Overview
Definition
A metabolic disorder characterized by hyperglycemia resulting from a progressive insulin secretory defect on the background of insulin resistance.
Epidemiology
Global epidemic affecting over 400 million people. Strongly associated with obesity.
Etiology & Risk Factors
- Insulin resistance in muscle/liver
- Progressive beta-cell failure in the pancreas
- Genetic predisposition and lifestyle factors
Clinical Symptoms
- Polyuria (frequent urination)
- Polydipsia (increased thirst)
- Polyphagia
- Blurred vision
- Fatigue
- Peripheral neuropathy (stocking-glove pattern)
Clinical Approach
Diagnosis
- Fasting Plasma Glucose ≥ 126 mg/dL
- A1C ≥ 6.5%
- 2-hour Plasma Glucose ≥ 200 mg/dL during OGTT
- Random plasma glucose ≥ 200 mg/dL with classic symptoms
Management
- Lifestyle modifications (Diet, Weight loss, Exercise)
- Metformin (first-line oral agent)
- SGLT2 Inhibitors (if CVD or HF or CKD present)
- GLP-1 Receptor Agonists (if ASCVD or obesity present)
- Insulin therapy (if severe or poorly controlled)
Complications
- Diabetic Retinopathy
- Diabetic Nephropathy
- Peripheral and Autonomic Neuropathy
- Coronary Artery Disease
- Diabetic Foot Ulcers