Marwan Zoghbi, MD
Family Medicine Specialist
Clinical Instructor, USJ
Type II Diabetes is defined as an elevation in blood glucose resulting from resistance to insulin action and deficit in insulin secretion. Diabetes is associated with other metabolic disturbances such as hyperlipidemia and hypertension.
Diabetes is a major cause of cardiovascular mortality and morbidity. It is associated with a variety of disabling and life threatening complications such as nephropathy, the renal complication of diabetes, retinopathy, the retinal complication, neuropathy, which is a source of disabling pain, hypotension and gastro intestinal symptoms. Diabetics are at higher risk of foot ulcers leading in some cases to amputation of lower limbs. They are more prone to infections, surgery complications and even get depressed more frequently.
Tight control of diabetes and of associated risk factors has been shown to reduce complications. Early intervention achieves tight control easier. Screening is the key for early diagnosis. Table 1 shows major screening recommendations. Screening is generally recommended in high-risk populations i.e.: age>45, family history, overweight, obesity, steroids. Screening relies mainly on fasting blood sugar. The normal range is typically below 100 mg/dL. People who have values above this threshold are at high risk and should monitor their blood sugar regularly. Abnormal is considered 126 (mg/dL) and with that value, the patient will need to come in and have a second test done. Diabetes is confirmed with two separate values greater than126 mg/dl. The ADA has recognized recently HBA1c as a valid screening tool. HBA1C values above 6.5% are diagnostic of diabetes. ADA has published online a risk calculator:
Patients are encouraged to check their risk and discuss with their physicians about the screening strategy to adopt.
Patients at high risk or those with pre diabetes (sugar values are above 100 mg/dl but less than 126 or HBA1C between 5.7 and 6.4%) should be followed up carefully. Evidence has shown that intensive lifestyle modifications, increased physical activity, and to a lesser degree pharmacologic treatment reduce the risk of developing subsequent diabetes. The identification of this group of patients is a shared responsibility between primary care physicians, endocrinologists, and patients. Identification can reduce diabetes prevalence and may help reduce the burden of this disease.