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General Medicine

Diabetes Mellitus, Type 2

Sanaa Ayyoub, MD and Samir Malkani, MD, MRCP—UK Reviewed 06/2019
 


BASICS

DESCRIPTION

Diabetes mellitus (DM) type 2 is due to a progressive insulin secretory defect in the setting of insulin resistance. 
Geriatric Considerations

Monitor elderly for hypoglycemia; adjust ...

DIAGNOSIS

HISTORY

Polyuria, polydipsia, polyphagia, weight loss, weakness, fatigue, blurry vision, neuropathy, and frequent infections 

PHYSICAL EXAM

BMI, funduscopic exam, oral exam, cardiopulmonary exa...

TREATMENT

Tight control of type 2 diabetes prevents long-term microvascular complications, but benefits on macrovascular outcomes are not as apparent (2). Individuals likely to benefit from a more agg...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

A1c twice a year for patients with well-controlled blood glucose and quarterly for patients with hyperglycemia or recent changes in therapy 

PATIENT EDUCATION

REFERENCES

1
American Diabetes Association. Standards of medical care. Diabetes Care.  2019;42(Suppl 1):S1–S193. [View Abstract on OvidMedline]
2
Davies MJ, D’Alessio DA, Fradkin J, et al. Managemen...

SEE ALSO

  • Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Hypertension, Essential

  • Algorithm: Type 2 Diabetes, Treatment

CODES

ICD10

  • E11.9 Type 2 diabetes mellitus without complications

  • E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

  • E11.21 Type 2 diabetes mellitus with nephropa...

CLINICAL PEARLS

Individualize A1c targets based on life expectancy, preexisting DM complications, comorbidities, and individual patient preferences and values. Hypoglycemia poses more short-term dange...

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Related Images
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Homeless diabetic man with painful foot showing gangrene and dystrophic nails
Homeless diabetic man with painful foot showing gangrene and dystrophic nails
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of the aorta (arrows), especially the ascending portion. Because the elevated blood pressure has caused left ventricular hypertrophy without dilatation, the radiographic appearance of the cardiac silhouette remains normal.
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of th...
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of the aorta (arrows), especially the ascending portion. Because the elevated blood pressure has caused left ventricular hypertrophy without dilatation, the radiographic appearance of the cardiac silhouette remains normal.
Fig CA 18-1 Essential (idiopathic) hypertension. (A) Frontal and (B) lateral views of the chest demonstrate characteristic tortuosity of th...
Figure 14.60. Pretibial diabetic skin changes: necrobiosis lipoidica diabeticorum.
Figure 14.60. Pretibial diabetic skin changes: necrobiosis lipoidica diabeticorum.
FIG. 11 Diabetic patient with acute spontaneous onset of low back pain and fever. A,B: Dramatic elements of two-level spondylodiscitis, L3-5, with secondary communicating psoas abscess component.
FIG. 11 Diabetic patient with acute spontaneous onset of low back pain and fever. A,B: Dramatic elements of two-level spondylodiscitis, L3-...
Figure 11.93. Neuropathic (Charcot) joints in two diabetic patients. A. Radiographs of both feet show bilateral neuropathic joints at the first metatarsophalangeal joints (arrows). On the left there is periarticular osteopenia, indicating superimposed infection. Frontal (B) and lateral (C) knee radiographs of another patient show disintegration of the knee joint with considerable bony debris (" bag of bones") and a large joint effusion. In the past, involvement o...
Figure 11.93. Neuropathic (Charcot) joints in two diabetic patients. A. Radiographs of both feet show bilateral neuropathic joints at the f...
Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.
Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.
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