From the Guidelines
To evaluate for secondary causes of diabetes, a comprehensive medical evaluation should be performed, including a thorough medical history and physical examination, as well as laboratory tests and screenings for endocrine disorders, as recommended by the 2023 standards of care in diabetes 1.
Key Components of Evaluation
- A thorough medical history, including symptoms, medication use, family history, and previous treatment, is essential to identify potential secondary causes of diabetes.
- A physical examination should include measurements of height, weight, blood pressure, and assessment of signs of diseases that can cause secondary diabetes, such as hemochromatosis or pancreatic disease 1.
- Laboratory tests, including fasting plasma glucose, hemoglobin A1c, C-peptide levels, and autoantibody testing, can help confirm the diagnosis and classify diabetes.
- Screenings for endocrine disorders, such as cortisol, thyroid function, and growth hormone, should be performed to identify potential underlying causes of diabetes.
Additional Considerations
- Medication review is crucial, as certain medications, such as glucocorticoids, antipsychotics, and immunosuppressants, can cause hyperglycemia.
- Genetic testing may be appropriate for patients with early-onset diabetes, strong family history, or atypical presentation.
- Pancreatic imaging with CT or MRI may be considered if pancreatic disease is suspected.
- A comprehensive medical evaluation should also include an assessment of overall health status, evaluation of diabetes complications, and development of a care management plan, as outlined in the 2023 standards of care in diabetes 1.
Importance of Early Identification
- Identifying secondary causes of diabetes is important, as treating the underlying cause may improve or resolve hyperglycemia, and standard diabetes treatments may be less effective without addressing the primary condition.
- A thorough medical history and physical examination, combined with laboratory tests and screenings, can help identify potential secondary causes of diabetes and guide treatment decisions, as recommended by the American Diabetes Association 1.
From the Research
Evaluating Secondary Causes of Diabetes
To evaluate for secondary causes of diabetes, several factors need to be considered:
- Physical examination findings that may indicate the presence of secondary causes, such as Cushing's syndrome or acromegaly 2
- Presence of counterregulatory hormones that can induce insulin resistance and glucose metabolism disorders, such as those found in Cushing's syndrome, acromegaly, and neuroendocrine tumors 3
- History of exposure to glucocorticoid excess, which can lead to insulin resistance and impaired insulin secretion 4
Identifying Predictive Factors
Predictive factors for requiring antihyperglycemic medication during treatment of secondary causes of diabetes include:
- Increasing baseline glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) 5
- History of diabetes or pre-diabetes 5
- Age, with younger patients being less likely to require antihyperglycemic medication 5
Management of Secondary Causes of Diabetes
Management of secondary causes of diabetes involves:
- Treatment of the underlying condition, such as Cushing's syndrome or acromegaly 3, 4
- Correction of glucocorticoid excess, which may not always resolve abnormalities of glucose homeostasis 4, 6
- Use of antihyperglycemic medications, such as metformin or insulin, to control hyperglycemia 3, 5
- Consideration of the effects of emerging drugs, such as pasireotide, on glucose homeostasis 5, 6