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JOE A. FLORENCE, M.D., and BRYAN F. YEAGER, PHARM.D., University of Kentucky College of Medicine, Lexington, Kentucky

Am Fam Physician. 1999 May 15;59(10):2835-2844.

  See related patient information handout on new treatments for diabetes, provided by an AAFP staff patient education writer.

  This article exemplifies for 1 last update 08 Aug 2020 the AAFP 1999 Annual Clinical Focus on management and prevention of the complications of diabetesThis article exemplifies the AAFP 1999 Annual Clinical Focus on management and prevention of the complications of diabetes.

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Type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes) causes abnormal carbohydrate, lipid and protein metabolism associated with insulin resistance and impaired insulin secretion. Insulin resistance is a major contributor to progression of the disease and to complications of diabetes. Type 2 diabetes is a common and underdiagnosed condition that poses treatment challenges to family practitioners. The introduction of new oral agents within the past three years has expanded the range of possible combination regimens available for treating type 2 diabetes. Despite the choice of pharmacologic agents, physicians must stress the nonpharmacologic approaches of diet modification, weight control and regular exercise. Pharmacologic approaches must be based on patient characteristics, level of glucose control and cost considerations. Combinations of different oral agents may be useful for controlling hyperglycemia before insulin therapy becomes necessary. A stepped-care approach to drug therapy may provide the most rational, cost-efficient approach to management of this disease. Pharmaco-economic analyses of clinical trials are needed to determine cost-effective treatment strategies for management of type 2 diabetes.

Diabetes mellitus affects approximately 16 million people in the United States and accounts for about one sixth of all expenditures for health care.1 Ninety percent of patients with diabetes have type 2 diabetes (formerly known as non–insulin-dependent diabetes) and often require oral agents or insulin for glucose control. The mortality rate in patients with diabetes may be up to 11 times higher than in persons without the disease.1 Diabetes is a leading cause of blindness, renal failure, and foot and leg amputations in adults. Managed care and budgeted resources challenge clinicians to provide comprehensive health care to patients with diabetes.

reverses diabetes type 2 in a sentence (🔴 lecture) | reverses diabetes type 2 home remediehow to reverses diabetes type 2 for Within the past three years, the introduction of new oral agents has prompted questions regarding the most cost-effective approach for management of type 2 diabetes. Since pharmaco-economic data concerning antidiabetic regimens are limited, clinicians must select the most appropriate agent(s) based on patient characteristics, level of glucose control and cost. A rational approach for managing patients with varying stages of disease requires an understanding of features that lead to disease progression, and a thorough review of the new oral agents for the treatment of type 2 diabetes and the clinical and economic basis for appropriate drug selection.

Disease Progression

Diabetes is a group of metabolic diseases with characteristic hyperglycemia associated with defects in insulin secretion, insulin action, or both. Type 1 diabetes (formerly known as insulin-dependent diabetes) is characterized by beta cell destruction, usually leading to absolute insulin deficiency. Its etiology is either immune mediated, related to physical destruction of the pancreas (as in pancreatitis or pancreatic cancer) or idiopathic. Type 2 diabetes presents as a spectrum of metabolic abnormalities with prominent insulin resistance and relative insulin deficiency.2 The effect of diabetes is not limited to carbohydrate metabolism. Lipid and protein metabolism play an important role in the progression of the disease.3 Abnormal glucose metabolism accounts for poorly regulated biochemical processes that glycosylate hemoglobin and other proteins and lipids throughout the body. The progression of diabetes is caused by numerous metabolic events that occur over a period of years. By controlling these metabolic events, the progression of the disease may be slowed or stopped.

The prevalence of diabetes in persons 45 to 64 years of age is 7 percent, but the proportion increases significantly in persons 65 years of age or older.4  Certain minority populations have even higher rates. Despite its high prevalence, diabetes is largely underdiagnosed (Table 1).5 It is estimated that over 8 million people in the United States alone are unaware that they have the disease.1 There is evidence that retinopathy begins to develop at least seven years before the clinical diagnosis of type 2 diabetes is made.6 Patients with undiagnosed diabetes mellitus are at serious risk for coronary heart disease, stroke and peripheral vascular disease, and have a greater likelihood of dyslipidemia, hypertension and obesity.

