Outline its treatment.

I. Initial Assessment and Diagnosis Confirmation

Following suspicion based on symptoms (polyuria, polydipsia, unexplained weight loss) or screening, diagnosis is confirmed through:

• Fasting Plasma Glucose (FPG): ≥126 mg/dL
• 2-hour Plasma Glucose during Oral Glucose Tolerance Test (OGTT): ≥200 mg/dL
• HbA1c: ≥6.5%
• Random Plasma Glucose: ≥200 mg/dL with classic symptoms

Further investigations include a lipid profile, renal function tests (serum creatinine, eGFR), liver function tests, and a urine microalbumin/creatinine ratio to assess for existing complications.

II. Lifestyle Modifications – The Cornerstone of Treatment

Lifestyle interventions are the first line of treatment and remain crucial throughout the disease course.

• Dietary Management: A balanced diet emphasizing whole grains, fruits, vegetables, lean proteins, and healthy fats. Carbohydrate counting and portion control are essential. Referral to a registered dietitian is recommended.
• Physical Activity: At least 150 minutes of moderate-intensity aerobic exercise per week, spread over at least 3 days, with no more than 2 consecutive days without exercise. Resistance training should be incorporated at least twice a week.
• Weight Management: Achieving and maintaining a healthy weight (BMI <25 kg/m²) through diet and exercise. For individuals with obesity (BMI ≥30 kg/m²), a weight loss of 5-10% can significantly improve glycemic control.
• Smoking Cessation: Smoking exacerbates diabetes complications.
• Alcohol Consumption: Moderate alcohol consumption (if any) should be discussed with a healthcare provider.

III. Pharmacological Interventions

If lifestyle modifications are insufficient to achieve glycemic targets (HbA1c <7% for most patients), pharmacological therapy is initiated.

• Metformin: Typically the first-line drug, it reduces hepatic glucose production and improves insulin sensitivity.
• Sulfonylureas: Stimulate insulin secretion from the pancreas. Risk of hypoglycemia.
• Thiazolidinediones (TZDs): Improve insulin sensitivity. Potential side effects include weight gain and fluid retention.
• DPP-4 Inhibitors: Enhance incretin hormone activity, increasing insulin secretion and decreasing glucagon secretion.
• SGLT2 Inhibitors: Reduce glucose reabsorption in the kidneys, increasing urinary glucose excretion. Cardiovascular and renal benefits demonstrated in clinical trials.
• GLP-1 Receptor Agonists: Enhance incretin hormone activity, promoting insulin secretion, suppressing glucagon secretion, and slowing gastric emptying. Often associated with weight loss.
• Insulin: May be required if other agents are insufficient or contraindicated. Various insulin regimens are available (basal, bolus, premixed).

IV. Monitoring and Complication Management

Regular monitoring is essential to assess treatment effectiveness and detect complications early.

• HbA1c: Every 3-6 months.
• FPG/SMBG (Self-Monitoring of Blood Glucose): Frequency determined by treatment regimen and individual needs.
• Lipid Profile: Annually.
• Renal Function Tests: Annually.
• Urine Microalbumin/Creatinine Ratio: Annually.
• Foot Examination: Annually, with more frequent checks for high-risk individuals.
• Eye Examination: Annually.

Complication management involves addressing specific issues such as:

• Neuropathy: Pain management, foot care.
• Nephropathy: Blood pressure control, ACE inhibitors/ARBs, dietary protein restriction.
• Retinopathy: Laser photocoagulation, intravitreal injections.
• Cardiovascular Disease: Statins, antiplatelet therapy, blood pressure control.

V. Patient Education and Self-Management

Empowering patients with knowledge and skills to manage their condition is crucial. This includes education on:

• Self-monitoring of blood glucose
• Medication adherence
• Hypoglycemia recognition and treatment
• Foot care
• Sick day management