Diabetes mellitus

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This page contains general information about Diabetes mellitus. For more information on specific types, please visit the pages:

Diabetes mellitus Main page

Patient Information

Type 1
Type 2



Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes

Differential Diagnosis





Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]Mehrian Jafarizade, M.D [3]

Synonyms and keywords: Diabetes; DM


Diabetes mellitus (DM) refers to a spectrum of disorders with different metabolic changes that result in hyperglycemia as a common feature. It is caused by interaction of environmental agents in a genetically susceptible person. The metabolic disarrangement that may result in hyperglycemia will define the pathologic feature of each type of DM. Decreased insulin secretion, insulin resistance, decreased glucose utilization and increased glucose production are the main metabolic dysregulations that are known to cause hyperglycemia.

Hyperglycemia may cause secondary changes in metabolic arrangement in different systems and it can involve every organ systems. DM is the leading cause of end-stage renal disease (ESRD), non-traumatic lower extremity amputations, and adult blindness worldwide.

Accordingly, early diagnosis and treatment can result in significant decrease in mortality and morbidity. The incidence of diabetes has been increased constantly. According to WHO reports, 346 million people worldwide have diabetes and it is projected to double by 2030. It's prevalence is more in developed countries but the death occurring from DM complications is more common in developing countries.

The prevalence of diabetes type 2 is more common than type 1 diabetes. Diabetes can cause many complications. Acute complications (hypoglycemia, ketoacidosis or nonketotic hyperosmolar coma) may occur if the disease is not adequately controlled.[1] Serious long-term complications include macrovascular (coronary heart disease, peripheral arterial disease and cerebrovascular disease), microvascular (retinopathy, neuropathy and nephropathy) and other organ involvement (gastrointestinal, genitourinary, dermatologic, infectious, cataracts, glaucoma, periodontal disease and hearing loss). The main goals of treatment are:

  1. Elimination of hyperglycemic symptoms
  2. Control of the long term complications
  3. Improvement of the patient's quality of life


Differential diagnosis

Disease History and symptoms Laboratory findings Additional findings
Polyuria Polydipsia Polyphagia Weight loss Weight gain Serum glucose Urinary Glucose Urine PH Serum Sodium Urinary Glucose 24 hrs cortisol level C-peptide level Serum glucagon
Type 1 Diabetes mellitus + + + + - Normal Normal N/ Normal Normal Auto antibodies present

(Anti GAD-65 and anti insulin anti bodies)

Type 2 Diabetes mellitus + + + + - Normal Normal Normal Normal Acanthosis nigricans
MODY + + + - + Normal Normal Normal Normal N -
Psychogenic polydipsia + + - - - Normal Normal Normal Normal Normal Normal Normal -
Diabetes insipidus + + - - - Normal Normal Normal Normal Normal Normal Normal -
Transient hyperglycemia - - - - - Normal Normal Normal Normal N/ In hospitalized patients especially in ICU and CCU
Steroid therapy + - - - + Normal Normal N/ N/ Acanthosis nigricans,
RTA 1 - - - + - Normal Normal Normal Normal Normal Normal Hypokalemia, nephrolithiasis
Glucagonoma - - - - - Normal Normal Normal - Normal Normal Necrolytic migratory erythema
Cushing syndrome - - - - + - Normal N/ Normal Normal Moon face, obesity, buffalo hump, easy bruisibility


Acute complications

Chronic complications




Other organs[6]

  • For more information on maternal complications of gestational diabetes click here.
  • For more information on fetal complications of gestational diabetes click here.


Diabetes mellitus type 1 and type 2

American Diabetes Association Diabetes Diagnostic Criteria 2018 (DO NOT EDIT)

ADA evidence-grading system for “Standards of Medical Care in Diabetes”
Level of evidence Description
  • Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, including
    • Evidence from a well-conducted multi-center trial
    • Evidence from a meta-analysis that incorporated quality ratings in the analysis
  • Compelling non-experimental evidence, i.e., “all or none” rule developed by the Center for Evidence-Based Medicine at the University of Oxford.
  • Supportive evidence from well-conducted randomized controlled trials that are adequately powered, including
    • Evidence from a well-conducted trial at one or more institutions
    • Evidence from a meta-analysis that incorporated quality ratings in the analysis
  • Supportive evidence from poorly controlled or uncontrolled studies
  • Conflicting evidence with the weight of evidence supporting the recommendation
  • Supportive evidence from poorly controlled or uncontrolled studies
  • Conflicting evidence with the weight of evidence supporting the recommendation
E Expert consensus or clinical experience

†:Random is defined as without regard to time since the last meal.

‡:Fasting is defined as no caloric intake for at least 8 hours.

¶:The test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water, not recommended for routine clinical use.

