Investigating for diabetes

The prevalence of diabetes mellitus is increasing in Australia, with approximately 1.7 million people affected. It is predicted that by the year 2025, up to 3 million Australians over the age of 25 years will have diabetes, and a significant proportion will remain undiagnosed. Both type 1 and type 2 diabetes are associated with increased microvascular and macrovascular disease, disability and premature mortality.

Diabetes mellitus is classified into different types according to aetiology (Box1). Type 1 diabetes is usually caused by autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency. Type 2 diabetes is the most common type of diabetes in adults and is characterised by a combination of different degrees of insulin deficiency and resistance. Hyperglycaemia is often detected through routine blood tests. If it is mild, the classic symptoms of polyuria, polydipsia and weight loss may not be present. The following case vignettes summarise the approach to the diagnosis and management of diabetes.

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