Diabetes Mellitus

Definition

Risk Factors

  • Age over 30y/o
  • Family history
  • Ethnic group
  • Overweight/obese
  • Lifestyle: sedentary, dietary habits, smoking, alcohol consumption, occupation
  • Hypertension
  • Dyslipidaemia
  • Obstetric history of large babies or gestational diabetes
  • Women with polycystic ovarian syndrome (PCOS)
  • Medications that impact weight and glycaemic status

Screening

Who should be screened?

  • symptomatic
    • individual who has T2DM symptoms (fatigue, lethargy, polyuria, nocturia, polydipsia, polyphagia, weight loss, pruritus vulvae, balanitis).
  • asymptomatic
    • overweight/obese adult (BMI ≥23 kg/m2)
    • women with history of GDM
    • all individuals with prediabetes
    • overweight/obese adolescents with risk factors

Screening tool

Capillary plasma glucose

  • can be done by using standard glucometers
  • no need prior fasting
  • should be done annually in asymptomatic
    Proceed confirmatory test if:
    • Random: ≥7.8 mmol/L
    • Fasting: ≥5.6 mmol/L

dm-screening-symptomatic.png

dm-screening-asymptomatic.png

Diagnostic

Diagnostic test?

  • symptomatic - one abnormal glucose value is diagnostic
  • asymptomatic - 2 abnormal glucose values are required

1. Fasting plasma glucose

  • venous plasma glucose
  • fasting at least 8 hrs
Results Fasting
(mmol/L)		 Random
(mmol/L)
Prediabetes / IFG 6.1 - 6.9 -
Diabetes ≥7.0 ≥11.1

2. Oral glucose tolerance test (OGTT)

  • need to fast
  • using 75 g of glucose
    dm-ogtt-result.png

3. HbA1c

  • symptomatic - single positive test is sufficient
  • asymptomatic - should be done 4 weeks after the first positive test
    dm-hba1c-result.png

Pathophysiology

Clinical Features

Symptoms

  • increased thirst (polydipsia)
  • polyphagia
  • polyuria and/or nocturia
  • malaise/fatigue

History

  • characteristics at onset (e.g. age, symptoms)
  • weight loss/gain – some patients may gain weight and develop diabetes e.g. in Cushing’s Syndrome
  • altered vision
  • frequent and recurrent infections
  • risk factors

Physical Examination

dm-physical-examination.png

Investigations

*investigations for baseline:

  • Fasting plasma glucose (FPG)
  • HbA1c
  • Renal profile
  • Lipid profile
  • Liver function test
  • Urinalysis for albumin, microalbuminuria if albuminuria is absent
  • ECG

Management

Pharmacological

Drugs & Medications for DM

Target for Glycaemic Control

Fasting or pre-prandial 4.4 - 7.0 mmol/L
Post-prandial 4.4 - 8.5 mmol/L
HbA1C <7.0%

Complications

Diabetic Retinopathy

Reference

Interactive Graph
Table Of Contents
Diabetes Mellitus
Definition
Risk Factors
Screening
Who should be screened?
Screening tool
Capillary plasma glucose
Diagnostic
Diagnostic test?
1. Fasting plasma glucose
2. Oral glucose tolerance test (OGTT)
3. HbA1c
Pathophysiology
Clinical Features
Symptoms
History
Physical Examination
Investigations
Management
Pharmacological
Target for Glycaemic Control
Complications
Reference