sign and symptoms of diabetes 2

Signs and symptoms type 2 diabetes mellitius

Many patients with type 2 diabetes are asymptomatic. Clinical manifestations include the following:

Classic symptoms: Polyuria, polydipsia, polyphagia, and weight loss
Blurred vision
Lower-extremity paresthesias
Yeast infections (eg, balanitis in men)

See Clinical Presentation for more specific information on the signs and symptoms of type 2 diabetes mellitus.
Diagnosis

Diagnostic criteria by the American Diabetes Association (ADA) includes the following[1] :

A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or
A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or
A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis

Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion or an optional criterion remains a point of controversy.

Indications for diabetes screening in asymptomatic adults includes the following[2, 3] :

Sustained blood pressure >135/80 mm Hg
Overweight and 1 or more other risk factors for diabetes (eg, first-degree relative with diabetes, BP >140/90 mm Hg, and HDL < 35 mg/dL and/or triglyceride level >250 mg/dL)
ADA recommends screening at age 45 years in the absence of the above criteria

See Workup for more specific information on testing and screening for type 2 diabetes mellitus.
Treatment

Goals of treatment are as follows:

Microvascular (ie, eye and kidney disease) risk reduction through control of glycemia and blood pressure
Macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction through control of lipids and hypertension, smoking cessation
Metabolic and neurologic risk reduction through control of glycemia

Recommendations for the treatment of type 2 diabetes mellitus from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) place the patient's condition, desires, abilities, and tolerances at the center of the decision-making process.[4, 5, 6]

The EASD/ADA position statement contains 7 key points:

Individualized glycemic targets and glucose-lowering therapies
Diet, exercise, and education as the foundation of the treatment program
Use of metformin as the optimal first-line drug unless contraindicated
After metformin, the use of 1 or 2 additional oral or injectable agents, with a goal of minimizing adverse effects if possible
Ultimately, insulin therapy alone or with other agents if needed to maintain blood glucose control
Where possible, all treatment decisions should involve the patient, with a focus on patient preferences, needs, and values
A major focus on comprehensive cardiovascular risk reduction

For patients older than 65 years, a new consensus statement from the ADA and the American Geriatrics Society recommends adjusting treatment goals for glycemia, blood pressure, and dyslipidemia according to life expectancy and the presence of comorbidities. The statement suggests 3 broad groupings [7, 8] :

Healthy: Patients with few coexisting chronic conditions and intact cognitive and functional status
Complex/intermediate: Patients with multiple coexisting chronic illnesses or 2 or more impairments in activities of daily living (ADL) or mild to moderate cognitive impairment
Very complex/poor health: Patients in long-term care or with end-stage chronic illnesses or moderate to severe cognitive impairment or with 2 or more ADL dependencies

Corresponding HbA1c targets might be < 7.5%, < 8%, and < 8.5%, respectively, for the 3 groups above.

Approaches to prevention of diabetic complications include the following:

HbA1c every 3-6 months
Yearly dilated eye examinations
Annual microalbumin checks
Foot examinations at each visit
Blood pressure < 130/80 mm Hg, lower in diabetic nephropathy
Statin therapy to reduce low-density lipoprotein cholesterol