Diabetes mellitus is the most common
diagnosis in my practice.
So, I feel like I know it really well and
I think I’ve got some good information to give you,
particularly regarding diagnosis and management.
So, let’s get underway.
So, I've got a patient who is six years old.
He's got hyperlipidemia and obesity.
A recent routine lab analysis found that
his serum glucose level was 146 mg/dL.
He’s asymptomatic at this time.
What’s the next best step in his care?
Should we talk about lifestyle changes and
recheck his glucose,
along with a hemoglobin A1c level
in the next several weeks?
Should we start metformin now or sulfonylurea
or dipeptidyl peptidase-4 inhibitor?
What do you think?
Given his lack of symptoms and that glucose level,
we are mandated to recheck his glucose level.
And I would check an A1c too
because, with his risk factors,
sounds like he probably has diabetes.
Of course, you’re going to advise
him on lifestyle changes now,
and so that makes sense.
He does not have -- meet the
formal criteria for diabetes
as of yet, but many people do.
Overall, there are now more
than 20 million Americans
with Type II diabetes and this number
is expected to more than double
within the next 20 years or so.
So, should we be screening for diabetes?
Well, this is what the United States Preventive
Services Task Force, or USPSTF, says.
Among adults aged 40 to 70 years, which is kind of
the sweet spot for identifying diabetes,
check for either glucose or A1c,
either one is a valid measure,
among patients who are obese
and among those with a family history of diabetes,
high risk racial or ethnic groups,
which include Latinos and African-Americans.
And if the patient has a history
of gestational diabetes
or polycystic ovary syndrome,
those patients get screened too.
Lots of people meet the screening criteria.
You can apply that fairly broadly across a population.