TABLE 1
Criteria for the Diagnosis of Diabetes Mellitus and Impaired Glucose Homeostasis

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Criteria for diagnosing diabetes in asymptomatic, undiagnosed patients are outlined in Table 2.5  These criteria are associated with the following factors: the steep rise in the incidence of the disease after 45 years of age, the negligible likelihood of developing any diabetic complications within three years after a negative screening test, and knowledge of documented risk factors for the disease (Table 3) .7 Studies have defined the glycosylated hemoglobin A1c (HbA1c) level above which the likelihood of having or developing macrovascular or microvascular disease increases. Because HbA1c and fasting blood glucose (FBG) are the measurements of choice for monitoring diabetes, decisions about when and how to implement treatment strategies are based on these parameters.8

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Recommendations for Diabetes Screening of Asymptomatic Persons

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Test at age 45; repeat every three years for patients 45 years of age or older

Test before age 45; repeat more frequently than every three years if patient has one or more of the following risk factors:

Obesity: ≥20% of desirable body weight or BMI ≥27 kg per m2

First-degree relative with diabetes mellitus

Member of high-risk ethnic group (black, Hispanic, Native American, Asian)

for 1 last update 08 Aug 2020

History of gestational diabetes mellitus or delivering a baby weighing more than 4,032 g (9 lb)

Hypertensive (≥140/90 mm Hg)

HDL cholestrol level ≤ 35 mg per dL (0.90 mmol per L) and/or triglyceride level ≥250 mg per dL (2.83 mmol per L)

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History of IGT or IFG on prior testing


BMI = body mass index; HDL = high-density lipoprotein; IGT = impaired glucose tolerance; IFG = impaired fasting glucose.

Adapted with permission from Report of the for 1 last update 08 Aug 2020 Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–97Adapted with permission from Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–97.

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Recommendations for Diabetes Screening of Asymptomatic Persons

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Test at age 45; repeat every three years for patients 45 years of age or for 1 last update 08 Aug 2020 olderTest at age 45; repeat every three years for patients 45 years of age or older

Test before age 45; repeat more frequently than every three years if patient has one or more of the following risk factors:

the 1 last update 08 Aug 2020

Obesity: ≥20% of desirable body weight or BMI ≥27 kg per m2

First-degree relative with diabetes mellitus

Member of high-risk ethnic group (black, Hispanic, Native American, Asian)

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History of gestational diabetes mellitus or delivering a baby weighing more than 4,032 g (9 lb)

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HDL cholestrol level ≤ 35 mg per dL (0.90 mmol per L) and/or triglyceride level ≥250 mg per dL (2.83 mmol per L)

History of IGT for 1 last update 08 Aug 2020 or IFG on prior testingHistory of IGT or IFG on prior testing


BMI = body mass index; HDL = high-density lipoprotein; IGT = impaired glucose tolerance; IFG = impaired fasting glucose.

Adapted with permission from Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–97.

View/Print Table

TABLE 3

Major Risk Factors for Type 2 Diabetes Mellitus

Family history of diabetes (parents or siblings with diabetes)

Obesity (≥120% over desired body weight or BMI ≥27 kg per m2)

Race/ethnicity (e.g., black, Hispanic, native American, Asian American, Pacific Islander)

Age ≥45 years

Previously identified IFG or IGT

Hypertension (≥140/90 mm the 1 last update 08 Aug 2020 Hg)Hypertension (≥140/90 mm Hg)

HDL cholesterol level ≤35 mg per dL (0.90 mmol per L) and/or a trigyceride level ≥250 mg per dL (2.83 mmol per L)

History of gestational diabetes mellitus or delivery of babies over 4,032 g (9 lb)


IFG = impaired fasting glucose; IGT = impaired glucose the 1 last update 08 Aug 2020 tolerance; HDL = high-density lipoprotein.IFG = impaired fasting glucose; IGT = impaired glucose tolerance; HDL = high-density lipoprotein.

Information from Screening for type 2 diabetes. Diabetes Care 1998;21(suppl 1):S20-2.

TABLE 3

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Family history of diabetes (parents or siblings with diabetes)

Obesity (≥120% over desired body weight or BMI ≥27 kg per m2)

Race/ethnicity (e.g., black, Hispanic, native American, Asian American, Pacific Islander)

Age ≥45 years

Previously identified IFG or IGT

Hypertension (≥140/90 mm for 1 last update 08 Aug 2020 Hg)Hypertension (≥140/90 mm Hg)

HDL cholesterol level ≤35 mg per dL (0.90 mmol per L) and/or a trigyceride level ≥250 mg per dL (2.83 mmol per L)

History of gestational diabetes mellitus or delivery of babies over 4,032 g (9 lb)


IFG = impaired fasting glucose; IGT = impaired glucose tolerance; HDL = high-density lipoprotein.

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The National Diabetes Data Group9 developed the current classification and diagnosis of diabetes that is used in the United States. Other diabetic states also may occur that have etiologies differing from those of type 1 and type 2 diabetes. These diabetic states include: genetic defects in beta cell function; genetic defects in insulin action; diseases of the exocrine pancreas (e.g., pancreatitis); trauma; cystic fibrosis; endocrinopathies (e.g., acromegaly, Cushing''s syndrome, Turner''div-gpt-ad-right''t miss a single issue. Sign up for the free AFP email table of contents.

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