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Diabetes

Type 2 diabetes is a chronic condition resulting in elevated sugar levels in the blood. Frequently, the cause is insulin resistance. The disease is increasing in prevalence with an estimated 29 million Americans having the disease. However, approximately one third of diabetics have not been tested or diagnosed. In many cases the disease is asymptomatic however symptoms can include thirst, frequent urination and unintentional weight loss. Just because the disease is asymptomatic does not mean it is silent. Persistent elevations in blood sugar can have a profound effect on the body. Frequently, diabetic complications are separated into microvascular (small blood vessel) and macrovascular (large blood vessel) complications. Common examples of microvascular disease include characteristic diabetic eye and kidney damage. Amongst the most concerning macrovascular complications is cardiovascular disease. In fact, in many instances, diabetes is considered a coronary artery disease equivalent. Diagnosis relies on blood tests, either blood glucose level measurement or hemoglobin A1c measurement (a long term marker of blood glucose levels) as well as assessment for symptoms. Once diagnosed with diabetes, lifestyle modifications can have dramatic improvement in blood glucose levels. Certain diets and weight loss can reduce glucose levels. Many patients will require medications with common initial treatment regimens including metformin. There are newer treatment options available including agents such as exenatide and canagliflozin. Some patients will require insulin injections. Beyond reduction in blood sugar, assessment for risk of complications is very important for diabetics. Many diabetics will need foot and eye exams. They will also need monitoring for concurrent diseases such as heart disease.

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Reference:
Vijan S. In The Clinic: Type 2 Diabetes. Ann Intern Med. 2015 Mar 3; 162 (5)