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Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is characterized by hyperglycemia and a marked predilection for long-term microvascular, macrovascular and neurologic complications. Eight million adults have diabetes, and 90% of diabetis


In type 2 diabetes, diabetes mellitus is caused by impaired insulin secretion, peripheral insulin resistance, increased hepatic glucose production, and impaired priming of the pancreas by the gut after an oral glucose load. Most patients are

The Diabetes Control and Complications Trial (DCCT) showed that tight glycemic control reduces the risk of onset diabetes and progression of retinopathy and nephropathy by 50-75%.

Diagnosis of Type 2 Diabetes

A complete lack of symptoms is the most common presentation of type 2 diabetes. Diabetes is often first detected by a screening urinalysis, obtained for other reasons.

Patients may only have fatigue and a vague sense of "not feeling well." Female patients may present with vulvovaginitis or intertriginous fungal infections.

Diagnostic Criteria for Diabetes Mellitus

Fasting plasma glucose =126 mg/dL. Fasting is defined as no caloric intake for at least 8 hours.

Symptoms of diabetes (polydipsia, polyuria, unexplained weight) plus

Type 1 diabetes is distinguished from type 2 by the young age of onset and by the production of ketones in type 1 diabetes.

Screening for Asymptomatic Type 2 Diabetes Mellitus diabetis

All individuals =45 years old should be screened for

Treatment consists of