Diabetes mellitus type 2 physical examination: Difference between revisions

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{{Diabetes mellitus type 2}}
{{Diabetes mellitus type 2}}
{{CMG}};{{AE}}{{MehdiP}}
{{CMG}};{{AE}}{{MehdiP}}{{Anahita}}
==Overview==
==Overview==
Usually patients with diabetes mellitus type 2 have normal physical examination findings unless complications develop in these patients. Common physical examination findings include, pigmented skin patches and [[acanthosis nigricans]].
Patients with [[diabetes mellitus type 2]] often have normal physical examination findings unless [[Complication (medicine)|complications]] develop in these patients. Common physical examination findings include pigmented skin patches and [[acanthosis nigricans]].
==Physical examination==
==Physical examination==
Usually patients with diabetes mellitus type 2 have normal physical examination findings unless complications develop in these patients.<ref name="pmid22873534">{{cite journal |vauthors=Inzucchi SE |title=Clinical practice. Diagnosis of diabetes |journal=N. Engl. J. Med. |volume=367 |issue=6 |pages=542–50 |year=2012 |pmid=22873534 |doi=10.1056/NEJMcp1103643 |url=}}</ref>
 
* Patients with [[diabetes mellitus type 2]] usually have normal physical examination findings unless [[Complication (medicine)|complications]] develop in these patients.<ref name="pmid22873534">{{cite journal |vauthors=Inzucchi SE |title=Clinical practice. Diagnosis of diabetes |journal=N. Engl. J. Med. |volume=367 |issue=6 |pages=542–50 |year=2012 |pmid=22873534 |doi=10.1056/NEJMcp1103643 |url=}}</ref>
===Appearance of the patient===
===Appearance of the patient===
Patients are usually well-appearing.
Patients are usually well-appearing.
===Vital signs===
===Vital signs===
[[Hypertension|High blood pressure]] with normal pulse pressure may be find.
 
* [[Hypertension|High blood pressure]] with normal [[pulse pressure]] may be seen.
===Skin===
===Skin===
*[[Pigmented lesions|Pigmented]] pretibial patches is seen in half of diabetic patients and it is associated to microangiopathic complications.
*[[Acanthosis nigricans]] is suggestive of [[insulin resistance]].
*[[Acanthosis nigricans]], is a sign for [[insulin resistance]].
*Diabetic dermopathy (DD), one of the skin findings of [[diabetes mellitus]], appears as dull red [[Papule|papules]] which cause bilateral involvements on bony prominences. Nevertheless, involvement of pretibial region is the most common presentation, described as [[Pigmented lesions|pigmented]] pretibial patches.<ref name="pmid294659263">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=29465926 | doi= | pmc= | url= }}</ref>
 
[[File:Diabetic Dermopathy.jpg|alt=Diabetic Dermopathy (DD)|center|thumb|530x530px|Diabetic Dermopathy (DD)<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/books/NBK481900/|title=Skin Manifestations of Diabetes Mellitus case courtesy by Jordan Rosen, BS|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> which is appeared as pretibial patches]]
<br />
 
*Skin thickening has been frequently seen on feet and hands. Skin appears waxy and [[Edema|edematous]].<ref name="pmid294659262">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=29465926 | doi= | pmc= | url= }}</ref>
*[[Xerosis]]
*[[Necrobiosis lipoidica]] ([[Necrobiosis lipoidica|NL]]): Although, it is usually found after the time of [[diagnosis]], still 14% to 24% of cases of [[Necrobiosis lipoidica|NL]] may occur before or at the time of [[diagnosis]].<ref name="pmid29465926">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=29465926 | doi= | pmc= | url= }}</ref>
 
[[File:Necrobiosis lipoidica (NL).jpg|center|thumb|573x573px|[[Necrobiosis lipoidica]] ([[Necrobiosis lipoidica|NL]]) <ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/books/NBK481900/|title=Skin Manifestations of Diabetes Mellitus case courtesy by Jordan Rosen, BS|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
 
