Diabetes Mellitus: Diagnosis and Management

by Charles Vega, MD

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    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.

    About the Lecture

    The lecture Diabetes Mellitus: Diagnosis and Management by Charles Vega, MD is from the course Chronic Care.

    Included Quiz Questions

    1. Double to 40 million people
    2. Decrease by half to 10 million people
    3. Triple to 60 million people
    4. Increase by 1.5 times to 30 million people
    5. Increase by 2.5 times to 50 million people
    1. A 55-year-old Caucasian man with a past medical history of anxiety and irritable bowel syndrome.
    2. A 40-year-old pre-menopausal Latino woman who is normal weight and does not have any medical problems.
    3. An asymptomatic 56-year-old overweight woman with a medial history of hypertension.
    4. A 42-year-old G2P2 woman with no current medical problems, but a history of gestational diabetes with her second pregnancy.
    5. A healthy 45-year-old African American man with no past medical history.

    Author of lecture Diabetes Mellitus: Diagnosis and Management

     Charles Vega, MD

    Charles Vega, MD

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