American Diabetes Association Diabetes Diagnostic Criteria 2018 (DO NOT EDIT)[6]

Criteria for the diagnosis of diabetes
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours.
2-h Plasma Glucose (PG) ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described

by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.

A1C ≥6.5% (48 mmol/mol).
  • The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.
  • In the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing.
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

Gestational diabetes

  • There are 2 strategies to confirm the GDM diagnosis.

One Step Strategy

  • Perform a 75 g glucose tolerance test in 24-28 weeks of pregnancy and read the measures 1 h and 2 hours after glucose ingestion as well as fasting glucose.[7] The OGTT should be performed in the morning after an overnight fast of at least 8 hours. The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded:
    • Fasting: 92 mg/dL (5.1 mmol/L)
    • 1 hour: 180 mg/dL (10.0 mmol/L)
    • 2 hours: 153 mg/dL (8.5 mmol/L)

Two Step Strategy

  • In this approach, screening with a 1 hour 50-g glucose load test (GLT) followed by a 3 hours 100-g OGTT for those who screen positive.[8]
  • The diagnosis of GDM is made when at least 2 out of 4 measures of 3 hours 100-g OGTT became abnormal.
Cut off (mg/dl)
Fasting 1 Hour 2 Hours 3 Hours
One step test
2 hour 75 g glucose tolerance test
92 180 153 ----
Two step test
1 hour 50 g screening test
---- 140 ---- ----
3 hour 100 g test if screening test became positive
Carpenter/Coustan approach[9]
95 180 155 140
National Diabetes Data Group (NDDG) approach[10]
105 190 165 145


Diabetes mellitus type 1

  • According to the American Diabetic Association, screening for type 1 DM is not recommended.

Diabetes mellitus type 2

Categories of Increased Risk for Diabetes (Prediabetics) Recommendations:

Criteria for testing for diabetes or prediabetes in asymptomatic adults
1. Testing should be considered in overweight or obese (BMI 25 kg/m2 or 23 kg/m2 in Asian Americans) adults who have one or more of the following risk factors:
2. Patients with prediabetes (A1C > 5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly.
3. Women who were diagnosed with GDM should have lifelong testing at least every 3 years.
4. For all other patients, testing should begin at age 45 years.
5. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status.
Categories of increased risk for diabetes (prediabetes)
FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG)
2-h PG during 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)
A1C 5.7–6.4% (39–47 mmol/mol)

