mellitus. Arch Med Res 2005;36(3):197-209.
Sparre T et al: Unraveling the pathogenesis of type 1 diabetes with proteomics: present and future directions. Mol Cell Proteomics 2005;4(4):441-457.
Diet and exercise have been shown to reduce the risk of developing type 2 diabetes by 58%. Several medications including metformin may also delay its onset by a more modest percentage. Tight control of hyperglycemia and blood pressure significantly reduce the complications of diabetes, and a sustained reduction in hemoglobin A1c (HbA1c) is associated with significant cost savings within 1-2 years.
Motivating individuals to make lifestyle changes is difficult but cost-effective and safe, and can result in reduced obesity and hypertension and improvement of lipid profiles. A low-fat, high-fiber diet, modest exercise, and smoking cessation are modalities vastly superior to the complexities of the care of patients with diabetes and its complications.
Harding AH et al: Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus: the European prospective investigation of cancer—Norfolk prospective study. Arch Intern Med 2008; 168(14): 1493-1499.
Knowler WC, Barrett-Connor E, Fowler SE, ...