diabetes%20mellitus
DIABETES MELLITUS
Diabetes mellitus (DM) is a heterogenous metabolic disorder characterized by the presence of hyperglycemia with carbohydrate, protein and fat metabolism disturbance which results from defects in either insulin secretion or action.
Patients with DM usually present with polyuria, polydipsia and unexplained weight loss.
Type 1 DM is caused by beta cell destruction which leads to complete insulin deficiency. It may be immune mediated or idiopathic.
Patients may present with ketoacidosis or acute onset of hyperglycemia while other patients may resemble type 2 DM or symptoms of other autoimmune disorders.
Type 2 DM is the most common form of diabetes. It is secondary to defect in insulin secretion concomitant with insulin resistance.
Majority of patients are asymptomatic. Ketoacidosis is uncommon and is usually secondary to stress (eg infection).
  1. American Diabetes Association. Standards of medical care in diabetes - 2013. Diabetes Care. 2013 Jan;36(Suppl 1):S11-S66. doi: 10.2337/dc13-S011. Accessed 02 Aug 2013. PMID: 23264422
  2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009 Jan;32(Suppl 1):S62-S72.
  3. American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008 Jan;31(Suppl 1):S61-S78. PMID: 18165339
  4. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2008 Jan;31(Suppl 1):S55-S60. http://www.ncbi.nlm.nih.gov/pubmed/18165338. PMID: 18165338
  5. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2008 Jan;31(Suppl 1):S12-S54. http://www.ncbi.nlm.nih.gov/pubmed/?term=18165335. PMID: 18165335
  6. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guideline for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2013 Apr;37(Suppl 1):S1-S212. http://guidelines.diabetes.ca.
  7. Bloomgarden ZT. The diabetic foot. Diabetes Care. 2008 Feb;31(2):372-376. http://care.diabetesjournals.org. Accessed 26 Jul 2012. PMID: 18227468
  8. Handelsman Y, Mechanick JI, Blonde L, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011 Mar;17(Suppl 2):001-53. http://www.aace.com. Accessed 16 May 2013. PMID: 21474420
  9. Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006 Sep;45(Suppl 5):S1-S66. http://www.acfas.org. Accessed 26 Jul 2012. PMID: 17280936
  10. Nathan DM, Buse JB, Davidson MB, et al for the American Diabetes Association and the European Association for the Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. Diabetes Care. 2009 Jan;32(1):193-203. doi: 10.2337/dc08-9025. PMID: 18945920
  11. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012 Jun;35(6):1364-1379. http://care.diabetesjournals.org. Accessed 09 Jul 2012. PMID: 22517736
  12. Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13(Suppl 1):001-68. PMID: 17613449
  13. Qaseem A, Humphrey LL, Sweet DE, et al. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Inter Med. 2012 Feb;156(3):218-231. http://annals.org/article.aspx?articleID=1033354. PMID: 22312141
  14. Riethof M, Flavin PL, Lindvall B, et al. Diagnosis and management of type 2 diabetes mellitus in adults. Institute for Clinical Systems Improvement. 2012 Apr. https://www.icsi.org.
