Source: Triplitt CL, Reasner
CA. Diabetes Mellitus. In: DiPiro JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM, eds. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://www.accesspharmacy.com/content.aspx?aid=7990956.
Accessed July 16, 2012.
- Adult onset diabetes mellitus (DM)
- Non-insulin–dependent diabetes mellitus (NIDDM)
- Disorder of carbohydrate regulation associated with:
- Reduced pancreatic insulin production
- Peripheral insulin resistance
- Impaired regulation of hepatic glucose production
- Excessive caloric intake, inadequate exercise, and obesity
coupled with susceptible genotype.
- Uncommon causes
- Medications (glucocorticoids, pentamidine, niacin, alfa-interferon)
- Usually characterized by insulin resistance and relative
- Insulin resistance manifested by:
lipolysis and free fatty acid production
- Increased hepatic glucose production
- Decreased skeletal muscle uptake of glucose
- β-Cell dysfunction is progressive
and contributes to worsening blood glucose control over time.
- Microvascular complications:
- Macrovascular complications:
- Coronary heart
- Peripheral vascular disease
- Accounts for 90% of DM cases.
- Affects 16 million individuals in Unites States; 30–40
million others have impaired glucose tolerance.
- More prevalent among Hispanics, Native Americans, African
Americans, and Asians/Pacific Islanders than
in non-Hispanic Whites.
- Maintain healthy diet, increased
physical activity, and appropriate body weight.
- Medications (metformin) may help prevent progression to type
2 DM in individuals with impaired glucose tolerance.
- Measure blood glucose at least every
3 years in people over age 45.
- Age >45 years
- Family history of diabetes
- Impaired glucose tolerance
- Low physical activity level
- Diabetes during previous pregnancy
- Polycystic ovarian syndrome
- Acanthosis nigricans
- Ethnicity (African Americans, Hispanic Americans, Asian Americans,
- Often asymptomatic; may be diagnosed from unrelated blood
- Significant weight loss less common
- Presence of complications (e.g., retinopathy, neuropathy,
nephropathy) may indicate long-term disease presence.
- Criteria for diagnosis of DM include any one of the following:
- A1C ≥6.5%
- Fasting plasma glucose ≥126 mg/dL
- Two-hour plasma glucose ≥200 mg/dL
(111.1 mmol/L) during oral glucose tolerance test (OGTT)
using 75 g anhydrous glucose in water
- Random plasma glucose concentration ≥200
mg/dL (111.1 mmol/L) with symptoms of hyperglycemia
- In absence of unequivocal hyperglycemia, confirm criteria
1 through 3 by repeat testing.
- Normal fasting plasma glucose (FPG) <100 mg/dL
- Impaired fasting glucose defined as FPG of 100–125
mg/dL (5.6–6.9 mmol/L).
- Impaired glucose tolerance diagnosed when 2-hour postload
sample of OGTT between 140–199 mg per dL (7.8–11.0
- Ameliorate symptoms of hyperglycemia.
- Reduce risk of complications.
- Reduce mortality.
- Improve quality of life.
- Achieve desirable plasma glucose and A1C levels (Table 1).
Table 1. Glycemic Goals
of Therapy |Favorite Table|Download (.pdf)
Table 1. Glycemic Goals
ACE and AACE
Preprandial plasma glucose