Editors

HanneleYki-Järvinen

Newly Diagnosed Type 2 Diabetes

Essentials

A person with diabetes should understand the permanent nature and severity of the illness - the condition is more an arterial illness than an illness of the glucose metabolism. In addition to hyperglycaemia, identify and treat effectively all other risk factors of atherosclerosis (smoking, hypertension, dyslipidaemia).
Explain the importance of self-care to the patient. It is possible to get rid of diabetes completely. Emphasize the importance of weight reduction to overweight patients. However, other lifestyle modifications Lifestyle Education in Type 2 Diabetes will also form a part of the treatment, even when they do not lead to weight reduction (exercise, smoking cessation, avoidance of energy-dense carbohydrates and saturated fat in the diet). At the early stage it is good to tell that particularly a patient with overweight may through lifestyle changes achieve remission and hence need no medications Intensive Weight Management for Remission of Type 2 Diabetes Lifestyle Education in Type 2 Diabetes.

Investigations at diagnosis

Diagnosis: see Diabetes: Definition, Differential Diagnosis and Classification
History
- Note especially
  - lifestyle (physical exercise, alcohol, smoking, sweets, energy drinks, soft drinks containing sugar, saturated fat and salt, see Lifestyle Education in Type 2 Diabetes)
  - symptoms of coronary heart disease may already be present at the time of diagnosis
  - family history (type 1 or 2 diabetes, CHD, hypertension, obesity?).
    - Siblings have a 40% risk of developing type 2 diabetes - investigation of family members is recommended.
Clinical examination, especially the following:
- Weight, height, body mass index (program Bmi)
- Blood pressure
- Heart and large arteries: auscultation
- Peripheral arteries: palpation, Doppler examination if available (video Normal Pulse Sounds at Pen Doppler Examination)
- Feet (monofilament test: see Diabetic Neuropathy; temperature, interdigital spaces of the toes, wounds, calluses: see Treatment of the Diabetic Foot, suitable footwear)
- Visual acuity
- Examination of the ocular fundi by fundus photography
Laboratory investigations
- Fasting blood glucose
- HbA_1c
- Urine ketones (usually negative in type 2 diabetes)
- Plasma cholesterol, HDL cholesterol, triglycerides, LDL cholesterol (program Ldl)
- ALT, AST, platelet count, calculate liver fibrosis index (FIB-4 Index http://www.mdcalc.com/fibrosis-4-fib-4-index-liver-fibrosis, see Metabolic Dysfunction-Associated Steatotic Liver Disease (Masld) and Steatohepatitis (Mash))
- Plasma creatinine
- Urine albumin/creatinine ratio or overnight urine for albumin excretion (< 20 µg/min normal, 20-200 µg/min microalbuminuria, > 200 µg/min macroalbuminuria)
- ECG
- C-peptide and GAD antibody concentrations are not to be determined routinely; see Diabetes: Definition, Differential Diagnosis and Classification.

Principles of patient education

See Lifestyle education in type 2 diabetes Lifestyle Education in Type 2 Diabetes

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Editors

Newly Diagnosed Type 2 Diabetes

Essentials

Investigations at diagnosis

Principles of patient education

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