Intensive glycemic control can reduce microvascular complications of diabetes.
The hemoglobin A1c goal for most patients is <7%; however, goals for glycemic control should be individualized based on presence of concurrent illness or complications, risk of hypoglycemia, and life expectancy.
To reduce macrovascular complications, management of cardiac risk factors such as hypertension and hyperlipidemia is necessary; reductions in glycemic control alone are unlikely to prevent significant cardiovascular morbidity and mortality.
Medication therapy management (MTM) providers should work with the patient and members of the healthcare team to tailor medication regimens that achieve therapeutic goals, promote adherence, reduce the risk of complications, and maximize quality of life for patients with diabetes.
Diabetes mellitus (DM) is a group of disorders characterized by hyperglycemia because of insulin resistance, reduced insulin secretion, or both. Diabetes may result in chronic complications including microvascular, macrovascular, and neuropathic disorders.1 Diabetes currently affects 29.1 million people in the United States, which represents approximately 9.3% of the population.2 Prediabetes, defined as impaired fasting glucose or impaired glucose tolerance, affects about 37% of adults over the age of 20, or approximately 86 million people.2 Diabetes also causes a large economic burden in the United States. Total costs are estimated at $245 billion, which includes $176 billion in direct medical costs and $69 billion in indirect medical costs because of reduced productivity.3
The most common forms of diabetes include type 1, type 2, and gestational diabetes. Type 2 diabetes mellitus (T2DM) is the most prevalent, accounting for 95% of cases of diabetes diagnosed in adults. Type 1 diabetes mellitus (T1DM) occurs in approximately 5% of those diagnosed with diabetes. It appears most often in children and young adults, although it may occur at any time. Table 21-1 provides an overview of the characteristics of T1DM and T2DM. Gestational diabetes mellitus (GDM) occurs in 2% to 10% of women during pregnancy, and most women will return to normoglycemia following pregnancy. However, women who have GDM during pregnancy have an increased likelihood of developing T2DM in the future.4 Less common causes of diabetes include infections, genetic defects, pancreatic destruction, endocrinopathies, and certain medications (Table 21-2).
TABLE 21-1Classical Clinical Presentation of Diabetes Mellitusa ||Download (.pdf) TABLE 21-1 Classical Clinical Presentation of Diabetes Mellitusa
|Characteristic ||Type 1 DM ||Type 2 DM |
|Age ||<30 yearsb ||>30 yearsb |
|Onset ||Abrupt ||Gradual |
|Body habitus ||Lean ||Obese or history of obesity |
|Insulin resistance ||Absent ||Present |
|Autoantibodies ||Often present ||Rarely present |
|Symptoms ||Symptomaticc ||Often asymptomatic |
|Ketones at diagnosis ||Present ||Absentd |
|Need for insulin therapy ||Immediate ||Years after diagnosis |
|Acute complications ||Diabetic ketoacidosis ||Hyperosmolar hyperglycemic state |
|Microvascular complications at diagnosis ||No ||Common |
|Macrovascular complications at or before diagnosis ||Rare ||Common |