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Editors
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 DiabetesLifestyle 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:
- Laboratory investigations
- Fasting blood glucose
- HbA1c
- 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 Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH))
- 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