Fast Five Quiz: Type 2 Diabetes Key Aspects

Romesh Khardori, MD, PhD

Disclosures

August 18, 2020

The diagnosis of diabetes is readily considered when a patient presents with classic symptoms (ie, polyuria, polydipsia, polyphagia, weight loss). Other symptoms that may suggest hyperglycemia include blurred vision, lower-extremity paresthesias, or yeast infections, particularly balanitis in men. However, many patients with T2D are asymptomatic, and their disease remains undiagnosed for many years.

The "dawn phenomenon" refers to hyperglycemia that occurs in the early morning hours and differs from the Somogyi effect in that it is not preceded by hypoglycemia. The prevalence is estimated to exceed 50% in both T1D and T2D.

According to the American Diabetes Association (ADA), screening for prediabetes and T2D with an informal assessment of risk factors or validated tools should be considered in asymptomatic adults. The ADA recommends T2D testing should be considered in overweight or obese adults who have one or more of the following risk factors:

  • First-degree relative with diabetes

  • High-risk race/ethnicity (eg, Black, Latinx, Native American, Asian American, Pacific Islander)

  • History of cardiovascular disease

  • Hypertension (≥ 140/90 mm Hg or on therapy for hypertension)

  • High-density lipoprotein cholesterol level < 35 mg/dL (0.90 mmol/L) and/or a triglyceride level > 250 mg/dL (2.82 mmol/L)

  • Polycystic ovary syndrome

  • Physical inactivity

  • Other clinical conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans)

The ADA recommends that, for all patients, testing should begin at age 45 years. Testing for prediabetes and/or T2D in asymptomatic patients should be considered in adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. Among Asian Americans, a BMI ≥ 23 kg/m2 is the threshold. For other patients, a BMI ≥ 25 kg/m2 is the threshold.

Read more about the presentation of T2D.

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