Key Points
ÎDiabetes is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the risk of long-term complications.
ÎDiabetes care is complex and requires that many issues, beyond glycemic control, be addressed.
Diagnosis and Assessment*
Classification of Diabetes The classification of diabetes includes four clinical classes:
ÎType 1 diabetes > Results from β-cell destruction, usually leading to absolute insulin deficiency
ÎType 2 diabetes
> Results from a progressive insulin secretory defect on the background of insulin resistance
ÎOther specific types of diabetes due to other causes, eg, genetic defects in
β-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced (such as in the treatment of HIV/AIDS or after organ transplantation)
ÎGestational diabetes mellitus (GDM) > Diabetes diagnosed during pregnancy that is not clearly overt diabetes
Testing for Diabetes in Asymptomatic Patients
ÎTesting to detect type 2 diabetes and assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (body mass index [BMI] ≥ 25 kg/m2
) and who have one
or more additional risk factors for diabetes (Table 2). In those without these risk factors, testing should begin at age 45 years. (B)
ÎIf tests are normal, repeat testing carried out at least at 3-year intervals is reasonable. (E)
ÎTo test for diabetes or to assess risk of future diabetes, glycohemoglobin (A1c), fasting plasma glucose (FPG), or 2-h 75-g oral glucose tolerance test (OGTT) is appropriate. (B)
ÎIn those identified with increased risk for future diabetes, identify and, if appropriate, treat other cardiovascular disease (CVD) risk factors. (B)
* To be used with appropriate care setting and patient type.
