Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- asymptomatic
- polydipsia
- polyuria
Other diagnostic factors
- candidal infections
- skin infections
- urinary tract infections
- fatigue
- blurred vision
- polyphagia
- unintentional weight loss
- paraesthesias
- acanthosis nigricans
Risk factors
- older age
- overweight/obesity
- gestational diabetes
- non-diabetic hyperglycaemia
- family history of type 2 diabetes
- non-white ancestry
- polycystic ovary syndrome
- hypertension
- dyslipidaemia
- cardiovascular disease
- stress
Diagnostic investigations
1st investigations to order
- fasting plasma glucose
- HbA1c
- 2-hour post-load glucose after 75 g oral glucose
- random plasma glucose
Investigations to consider
- fasting lipid profile
- urine ketones
- albumin to creatinine ratio (ACR)
- serum creatinine and estimated GFR
- ECG
- ankle-brachial pressure index (ABPI)
- random C-peptide
- autoantibody testing
- liver function tests (LFTs)
Treatment algorithm
at initial diagnosis
HbA1C above goal: non-pregnant
HbA1C above agreed threshold on initial pharmacotherapy or cardiovascular risk changes: non-pregnant
pregnant
Contributors
Authors
Surya Rajeev, MBBS, MRCP, MD
Consultant Physician and Clinical Director
Department of Diabetes and Endocrinology
Liverpool University Hospital NHS Foundation Trust
UK
Disclosures
SR has received reimbursement from Novo Nordisk for conferences, and has presented paid lectures.
Acknowledgements
Dr Surya Rajeev would like to gratefully acknowledge Dr Partha Kar, Dr Amar Puttanna, Dr Patrick J. O'Connor and Dr JoAnn M. Sperl-Hillen, the previous contributors to this topic.
Disclosures
PK has sat on advisory boards and attended events reimbursed by Novo Nordisk, Eli Lilly, and Sanofi. AP has received honoraria from Napp, Novo Nordisk, Sanofi, Lilly-Boehringer Ingelheim, Daiichi-Sankyo, and AstraZeneca for presentation at meetings, conference registration, or participating in advisory boards. PJO receives research funding from the National Institutes of Health on multiple projects and is an author of a number of references cited in this topic. JMS-H is an author of a number of references cited in this topic and is an inventor on a US patent for Disease Treatment Simulation, a simulation-based technology developed without commercial support to educate health providers on chronic disease management in a virtual environment.
Peer reviewers
Vinod Patel, MD, FRCP, FHEA, MRCGP, DRCOG, MBChB, BSc (Hons), RCPathME
Professor, Diabetes and Clinical Skills
Warwick Medical School
University of Warwick
Hon Consultant in Endocrinology and Diabetes, Acute Medicine, Medical Obstetrics
Diabetes and Endocrinology Centre
George Eliot Hospital NHS Trust
Nuneaton
Clinical Director for Diabetes West Midlands Clinical Networks & Clinical Senate
NHS England and NHS Improvement - Midlands
UK
Disclosures
VP declares he has worked with most of the large pharmaceutical industry groups over the years with the majority of the work being in education of healthcare professionals in diabetes care. This includes Novo Nordisk, Eli Lily, MSD, BI, Sanofi, Napp, Internis, Takeda, and AZ. VP has been part of advisory board work on occasions. VP has received conference arrangements and lecture fees. VP is a trustee of the charity South Asian Health Foundation.
Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA
Price-Evans Professor of Cardiovascular Medicine
University of Liverpool
Senior Investigator
National Institute for Health Research
UK
Distinguished Professor
Faculty of Medicine
Aalborg University
Denmark
Adjunct Professor
Yonsei University
Seoul
South Korea
Disclosures
GL has acted as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo.
References
Key articles
National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. Jun 2022 [internet publication].Full text
Marx N, Federici M, Schütt K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-140.Full text Abstract
National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication].Full text
Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-86.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Non-diabetic hyperglycaemia (pre-diabetes)
- Diabetes mellitus, type 1
- Latent autoimmune diabetes in adults (LADA)
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- 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes
- Management of hyperglycaemia in type 2 diabetes, 2022
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