Type 2 Diabetes Mellitus

David M. Capuzzi, M.D., Ph.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Boas Gonen, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

The Planners of this activity have no relationships to disclose.

David M. Capuzzi, MD, PhD, is professor of medicine, biochemistry and molecular pharmacology at Jefferson Medical College, and director of cardiovascular disease prevention at Jefferson Heart Institute. Boas Gonen, MD, is visiting associate professor at the Medical College of Pennsylvania. Here, they define Type 2 diabetes mellitus, noting that it is the current term for what was once called noninsulin-dependent diabetes mellitus (NIDDM).

This lecture and the post-test is worth 1.5 credit hours.

The authors discuss the patient profile at diagnosis for Type 2 diabetes mellitus – over 40, overweight, and with a predisposition to heart disease – its epidemiology, especially prevalence in some ethnic groups, and its incidence related to obesity, diet, and sedentary lifestyle.

Because of the risk of such complications as retinopathy beginning at lower glucose level cut points, the American Diabetes Association revised its criteria for diagnosis of Type 2 diabetes mellitus. The disease is progressive, is one of lifestyle, and is characterized by abnormalities in glucose and lipid metabolism. The authors note the prevalence of hypertension in diabetes, and also discuss cardiovascular complications in diabetes that account for the vast majority of morbidity and 60-70% of its mortality. They cover retinopathy, nephropathy and neuropathy as microvascular complications, with the Diabetes Control and Complications Trial showing that glycemic control reduces those complications in Type 1 Diabetes ... a finding later corroborated for Type 2.

The authors list several of the risk factors for diabetic nephropathy, including microalbuminuria which is also an important predictor of cardiovascular disease. As with the other two microvascular complications, diabetic neuropathy is also related to degree of hyperglycemia.

Current therapy, say the authors, is a two-pronged attack on hyperglycemia and hyperlipidemia. This can involve one of four types of hypoglycemic agents. Where glycemic control becomes inadequate, insulin injections may become necessary.

The lecture concludes with a discussion of therapy for dyslipidemia and hypertension, with statins being the mainstay of treatment for the former; and thiazide diuretics for the latter. The authors stress the importance of patient education and empowerment ... and the involvement of such additional team members as ophthalmologists, podiatrists, and nutritionists in the therapeutic process.