Diabetes Mellitus: Diagnosis and Management

00:01 Diabetes mellitus is the most common diagnosis in my practice.

00:05 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.

00:13 So, let’s get underway.

00:15 So, I've got a patient who is six years old.

00:19 He's got hyperlipidemia and obesity.

00:21 A recent routine lab analysis found that his serum glucose level was 146 mg/dL.

00:29 He’s asymptomatic at this time.

00:32 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.

00:57 And I would check an A1c too because, with his risk factors, sounds like he probably has diabetes.

01:02 Of course, you’re going to advise him on lifestyle changes now, and so that makes sense.

01:06 He does not have -- meet the formal criteria for diabetes as of yet, but many people do.

01:14 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.

01:26 So, should we be screening for diabetes? Well, this is what the United States Preventive Services Task Force, or USPSTF, says.

01:34 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.

01:55 And if the patient has a history of gestational diabetes or polycystic ovary syndrome, those patients get screened too.

02:01 Lots of people meet the screening criteria.

02:04 You can apply that fairly broadly across a population.