Diabetes mellitus type 2: Difference between revisions

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==Diagnosis==
The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occassions,of either<ref name="who-99">.{{cite web |url=http://www.who.int/diabetes/publications/en/ |author=World Health Organization | title= Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part 1. Diagnosis and classification of diabetes mellitus |accessdate=2007-05-29 |format= |work=}}</ref>:
* fasting plasma glucose ≥ 7.0mmol/l (126mg/dl)
:or
* With a [[Glucose tolerance test]], two hours after the oral dose a plasma glucose ≥ 11.1mmol/l (200mg/dl)
==Screening and prevention==
Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose"<ref name="pmid12558361">{{cite journal |author=U.S. Preventive Services Task Force |title=Screening for type 2 diabetes mellitus in adults: recommendations and rationale |journal=Ann. Intern. Med. |volume=138 |issue=3 |pages=212-4 |year=2003 |pmid=12558361 |url=http://www.annals.org/cgi/content/full/138/3/212}}  [http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=3523 National Guidelines Clearinghouse: Complete Summary]</ref><ref name="pmid12558362">{{cite journal |author=Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN |title=Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=138 |issue=3 |pages=215-29 |year=2003 |pmid=12558362|url=http://www.annals.org/cgi/content/full/138/3/215}}</ref>, this was a [http://www.ahrq.gov/clinic/3rduspstf/ratings.htm grade I recommendation] when published in 2003.
In 2005, an [http://www.ahrq.gov/clinic/epcindex.htm evidence report] by the [[Agency for Healthcare Research and Quality]] concluded that  "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".<ref name="pmid16194123">{{cite journal |author=Santaguida PL, Balion C, Hunt D, ''et al'' |title=Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose |journal=Evidence report/technology assessment (Summary) |volume= |issue=128 |pages=1-11 |year=2005 |pmid=16194123 |doi= | url=http://www.ahrq.gov/clinic/epcsums/impglusum.htm}}</ref>
Since publication of the USPSTF statement, a [[randomized controlled trial]] of prescribing [[acarbose]]to patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. They were eligible for the study if they had [[Impaired glucose tolerance|IGT]] according to the [[World Health Organization]] criteria, plus [[impaired fasting glucose]] (a fasting plasma glucose concentration of between ''100'' and 140 mg/dL or 5.5 and 7.8 mmol/L) found a [[number needed to treat]] of  44 (over 3.3 years) to prevent a major cardiovascular event<ref name="pmid12876091">{{cite journal |author=Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M |title=Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial |journal=JAMA |volume=290 |issue=4 |pages=486-94 |year=2003 |pmid=12876091 |doi=10.1001/jama.290.4.486}} [http://www.acpjc.org/Content/140/1/issue/ACPJC-2004-140-1-002.htm ACP Journal Club review]</ref>.
Other studies have shown that life-style changes<ref name="pmid17098085">{{cite journal |author=Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J |title=Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study |journal=Lancet |volume=368 |issue=9548 |pages=1673-9 |year=2006 |pmid=17098085|doi=10.1016/S0140-6736(06)69701-8}}[http://www.acpjc.org/Content/146/2/issue/ACPJC-2007-146-2-037.htm  ACP Journal Club review]</ref> and [[metformin]]<ref name="pmid11832527">{{cite journal |author=Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM |title=Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin |journal=N. Engl. J. Med. |volume=346 |issue=6 |pages=393-403 |year=2002 |pmid=11832527|doi=10.1056/NEJMoa012512}} [http://www.acpjc.org/Content/137/2/issue/ACPJC-2002-137-2-055.htm ACP Journal Club review]</ref> can delay the onset of diabetes.
==Treatment==
==Treatment==
===Oral agents===
===Oral agents===

Revision as of 16:36, 18 July 2007

Diagnosis

The World Health Organization definition of diabetes is for a single raised glucose reading with symptoms, otherwise raised values on two occassions,of either[1]:

  • fasting plasma glucose ≥ 7.0mmol/l (126mg/dl)
or

Screening and prevention

Interest has arisen in preventing diabetes due to research on the benefits of treating patients before overt diabetes. Although the U.S. Preventive Services Task Force (USPSTF) concluded that "the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose"[2][3], this was a grade I recommendation when published in 2003.

In 2005, an evidence report by the Agency for Healthcare Research and Quality concluded that "there is evidence that combined diet and exercise, as well as drug therapy (metformin, acarbose), may be effective at preventing progression to DM in IGT subjects".[4]

Since publication of the USPSTF statement, a randomized controlled trial of prescribing acarboseto patients with "high-risk population of men and women between the ages of 40 and 70 years with a body mass index (BMI), calculated as weight in kilograms divided by the square of height in meters, between 25 and 40. They were eligible for the study if they had IGT according to the World Health Organization criteria, plus impaired fasting glucose (a fasting plasma glucose concentration of between 100 and 140 mg/dL or 5.5 and 7.8 mmol/L) found a number needed to treat of 44 (over 3.3 years) to prevent a major cardiovascular event[5].

Other studies have shown that life-style changes[6] and metformin[7] can delay the onset of diabetes.

Treatment

Oral agents

A systematic review of randomized controlled trials found that second-generation sulfonylureas and metformin are excellent choices.[8]

References

  1. ↑ .World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part 1. Diagnosis and classification of diabetes mellitus. Retrieved on 2007-05-29.
  2. ↑ U.S. Preventive Services Task Force (2003). "Screening for type 2 diabetes mellitus in adults: recommendations and rationale". Ann. Intern. Med. 138 (3): 212-4. PMID 12558361. National Guidelines Clearinghouse: Complete Summary
  3. ↑ Harris R, Donahue K, Rathore SS, Frame P, Woolf SH, Lohr KN (2003). "Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force". Ann. Intern. Med. 138 (3): 215-29. PMID 12558362.
  4. ↑ Santaguida PL, Balion C, Hunt D, et al (2005). "Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose". Evidence report/technology assessment (Summary) (128): 1-11. PMID 16194123. [e]
  5. ↑ Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M (2003). "Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial". JAMA 290 (4): 486-94. DOI:10.1001/jama.290.4.486. PMID 12876091. Research Blogging. ACP Journal Club review
  6. ↑ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet 368 (9548): 1673-9. DOI:10.1016/S0140-6736(06)69701-8. PMID 17098085. Research Blogging. ACP Journal Club review
  7. ↑ Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". N. Engl. J. Med. 346 (6): 393-403. DOI:10.1056/NEJMoa012512. PMID 11832527. Research Blogging. ACP Journal Club review
  8. ↑ Bolen S et al. Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus. Ann Intern Med 2007;147:6
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