From the Guidelines
The next step in managing a patient with suspected diabetes mellitus is to perform a complete medical evaluation at the initial visit to confirm the diagnosis, classify diabetes, and evaluate for complications and comorbid conditions. This evaluation should include a thorough medical history, physical examination, and laboratory tests such as fasting plasma glucose, oral glucose tolerance test, or hemoglobin A1C to confirm the diagnosis 1.
Initial Evaluation and Management
The initial evaluation should also assess for potential comorbid conditions and complications, and begin patient engagement in the formulation of a care management plan 1. Lifestyle modifications, including dietary changes, regular physical activity, and weight management if appropriate, should be initiated. Medication therapy, typically starting with metformin, may be added if lifestyle efforts alone do not achieve glycemic goals 1.
Ongoing Management
Ongoing management should be guided by the assessment of diabetes complications and shared decision-making to set therapeutic goals 1. This includes regular follow-up visits to assess interval medical history, medication-taking behavior, physical examination, laboratory evaluation, and risk for complications. Patient education on blood glucose monitoring, recognition of hypoglycemia and hyperglycemia, and self-management strategies is crucial 1.
Screening for Complications
Concurrent screening for complications should be performed, including comprehensive eye examination, foot examination, lipid panel, kidney function tests, and urine albumin-to-creatinine ratio. The 10-year risk of a first atherosclerotic cardiovascular disease event should also be assessed using the race- and sex-specific Pooled Cohort Equations to better stratify atherosclerotic cardiovascular disease risk 1.
Key Considerations
Key considerations in the management of diabetes mellitus include maintaining glycemic control, addressing associated cardiovascular risk factors, and providing patient-centered care through shared decision-making and education 1. By following this approach, the risk of diabetes-related complications can be significantly reduced, and quality of life can be improved.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION There is no fixed dosage regimen for the management of diabetes mellitus with glipizide or any other hypoglycemic agent. In addition to the usual monitoring of urinary glucose, the patient's blood glucose must also be monitored periodically to determine the minimum effective dose for the patient; to detect primary failure, i.e., inadequate lowering of blood glucose at the maximum recommended dose of medication; and to detect secondary failure, i.e., loss of an adequate blood-glucose-lowering response after an initial period of effectiveness.
The next step in managing a patient with suspected diabetes mellitus is to monitor the patient's blood glucose periodically to determine the minimum effective dose.
- The patient's blood glucose should be monitored to detect primary failure or secondary failure.
- Glycosylated hemoglobin levels may also be of value in monitoring the patient's response to therapy 2. The initial dose of glipizide is 5 mg, given before breakfast.
- Dosage adjustments should ordinarily be in increments of 2.5–5 mg, as determined by blood glucose response.
- At least several days should elapse between titration steps.
From the Research
Next Steps in Managing a Patient with Suspected Diabetes Mellitus
The management of a patient with suspected diabetes mellitus involves several key steps, including diagnosis, assessment of glycemic control, and initiation of appropriate therapy.
- Diagnosis: The diagnosis of diabetes mellitus is typically made based on the presence of symptoms such as polyuria, polydipsia, and unexplained weight loss, in addition to elevated blood glucose levels 3.
- Assessment of Glycemic Control: Glycemic control can be assessed using various measures, including fasting plasma glucose (FPG) levels, hemoglobin A1c (HbA1c) levels, and postprandial glucose (PPG) levels 4.
- Initiation of Therapy: The choice of therapy for a patient with diabetes mellitus depends on various factors, including the severity of the disease, the presence of comorbidities, and the patient's lifestyle and preferences.
Treatment Options
Several treatment options are available for managing diabetes mellitus, including lifestyle modifications, oral medications, and insulin therapy.
- Lifestyle Modifications: Lifestyle modifications, such as diet and exercise, are an essential component of diabetes management and can help improve glycemic control and reduce the risk of complications 5.
- Oral Medications: Oral medications, such as metformin and sulfonylureas, can help improve glycemic control by increasing insulin sensitivity, reducing glucose production in the liver, and stimulating insulin secretion 6, 7.
- Insulin Therapy: Insulin therapy may be necessary for patients with more severe disease or those who are unable to achieve adequate glycemic control with oral medications alone 5.
Monitoring and Follow-up
Regular monitoring and follow-up are essential for managing diabetes mellitus and preventing complications.
- Regular Blood Glucose Monitoring: Regular blood glucose monitoring can help patients and healthcare providers assess glycemic control and make adjustments to therapy as needed 3, 4.
- Regular Follow-up Appointments: Regular follow-up appointments with a healthcare provider can help patients receive ongoing education and support, as well as monitoring for complications and adjustment of therapy as needed 5, 7.