Diagnosis, pathogenesis, and management of diabetes mellitus.

Proper care of the patient with diabetes mellitus poses a challenge for all health care professionals. The diagnosis is often established at the onset of symptoms. Early diagnosis through screening of patients at high risk allows prompt initiation of therapy and may help prevent long-term complications. The fasting plasma glucose determination is the most useful diagnostic test, but random plasma glucose and the oral glucose tolerance test are also used to diagnose diabetes, depending on the circumstances. Complex insulin programs and frequent self-monitoring of blood glucose are required to achieve acceptable glucose control in patients with insulin-dependent diabetes mellitus. Treatment of non-insulin-dependent diabetes mellitus requires a choice among diet, sulfonylureas, insulin, or a combination of these therapies. Achievement of treatment goals requires diet, monitoring, education, and continuing care in addition to medication. A general understanding of these goals may help the optometrist participate more effectively in the care of this challenging and important class of patients.