00:01
Diabetes mellitus is the most common
diagnosis in my practice.
00:05
So, I feel like I know it really well and
I think I’ve got some good information to give you,
particularly regarding diagnosis and management.
00:13
So, let’s get underway.
00:15
So, I've got a patient who is six years old.
00:19
He's got hyperlipidemia and obesity.
00:21
A recent routine lab analysis found that
his serum glucose level was 146 mg/dL.
00:29
He’s asymptomatic at this time.
00:32
What’s the next best step in his care?
Should we talk about lifestyle changes and
recheck his glucose,
along with a hemoglobin A1c level
in the next several weeks?
Should we start metformin now or sulfonylurea
or dipeptidyl peptidase-4 inhibitor?
What do you think?
Given his lack of symptoms and that glucose level,
we are mandated to recheck his glucose level.
00:57
And I would check an A1c too
because, with his risk factors,
sounds like he probably has diabetes.
01:02
Of course, you’re going to advise
him on lifestyle changes now,
and so that makes sense.
01:06
He does not have -- meet the
formal criteria for diabetes
as of yet, but many people do.
01:14
Overall, there are now more
than 20 million Americans
with Type II diabetes and this number
is expected to more than double
within the next 20 years or so.
01:26
So, should we be screening for diabetes?
Well, this is what the United States Preventive
Services Task Force, or USPSTF, says.
01:34
Among adults aged 40 to 70 years, which is kind of
the sweet spot for identifying diabetes,
check for either glucose or A1c,
either one is a valid measure,
among patients who are obese
and among those with a family history of diabetes,
high risk racial or ethnic groups,
which include Latinos and African-Americans.
01:55
And if the patient has a history
of gestational diabetes
or polycystic ovary syndrome,
those patients get screened too.
02:01
Lots of people meet the screening criteria.
02:04
You can apply that fairly broadly across a population.