  15. Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009 Sep;15(6):540-559. PMID: 19858063
  16. Tesfaye S, Boulton AJM, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010 Oct;33(10):2285-2293. http://care.diabetesjournals.org/content/33/10/2285.full.pdf+html. Accessed 09 Jul 2012. PMID: 20876709
  17. Shakher J, Stevens MJ. Update on the management of diabetic polyneuropathies. Diabetes Metab Syndr Obes. 2011;4:289-305. http://www.ncbi.nlm.nih.gov. Accessed 09 Jul 2012. PMID: 21887102
  18. U.S. Food And Drug Administration. FDA Drug safety communication: update to ongoing safety review of Actos (pioglitazone) and increased risk of bladder cancer. US FDA. 2011 Jun. http://www.fda.gov. Accessed 01 Jul 2011
  19. U.S. Food And Drug Administration. FDA Drug safety communication: updated risk evaluation and mitigation strategy (REMS) to restrict access to rosiglitazone-containing medicines including Avandia, Avandamet, and Avadaryl. US FDA. 2011 May. http://www.fda.gov. Accessed 21 Jun 2011
  20. Velasquez W, Valles A, Curbelo W. Impact of epidermal growth factor on the treatment of diabetic ulcers. Biotecnologia Aplicada. 2010;27:136-141. http://elfosscientiae.cigb.edu.cu. Accessed 26 Jul 2012
  21. Wang JS, Tu ST, Lee IT, et al. Contribution of postprandial glucose to excess hyperglycemia in Asian type 2 diabetic patients using continuous glucose monitoring. Diabetes Metab Res Rev. 2011 Jan;27(1):79-84. PMID: 21218511
  22. Ziegler D. Current Concepts in the management of diabetic polyneuropathy. Cur Diabetes Rev. 2011 May;7(3):208-220. PMID: 21534920
  23. Whitmer RA, Karter AJ, Yaffe K, et al. Hypoglycemic episodes and risk in dementia in older patients with type 2 diabetes mellitus. JAMA. 2009 Apr;301(15):1565-1572. PMID: 19366776
  24. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain: how far have we come?. Diabetes Care. 2008 Feb;31(Suppl 2):S255-S261. doi: 10.2337/dc08-s263. PMID: 18227494
  25. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  26. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  27. Malaysian Endocrine & Metabolic Society, Ministry of Health Malaysia, Academy of Medicine Malaysia, Persatuan Diabetes Malaysia. Clinical practice guidelines: management of type 2 diabetes mellitus. 4th ed. http://www.moh.gov.my. May 2009.
  28. Ministry of Health Singapore. Clinical practice guidelines: diabetes mellitus. MOH (Singapore). http://www.moh.gov.sg. Jun 2006. Accessed 25 Mar 2011.
  29. Scottish Intercollegiate Guidelines Network. Management of diabetes: a national clinical guideline. SIGN. http://www.sign.ac.uk. Mar 2010. Accessed 23 May 2011.
  30. IDF Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes. http://www.idf.org. 2012. Accessed 14 May 2013.
  31. National Institute for Health and Care Excellence. NICE Clinical Guideline 87 Type 2 diabetes: the management of type 2 diabetes. NICE. http://www.nice.org.uk. May 2009.
  32. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014 Jan;37(Suppl 1):S81-S90. http://care.diabetesjournals.org. Accessed 18 Feb 2014. PMID: 24357215
  33. American Diabetes Association. Standards of medical care in diabetes - 2014. Diabetes Care. 2014 Jan;37(Suppl 1):S14-S80. http://care.diabetesjournals.org. PMID: 24357209
  34. Bailey JB, Day C. SGLT2 inhibitors: glucuretic treatment for type 2 diabetes. Br J Diabetes Vasc Dis. 2010;10:193-199.
  35. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014 Jan;37(Suppl 1):S120-S143. http://care.diabetesjournals.org. Accessed 19 Feb 2014. PMID: 24357208
  36. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocr Pract. 2013 Mar-Apr;19(2):327-336.
  37. Kim Y, Babu AR. Clinical potential of sodium-glucose cotransporter 2 inhibitors in the management of type 2 diabetes. Diabetes Metab Syndr Obes. 2012;5:313-327.
  38. Stenlöf K, Cefalu WT, Kim KA, et al. Efficacy and safety of canagliflozin monotherapy in subjects with type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetes Obes Metab. 2013 Apr;15(4):372-382.
  39. Varkonyi T, Putz Z, Keresztes K, et al. Current options and perspectives in the treatment of diabetic neuropathy. Current Pharmaceutical Design. 2013;19(27):4981-5007. PMID: 23278494
  40. Wulffelé MG, Kooy A, de Zeeuw D, et al. The effect of metformin on blood pressure, plasma cholesterol and triglycerides in type 2 diabetes mellitus: a systematic review. J Intern Med. 2004 Jul;256(1):1-14.
