Diabetes Mellitus (AACE) (free)

AACE Diabetes Mellitus Comprehensive Care

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Classification Developed in cooperation with: AACE Task Force for Developing a Diabetes Comprehensive Care Plan Chairpersons: Yehuda Handelsman, MD, FACP, FACE, FNLA Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU Lawrence Blonde, MD, FACP, FACE George Grunberger, MD, FACP, FACE Task Force Members: Zachary T. Bloomgarden, MD, FACE George A. Bray, MD, MACP, MACE Samuel Dagogo-Jack, MD, FACE Jaime A. Davidson, MD, FACP, MACE Daniel Einhorn, MD, FACP, FACE Om Ganda, MD, FACE Alan J. Garber, MD, PhD, FACE Irl B. Hirsch, MD Edward S. Horton, MD, FACE Faramarz Ismail-Beigi, MD, PhD Paul S. Jellinger, MD, MACE Kenneth L. Jones, MD Lois Jovanovič, MD, MACE Harold Lebovitz, MD, FACE Philip Levy, MD, MACE Etie S. Moghissi, MD, FACP, FACE Eric A. Orzeck, MD, FACP, FACE Aaron I. Vinik, MD, PhD, FACP, MACP Kathleen L. Wyne, MD, PhD, FACE ÎDiabetes mellitus (DM) represents a group of heterogeneous metabolic disorders that develop when insulin secretion is insufficient to maintain normal plasma glucose levels. ÎType 2 DM (T2DM) is the most common form of DM, accounting for more than 90% of cases. It is typically identified in patients older than 30 years who are overweight or obese and/or have a positive family history but do not have autoantibodies characteristic of type 1 DM (T1DM). > Most persons with T2DM have evidence of insulin resistance (such as high triglycerides or low high-density lipoprotein cholesterol [HDL-C]) (A-1). ÎT1DM is usually characterized by absolute insulin deficiency and may be confirmed by the presence of autoantibodies to glutamic acid decarboxylase, pancreatic islet β-cells (tyrosine phosphatase IA-2), and/or insulin (A-1). ÎGestational DM (GDM) is a condition in which women without previously diagnosed DM exhibit elevated plasma glucose levels (C-3). ÎThe very rare Monogenic T1DM (formerly maturity-onset diabetes of the young) occurs in obese children and adolescents. A careful family history, levels of insulin and C-peptide and the presence or absence of immune markers may be useful in making this diagnosis (A-1). > Evaluation for monogenic DM is recommended for any child with an atypical presentation, course, or response to therapy. Diagnostic likelihood is strengthened by a family history over 3 generations suggesting autosomal dominant inheritance. This type of DM can occur in the child before appearing in the parent or other relatives (A-1).

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