Twenty million Americans have type 2 diabetes mellitus. Approximately 1.5 million new cases are diagnosed per year. The number of cases of diabetes is projected to nearly double by the year 2050.
Diabetes should be suspected in patients with polyuria, polydipsia, and unexplained weight loss and in those with evidence of possible diabetes complications (retinopathy, neuropathy, impotence, renal dysfunction, acanthosis nigricans, or frequent infections). The American Diabetes Association recommends fasting plasma glucose as the criterion for diagnosis. A fasting plasma glucose level that is 126 mg/dl or greater and is confirmed after repeated testing on another day confirms a diagnosis of diabetes. A fasting plasma glucose of 100 to 125 mg/dl suggests prediabetes. An elevated glycosylated hemoglobin (HgA1C) is not diagnostic of diabetes.
The goals of glycemic control are to reduce long-term microvascular and neuropathic complications. Interestingly, the most appropriate target levels for daily blood glucose and HgA1C have not been systematically studied but are based on “practicality” and projected reduction in complications over time. The glycemic goal most recently recommended by the American Diabetes Association is “in general” a HgA1C level < 7%. For “the individual patient”, the HgA1C should be “as close to normal (<6%) as possible without significant hypoglycemia.”[1]
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