  41. American Diabetes Association. Standards of medical care in diabetes - 2015. Diabetes Care. 2015 Jan;38(Suppl 1):S1-S93. Accessed 26 Jun 2015
  42. Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015. Endocr Pract. 2015 Apr;21:1-87. doi: 10.4158/EP15672.GL. PMID: 25869408
  43. Malaysian Endocrine & Metabolic Society. Practical guide to insulin therapy in type 2 diabetes. MEMS.my. http://www.mems.my. 2011. Accessed 26 Jun 2015.
  44. Malaysian Endocrine & Metabolic Society. Clinical practice guidelines on management of type 2 diabetes mellitus. 5th edition. MEMS. http://www.mems.org.my. 2015. Accessed 08 Dec 2015.
  45. American Diabetes Association. Standards of medical care in diabetes – 2016. Diabetes Care. 2016 Jan;39(Suppl 1):S1-119. http://care.diabetesjournals.org. Accessed 05 Feb 2016
  46. Jeremiah P. Role of statins in diabetic kidney disease (DKD). MIMS Doctor. Selangor, Malaysia: MIMS Medica Sdn Bhd; 2016 Aug.
  47. Guerrero AE, Gonzalez-Santos LE, Caole-Ang IV, et al. 2015 Updated clinical practice guidelines for the management of dyslipidemia in the Philippines. Philippine Society of Endocrinology, Diabetes and Metabolism. http://endo-society.org.ph. 2015. Accessed 03 Aug 2016.
  48. Unite for Diabetes Philippines. Philippine practice guidelines on the diagnosis and management of diabetes mellitus. Philippine Society of Endocrinology, Diabetes and Metabolism. http://endo-society.org.ph. 2014.
  49. Garber AJ, Abrahamson MJ, Brazilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2016 executive summary. Endocr Pract. 2016 Jan;22(1):84-113. doi: 10.4158/EP151126.CS. PMID: 26731084
  50. Garber AJ, Abrahamson MJ, Barzilay JL, et al. Consensus statement by the American Association of Clinical Endocrinologists (AACE) & American College of Endocrinology (ACE) on the comprehensive type 2 diabetes management algorithm 2017 executive summary. Endo Pract. 2017 Feb;23(2):207-238. doi: 10.4158/EP161682.CS. PMID: 28095040
  51. American Diabetes Association. Standards of medical care in diabetes – 2017. Diabetes Care. 2017 Jan;40(Suppl 1):S1-S135. http://professional.diabetes.org. Accessed 6 Feb 2017
  52. Lau IT. A clinical practice guideline to guide a system approach to diabetes care in Hong Kong. Diabetes Metab J. 2017 Apr;41(2):81-88. doi: 10.4093/dmj.2017.41.2.81. Accessed 08 Aug 2017. PMID: 28447435
  53. Task Force on Conceptual Model and Preventive Protocols, Working Group on Primary Care and Hong Kong Food and Health Bureau. Hong Kong reference framework for diabetes care for adults in primary care settings. Revised edition 2017. Department of Health, The Government of the Hong Kong Special Administrative Region website. http://www.pco.gov.hk. 2017. Accessed 01 Aug 2017.
  54. Neal B, Perkovic V, Mahaffey KW, et al; CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017 Aug 17;377(7):644-657. doi: 10.1056/NEJMoa1611925. PMID: 28605608.
  55. Schwartz SS, Ahmed I. Sodium-glucose cotransporter 2 inhibitors: an evidence-based practice approach to their use in the natural history of type 2 diabetes. Curr Med Res Opin. 2016 May;32(5):907-919. doi: 10.1185/03007995.2016.1151774. PMID: 26854518
  56. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017 Nov 7:pii: S0735-1097(17)41519-1. doi: 10.1016/j.jacc.2017.11.006. Accessed 16 Nov 2017. PMID: 29146535
  57. American Diabetes Association. Standards of medical care in diabetes - 2018. Diabetes Care. 2018 Jan;41(Suppl 1):S1-118. https://professional.diabetes.org/.
