216 - Diabetes Mellitus

Abstract

Diabetes mellitus is a chronic disorder characterized by elevated blood glucose, which occurs as a consequence of insulin deficiency and, in some cases, impaired insulin action. Although heterogeneous, diabetes can be separated into two broad categories. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells and results in total (or near total) insulin deficiency. Type 2 diabetes is strongly associated with obesity and is characterized by relative insulin deficiency and variable defects in insulin sensitivity. Chronic hyperglycemia from all forms of diabetes can result in microvascular complications (retinopathy, nephropathy, neuropathy), as well as increased risk for atherosclerotic cardiovascular disease. Aggressive control of hyperglycemia and related risk factors, which includes medical nutrition therapy, exercise, weight management, and medications, can substantially reduce the risk of complications. Treatment of type 1 diabetes requires physiologic insulin replacement using multiple daily injections or a continuous subcutaneous insulin infusion pump. Pharmacologic options for treating type 2 diabetes include several classes of oral and injectable medications, which are often used in combination in order to achieve and maintain adequate glucose control. Acute, life-threatening complications of diabetes can occur and include diabetic ketoacidosis, hyperglycemic hyperosmolar state, and iatrogenic hypoglycemia. Recent advances in technology, including continuous glucose monitors, and availability of newer pharmacologic agents have improved quality of life for many patients with diabetes and have the potential to reduce the burden of the disease.