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    • Patient: 52yo male, overweight with fatigue, blurred vision, and frequent nighttime urination.
    • Definition: Chronic metabolic disorder caused by insulin resistance and progressive pancreatic beta-cell dysfunction.1
    • Epidemiology: Affects over 10% of adults globally; drives a 2- to 4-fold increase in cardiovascular mortality.^1^,^2

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Diabetes Poster

A global health challenge

Risk Factors & Pathophysiology

    • Risk Factors: Obesity (BMI≥25), physical inactivity, family history, age ≥45.3
    • Pathophysiology: 1. Target tissues resist insulin action. 2. Liver overproduces glucose. 3. Pancreas fails to secrete enough compensatory insulin.4

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Diabetes Poster

A global health challenge

History & Physical Exam

    • History (BOLDCARTS): Gradual onset of constant, unquenchable thirst (polydipsia), increased appetite (polyphagia), and frequent urination (polyuria/nocturia).
    • Physical Exam: Acanthosis nigricans (dark, velvety skin plaques on neck/axillae), high blood pressure, and decreased sensation to foot microfilament tests.

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Labs, Imaging, & Diagnosis

    • Imaging: Not used for primary diagnosis; Doppler ultrasound is utilized for peripheral artery complications.
    • Labs: Hyperglycemia, dyslipidemia (high triglycerides, low HDL), and microalbuminuria (UACR≥30 mg/g).5
    • Diagnostic Criteria (ADA): Confirmed by any of the following:5
      • HbA1c≥6.5%
      • Fasting Plasma Glucose ≥126 mg/dL
      • 2-hour Oral Glucose Tolerance Test ≥200 mg/dL
      • Random Glucose ≥200 mg/dL with classic symptoms

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Diabetes Poster

A global health challenge

Management & Complications

    • Management: Weight loss (≥5–7%), exercise (150 min/wk), first-line Metformin, and secondary cardioprotective agents (GLP-1 receptor agonists or SGLT2 inhibitors).6
    • Complications: Retinopathy (blindness), nephropathy (kidney failure), neuropathy (ulcers/amputation), and myocardial infarction (heart attack).2
    • Likelihood Ratios (LR): Presence of Acanthosis nigricans yields a LR+ of ~3.1; active polyuria/polydipsia yields a LR+ of ~6.5 for predicting diabetes.7

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References:

    • World Health Organization. Global Report on Diabetes. Geneva: World Health Organization; 2024.
    • Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93-e621.
    • Kyrou I, Tsigos C, Mavrogianni C, et al. Changing lifestyles for the prevention and treatment of type 2 diabetes. Endotext. Updated January 15, 2025.
    • Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet. 2014;383(9922):1068-1083.
    • American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S13-S40.
    • American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S150-S168.
    • McGee S. Evidence-Based Physical Diagnosis. 5th ed. Philadelphia, PA: Elsevier; 2022.

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