  58. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2018 executive summary. Endocr Pract. 2018 Jan;24(1):91-120. doi: 10.4158/CS-2017-0153.
  59. Marinangeli CPF, Foisy S, Shoveller AK, et al. An appetite for modernizing the regulatory framework for protein content claims in Canada. Nutrients. 2017 Sep;9(9):921. doi: 10.3390/nu9090921. PMID: 28832556
  60. Mirasol R, Thai AC, Ahmad A, et al. A consensus of key opinion leaders on the management of pre-diabetes in the Asia-Pacific region. Journal of the ASEAN Federation of Endocrine Societies. 2017 May;2(1):1-17. http://asean-endocrinejournal.org.
  61. Schaafsma G. The protein digestibility-corrected amino acid score. J Nutr. 2000 Jul;130(7):1865S–1867S. doi: 10.1093/jn/130.7.1865S. PMID: 10867064
  62. Beshyah SA, Chatterjee S, Davies MJ. Use of SGLT2 inhibitors during Ramadan: a survey of physicians’ views and practical guidance. Br J Diabetes. 2016;16:20-24. http://dx.doi.org/10.15277/bjd.2016.058.
  63. European Medicines Agency. SGLT2 inhibitors (previously Canagliflozin). European Medicines Agency. http://www.ema.europa.eu. 2017.
  64. U.S. Food and Drug Administration. FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. US FDA. https://www.fda.gov. 2016. Accessed 14 Jun 2018.
  65. American Diabetes Association. Standards of medical care in diabetes – 2019. Diabetes Care. 2019 Jan;42(Suppl 1):S90-S101. doi: 10.2337/dc19-S006. PMID: 30559232
  66. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018 Dec;61(12):2461-2498. doi: 10.1007/s00125-018-4729-5. PMID: 30288571
  67. World Health Organization. Guidelines on second-and third-line medicines and type of insulin for the control of blood glucose levels in non-pregnant adults with diabetes mellitus. WHO. www.who.int. 2018.
  68. Glycemic index and diabetes. American Diabetes Association. http://www.diabetes.org. 14 May 2014. Accessed 03 Apr 2019.
  69. Davidson JA. SGLT2 inhibitors in patients with type 2 diabetes and renal disease: overview of current evidence. Postgrad Med. 2019 May;131(4):251-260. doi: 10.1080/00325481.2019.1601404. PMID: 30929540
  70. Durnwald C. Gestational diabetes mellitus: glycemic control and maternal prognosis. UpToDate. www.uptodate.com. 21 Feb 2019.
  71. FDA Drug Safety Communication: FDA eliminates the Risk Evaluation and Mitigation Strategy (REMS) for rosiglitazone-containing diabetes medicines. U.S. Food & Drug Administration. https://www.fda.gov. Dec 2015.
  72. Gerstein HC, Colhoun HM, Dagenais GR, et al; REWIND Investigators. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019 Jun 7;pii: S0140-6736(19):31149-3. doi: 10.1016/S0140-6736(19)31149-3. PMID: 31189511
  73. Mirghani Dirar A, Doupis J. Gestational diabetes from A to Z. World J Diabetes. 2017 Dec 15;8(12):489-511. doi: 10.4239/wjd.v8.i12.489. PMID: 29290922
  74. Sugiyama S, Jinnouchi H, Yoshida A, et al. Renoprotective effects of additional SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus and chronic kidney disease stages 3b-4: a real world report from a Japanese specialized diabetes care center. J Clin Med Res. 2019 Apr;11(4):267-274. doi: 10.14740/jocmr3761. PMID: 30937117
  75. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. ESC. http://www.escardio.org. 31 Aug 2019.
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