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  • 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.

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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.

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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.  [PubMed: 15925010]
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.  [PubMed: 15699484]

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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.

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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.  [PubMed: 18663161]
Knowler WC, Barrett-Connor E, Fowler SE, ...

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