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Overview of medical care in adults with diabetes mellitus

INTRODUCTION

The estimated overall prevalence of diabetes among adults in the United States ranges from 5.8 to 12.9 percent (median 8.4 percent) [1,2]. However, because of the associated microvascular and macrovascular disease, diabetes accounts for almost 14 percent of United States health care expenditures, at least one-half of which are related to complications such as myocardial infarction (MI), stroke, end-stage renal disease, retinopathy, and foot ulcers [3].

Numerous factors, in addition to directly related medical complications, contribute to the impact of diabetes on quality of life and economics. Diabetes is associated with a high prevalence of depression [4] and adversely impacts employment, absenteeism, and work productivity [5].

This review will provide an overview of the medical care for patients with diabetes (table 1). The management approach is consistent with guidelines from the American Diabetes Association (ADA) for health maintenance in patients with diabetes, which are published yearly [6]. Consensus recommendations for the management of glycemia in type 2 diabetes were published in 2006 and are updated regularly. Detailed discussions relating to screening, diagnosis, and management of hyperglycemia are discussed separately. (See "Screening for type 2 diabetes mellitus" and "Clinical presentation and diagnosis of diabetes mellitus in adults" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".)

EVALUATION

Initial — Patients with newly diagnosed diabetes require a history and physical examination to assess the characteristics of onset of diabetes (asymptomatic laboratory finding or symptomatic polyuria and polydipsia), nutrition and weight history, physical activity, cardiovascular risk factors, history of diabetes-related complications, and current management. If not measured in the past two to three months, we measure glycated hemoglobin (A1C) (see "Estimation of blood glucose control in diabetes mellitus", section on 'Glycated hemoglobin'). If not measured in the past one year, we measure fasting lipid profile, liver function tests, urine albumin excretion (spot urine), and serum creatinine.

Type 2 diabetes accounts for over 90 percent of cases of diabetes in the United States, Canada, and Europe; type 1 diabetes accounts for another 5 to 10 percent, with the remainder due to other causes (table 2). The etiologic classification of diabetes, including distinguishing type 2 from type 1 diabetes, and monogenic forms of diabetes (formerly referred to as maturity onset diabetes of the young [MODY]) from type 1 and type 2 diabetes, is reviewed elsewhere. (See "Classification of diabetes mellitus and genetic diabetic syndromes".)

                             

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Literature review current through: Oct 2014. | This topic last updated: Nov 3, 2014.
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