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LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the incidence of diabetes mellitus (DM).

  2. Distinguish clinical differences in type 1, Latent Autoimmune Diabetes of Adulthood, type 2, and gestational diabetes.

  3. List screening and diagnostic criteria for DM.

  4. Discuss therapeutic goals for blood glucose (BG) and blood pressure (BP) for a patient with diabetes.

  5. Recommend nonpharmacologic therapies, including meal planning and physical activity, for patients with diabetes.

  6. Compare oral agents used in treating diabetes by their mechanisms of action, time of action, side effects, contraindications, and effectiveness.

  7. Select appropriate insulin therapy based on onset, peak, and duration of action.

  8. Discuss the signs, symptoms, and treatment of hypoglycemia.

  9. Define diabetic ketoacidosis and discuss treatment goals.

  10. Develop a comprehensive therapeutic monitoring plan for a patient with diabetes based on patient-specific factors.

INTRODUCTION

Diabetes mellitus (DM) describes a group of chronic metabolic disorders. Image not available. DM is characterized by hyperglycemia that may result in long-term microvascular and neuropathic complications. These complications contribute to DM being the leading cause of (a) new cases of blindness among adults, (b) end-stage renal disease, and (c) nontraumatic lower limb amputations. Macrovascular complications (coronary artery disease, peripheral vascular disease, and stroke) are also associated with DM.

EPIDEMIOLOGY

DM affects an estimated 30.3 million persons in the United States, or 9.4% of the population.1 Although an estimated 23.1 million persons have been diagnosed, another 7.2 million have DM but are unaware they have the disease.

DM is characterized by a complete lack of insulin, a relative lack of insulin, or insulin resistance as well as disorders of other hormones. These defects result in an inability to use glucose for energy. The increasing prevalence of DM is partly caused by three influences: lifestyle, ethnicity, and age.

Lifestyle

A sedentary lifestyle coupled with greater consumption of high-fat, high-carbohydrate foods, and larger portion sizes have resulted in increasing rates of obesity. Current estimates indicate that 36.5% of the US population is obese when obesity is defined as a body mass index (BMI) of greater than 30 kg/m2.2 Only 1 in 5 adults currently meet physical activity guidelines set forth by the Centers for Disease Control and Prevention (CDC) and persons living in the American South are less likely to be physically active than those living in other areas of the country.3

Ethnicity

Certain ethnic groups are at a disproportionately high risk for developing type 2 DM (T2DM). The prevalence of DM is 15.1% among American Indians/Alaska Natives, 12.7% among non-Hispanic blacks, and 12.1% among persons of Hispanic ethnicity; whereas, among non-Hispanic whites, the prevalence is only 7.4%.1 Socioeconomic status, when examined as a function of education level, also plays a role in the development of DM. The rate of DM ...

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