* The following skin disorders are reported more frequently in diabetic patients: <ref name="de MacedoNunes2016">{{cite journal|last1=de Macedo|first1=Geisa Maria Campos|last2=Nunes|first2=Samanta|last3=Barreto|first3=Tania|title=Skin disorders in diabetes mellitus: an epidemiology and physiopathology review|journal=Diabetology & Metabolic Syndrome|volume=8|issue=1|year=2016|issn=1758-5996|doi=10.1186/s13098-016-0176-y}}</ref>
** [[Onychomycosis]]
** [[Athlete's foot|Tinea pedis]]
** [[Candidiasis]]
** Non-candidal [[intertrigo]]
** [[Eczema]]  
** [[Psoriasis]] <br />
===HEENT===
===HEENT===
[[Periorbital edema]] is a finding in patients with [[diabetic nephropathy]].
 
* [[Periorbital edema]] is a finding in patients with [[diabetic nephropathy]].
===Neck===
===Neck===
[[Carotid bruits]] may be auscultated unilaterally using the bell of the stethoscope is a sign in patients with [[atherosclerosis]].
 
* [[Carotid bruits]] may be auscultated unilaterally using the bell of the [[stethoscope]], it is a sign suggestive of [[atherosclerosis]].
===Lungs===
===Lungs===
Normal [[auscultation]].
 
* Pulmonary examination of patients with [[Diabetes mellitus type 2]] is usually normal.
===Heart===
===Heart===
Normal findings unless complications occur which may lead to [[heart failure with preserved EF]] (HFpEF).
 
* Normal findings unless [[Complication (medicine)|complications]] occur which may lead to [[heart failure with preserved EF]] ([[Heart failure with preserved ejection fraction|HFpEF]]).
===Abdomen===
===Abdomen===
Normal physical examination findings.
 
===Extremities===
* Abdominal examination of patients with [[Diabetes mellitus|Diabetes Mellitus]] is usually normal.
Signs of [[pretibial myxedema]] or [[ankle edema]] are findings in late diabetes.
 
=== Back ===
 
* Back examination of patients with [[Diabetes mellitus|Diabetes Mellitus]] is usually normal.
 
=== Genitourinary ===
 
* Genitourinary examination of patients with [[Diabetes mellitus|Diabetes Mellitus]] is usually normal.
 
===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
 
*The patient is usually oriented in person, place, and time.
*Bilateral [[sensory loss]] in the upper and lower extremities may develop as [[neuropathy]] progresses.
*Bilateral [[sensory loss]] in the upper and lower extremities may develop as [[neuropathy]] progresses.
===Extremities===
* Signs of [[pretibial myxedema]] or [[ankle edema]] are findings in late [[diabetes]].
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]

Latest revision as of 22:03, 10 September 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]Anahita Deylamsalehi, M.D.[3]

Overview

Patients with diabetes mellitus type 2 often have normal physical examination findings unless complications develop in these patients. Common physical examination findings include pigmented skin patches and acanthosis nigricans.

Physical examination

Appearance of the patient

Patients are usually well-appearing.

Vital signs

Skin

Diabetic Dermopathy (DD)
Diabetic Dermopathy (DD)[3] which is appeared as pretibial patches


Necrobiosis lipoidica (NL) [6]

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

  • The patient is usually oriented in person, place, and time.
  • Bilateral sensory loss in the upper and lower extremities may develop as neuropathy progresses.

Extremities

References

  1. ↑ Inzucchi SE (2012). "Clinical practice. Diagnosis of diabetes". N. Engl. J. Med. 367 (6): 542–50. doi:10.1056/NEJMcp1103643. PMID 22873534.
  2. ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID 29465926.
  3. ↑ "Skin Manifestations of Diabetes Mellitus case courtesy by Jordan Rosen, BS".
  4. ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID 29465926.
  5. ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID 29465926.
  6. ↑ "Skin Manifestations of Diabetes Mellitus case courtesy by Jordan Rosen, BS".
  7. ↑ de Macedo, Geisa Maria Campos; Nunes, Samanta; Barreto, Tania (2016). "Skin disorders in diabetes mellitus: an epidemiology and physiopathology review". Diabetology & Metabolic Syndrome. 8 (1). doi:10.1186/s13098-016-0176-y. ISSN 1758-5996.
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