Diabetes Mellitus: Pathophysiology, Diagnosis, Screening, and Risk Factors

By Lee, Jiehyun; Dang, Devra K. | Drug Topics, September 2012 | Go to article overview
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Diabetes Mellitus: Pathophysiology, Diagnosis, Screening, and Risk Factors


Lee, Jiehyun, Dang, Devra K., Drug Topics


Abstract

Diabetes is one of the most common medical conditions worldwide and exerts a tremendous impact on both the healthcare system and the individual patient. Uncontrolled hyperglycemia can result in both short-term and long-term complications that affect virtually every major organ system in the body. This article summarizes the pathophysiology and diagnosis of type 1 and type 2 diabetes and the risk factors and screening for type 2 diabetes in adults. A synopsis of the diagnosis and treatment of pre-diabetes as well as a brief review of acute hyperglycemic crises is also provided. This overview provides the foundation for future articles on more specific topics in this diabetes series.

Medication Therapy Management (MTM) in Patients with Diabetes CPE Series

Welcome to a new Medication Therapy Management (MTM) in Patients with Diabetes CPE Series, which has been designed for pharmacists who take care of patients with diabetes. Beginning this month and continuing through March 2013, pharmacists can earn up to 14 hours of CPE credit with 7 monthly knowledge-based activities from the University of Connecticut School of Pharmacy and Drug Topics. This month, the professional development activity will cover the pathophysiology, diagnosis, screening, and risk factors associated with diabetes mellitus. In October 2012, pharmacists will learn about medical nutrition therapy, physical activity, and health maintenance considerations for diabetic patients. In November and December 2012, the activities will focus on therapeutic considerations, including oral and injectable agents for diabetes care and management. In January 2013, the CPE article will cover macrovascular and microvascular complications of diabetes, and in February 2013, the focus will be psychosocial considerations in the management of the disease. In March 2013, the last knowledge-based activity will enable greater understanding of drug-induced hyper- and hypoglycemia, nonprescription medications, and complementary and alternative medicine for diabetes care.

The MTM CPE Series will also be offering application-based and practicebased activities for an additional 9 CPE credits. Online interactive case-based studies will be available with 1 hour of CPE credit, starting in February 2013 and continuing through April 2013. The MTM CPE Series will conclude with a live meeting at the University of Connecticut School of Pharmacy in May 2013, offering application of MTM concepts to the patient with diabetes and motivational interviewing skills development for health behavior change in diabetes management.

Diabetes mellitus is one of the most common medical conditions globally. The number of people with diabetes is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity.' According to the World Health Organization, this diabetes epidemic is expected to continue to increase even if the prevalence of obesity remains stable.' In the United States approximately 26 million persons, or 8-3% of the population, are affected by diabetes and it is the 7th leading cause of death.2 Understanding the risk factors as well as the underlying pathophysiologic mechanisms of diabetes can lead to appropriate screening, diagnosis, and management.

Pathophysiology

Diabetes mellitus describes a group of metabolic disorders characterized by hyperglycemia due to impaired glucose homeostasis. The main types of diabetes are type 1, in which there is absolute insulin deficiency, and type 2, characterized primarily by both relative insulin deficiency and insulin resistance. Type 1 and type 2 diabetes account for over 95% of all patients with diabetes. Many other types of diabetes exist, including gestational diabetes mellitus, diabetes from endocrinopathies (e.g., Cushing syndrome), and drug-induced diabetes.3 The focus of this article is on type 1 and type 2 diabetes.

Type 1 diabetes

The etiology of type 1 diabetes is autoimmune in more than 95% of cases and idiopathic in the remaining cases, with both resulting in absolute insulin deficiency.

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