| TYPE 2 DIABETES: DIAGNOSIS AND MANAGEMENT |
| Diagnostic criteria i |
|
Fasting plasma glucose mmol/L (mg/dl) ii |
Oral glucose tolerance test (OGTT) 2-h value mmol/L (mg/dl) iii |
| Diabetes |
≥ 7.0 (126) OR → |
≥ 11.1 (200) |
Impaired glucose
tolerance (IGT) |
< 7.0 (126) AND → |
7.8 – 11.0 (140 – 199) |
Impaired fasting
glucose (IFG) |
6.1 – 6.9
(110 – 125) AND → |
< 7.8 (140) |
|
| i |
As defined by WHO and International Diabetes Federation (2005) |
| ii |
An abnormal finding should be repeated before confirming the diagnosis. |
| iii |
Is recommended in patients with fasting blood glucose 6.1 – 6.9 mmol/L (110 – 125 mg/dL) as it may identify patients with overt diabetes. |
| Both IGT and IFG increase CV morbidity and mortality, and increase the risk of developing diabetes by 4-6 fold. These patients should be targeted for life style intervention, and their CV risk factors must be evaluated and treated. |
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INTERVENTIONS FOR TREATMENT OF DIABETES
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- some experts consider pioglitazone as first-line monotherapy for a lipoatrophic diabetic patient
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Management of patients with diabetes
Treatment goals: glucose control (HbA1c < 6.5-7.0% without hypoglycaemia, fasting plasma glucose 4-6 mmol/l (73-110 mg/dl));
Normal blood lipids and blood pressure < 130/80 mmHg (see p. 49 and p. 44).
Acetylsalisylic acid (75-150mg/d) considered in diabetics with elevated underlying CVD risk (see p. 42)
Nephropathy, polyneuropathy and retinopathy screening should be performed as in diabetic patients without HIV
Consultation with a specialist in diabetology is recommended.
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