Gestational diabetes



  1. Pasquale LR, Kang JH, Manson JE, Willett WC, Rosner BA, Hankinson SE (2006). "Prospective study of type 2 diabetes mellitus and risk of primary open-angle glaucoma in women". Ophthalmology. 113 (7): 1081–6. doi:10.1016/j.ophtha.2006.01.066. PMID 16757028.
  2. Seshasai SR, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, Whincup PH, Mukamal KJ, Gillum RF, Holme I, Njølstad I, Fletcher A, Nilsson P, Lewington S, Collins R, Gudnason V, Thompson SG, Sattar N, Selvin E, Hu FB, Danesh J (2011). "Diabetes mellitus, fasting glucose, and risk of cause-specific death". N. Engl. J. Med. 364 (9): 829–41. doi:10.1056/NEJMoa1008862. PMC 4109980. PMID 21366474.
  3. Franco OH, Steyerberg EW, Hu FB, Mackenbach J, Nusselder W (2007). "Associations of diabetes mellitus with total life expectancy and life expectancy with and without cardiovascular disease". Arch. Intern. Med. 167 (11): 1145–51. doi:10.1001/archinte.167.11.1145. PMID 17563022.
  4. Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, Joss N, Leese G, Leslie P, McCrimmon RJ, Metcalfe W, McKnight JA, Morris AD, Pearson DW, Petrie JR, Philip S, Sattar NA, Traynor JP, Colhoun HM (2015). "Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010". JAMA. 313 (1): 37–44. doi:10.1001/jama.2014.16425. PMC 4426486. PMID 25562264.
  5. Nicolucci A (2008). "Aspirin for primary prevention of cardiovascular events in diabetes: still an open question". JAMA. 300 (18): 2180–1. doi:10.1001/jama.2008.625. PMID 18997199.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 "Standards of Medical Care in Diabetes-2017: Summary of Revisions". Diabetes Care. 40 (Suppl 1): S4–S5. 2017. doi:10.2337/dc17-S003. PMID 27979887.
  7. 7.0 7.1 "Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers". Clin Diabetes. 34 (1): 3–21. 2016. doi:10.2337/diaclin.34.1.3. PMID 26807004.
  8. "Professional Practice Committee for the Standards of Medical Care in Diabetes-2016". Diabetes Care. 39 Suppl 1: S107–8. 2016. doi:10.2337/dc16-S018. PMID 26696673.
  9. Carpenter MW, Coustan DR (1982). "Criteria for screening tests for gestational diabetes". Am. J. Obstet. Gynecol. 144 (7): 768–73. PMID 7148898.
  10. "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group". Diabetes. 28 (12): 1039–57. 1979. PMID 510803.
  11. Liu, Xiaoqian; Li, Changping; Gong, Hui; Cui, Zhuang; Fan, Linlin; Yu, Wenhua; Zhang, Cui; Ma, Jun (2013). "An economic evaluation for prevention of diabetes mellitus in a developing country: a modelling study". BMC Public Health. 13 (1). doi:10.1186/1471-2458-13-729. ISSN 1471-2458.
  12. "2. Classification and Diagnosis of Diabetes". Diabetes Care. 40 (Suppl 1): S11–S24. 2017. doi:10.2337/dc17-S005. PMID 27979889.
  13. "International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes". Diabetes Care. 32 (7): 1327–34. 2009. doi:10.2337/dc09-9033. PMC 2699715. PMID 19502545.
  14. Schellenberg ES, Dryden DM, Vandermeer B, Ha C, Korownyk C (2013). "Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis". Ann. Intern. Med. 159 (8): 543–51. doi:10.7326/0003-4819-159-8-201310150-00007. PMID 24126648.
  15. Perreault L, Pan Q, Mather KJ, Watson KE, Hamman RF, Kahn SE (2012). "Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study". Lancet. 379 (9833): 2243–51. doi:10.1016/S0140-6736(12)60525-X. PMC 3555407. PMID 22683134.
  16. "2. Classification and Diagnosis of Diabetes". Diabetes Care. 39 Suppl 1: S13–22. 2016. doi:10.2337/dc16-S005. PMID 26696675.
  17. Moyer VA (2014). "Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement". Ann. Intern. Med. 160 (6): 414–20. doi:10.7326/M13-2905. PMID 24424622.
  18. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet. 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085.
  19. Lindstrom, J. (2003). "Prevention of Diabetes Mellitus in Subjects with Impaired Glucose Tolerance in the Finnish Diabetes Prevention Study: Results From a Randomized Clinical Trial". Journal of the American Society of Nephrology. 14 (90002): 108S–113. doi:10.1097/01.ASN.0000070157.96264.13. ISSN 1046-6673.
  20. Tuomilehto, Jaakko; Lindström, Jaana; Eriksson, Johan G.; Valle, Timo T.; Hämäläinen, Helena; Ilanne-Parikka, Pirjo; Keinänen-Kiukaanniemi, Sirkka; Laakso, Mauri; Louheranta, Anne; Rastas, Merja; Salminen, Virpi; Aunola, Sirkka; Cepaitis, Zygimantas; Moltchanov, Vladislav; Hakumäki, Martti; Mannelin, Marjo; Martikkala, Vesa; Sundvall, Jouko; Uusitupa, Matti (2001). "Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance". New England Journal of Medicine. 344 (18): 1343–1350. doi:10.1056/NEJM200105033441801. ISSN 0028-4793.
  21. "Primary Prevention of Type 2 Diabetes Mellitus by Lifestyle Intervention: Implications for Health Policy". Annals of Internal Medicine. 140 (11): 951. 2004. doi:10.7326/0003-4819-140-11-200406010-00036. ISSN 0003-4819.
  22. Buse, John B.; Ginsberg, Henry N.; Bakris, George L.; Clark, Nathaniel G.; Costa, Fernando; Eckel, Robert; Fonseca, Vivian; Gerstein, Hertzel C.; Grundy, Scott; Nesto, Richard W.; Pignone, Michael P.; Plutzky, Jorge; Porte, Daniel; Redberg, Rita; Stitzel, Kimberly F.; Stone, Neil J. (2007). "Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus". Circulation. 115 (1): 114–126. doi:10.1161/CIRCULATIONAHA.106.179294. ISSN 0009-7322.
  23. Cezaretto, Adriana; Siqueira-Catania, Antonela; de Barros, Camila Risso; Salvador, Emanuel Péricles; Ferreira, Sandra Roberta G. (2011). "Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus". Quality of Life Research. 21 (1): 105–113. doi:10.1007/s11136-011-9919-2. ISSN 0962-9343.
  24. "Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus". New England Journal of Medicine. 379 (16): 1529–1539. 2018. doi:10.1056/NEJMoa1804988. ISSN 0028-4793.
  25. Chiasson, Jean-Louis; Josse, Robert G; Gomis, Ramon; Hanefeld, Markolf; Karasik, Avraham; Laakso, Markku (2002). "Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial". The Lancet. 359 (9323): 2072–2077. doi:10.1016/S0140-6736(02)08905-5. ISSN 0140-6736.