Diabetes mellitus type 2 physical examination
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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
- Patients with diabetes mellitus type 2 usually have normal physical examination findings unless complications develop in these patients.[1]
Appearance of the patient
Patients are usually well-appearing.
Vital signs
- High blood pressure with normal pulse pressure may be seen.
Skin
- Acanthosis nigricans is suggestive of insulin resistance.
- Diabetic dermopathy (DD), one of the skin findings of diabetes mellitus, appears as dull red papules which cause bilateral involvements on bony prominences. Nevertheless, involvement of pretibial region is the most common presentation, described as pigmented pretibial patches.[2]
- Skin thickening has been frequently seen on feet and hands. Skin appears waxy and edematous.[4]
- Xerosis
- Necrobiosis lipoidica (NL): Although, it is usually found after the time of diagnosis, still 14% to 24% of cases of NL may occur before or at the time of diagnosis.[5]
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- The following skin disorders are reported more frequently in diabetic patients: [7]
- Onychomycosis
- Tinea pedis
- Candidiasis
- Non-candidal intertrigo
- Eczema
- Psoriasis
HEENT
- Periorbital edema is a finding in patients with diabetic nephropathy.
Neck
- Carotid bruits may be auscultated unilaterally using the bell of the stethoscope, it is a sign suggestive of atherosclerosis.
Lungs
- Pulmonary examination of patients with Diabetes mellitus type 2 is usually normal.
Heart
- Normal findings unless complications occur which may lead to heart failure with preserved EF (HFpEF).
Abdomen
- Abdominal examination of patients with Diabetes Mellitus is usually normal.
Back
- Back examination of patients with Diabetes Mellitus is usually normal.
Genitourinary
- Genitourinary examination of patients with Diabetes Mellitus is usually normal.
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
- Signs of pretibial myxedema or ankle edema are findings in late diabetes.
References
- ↑ Inzucchi SE (2012). "Clinical practice. Diagnosis of diabetes". N. Engl. J. Med. 367 (6): 542–50. doi:10.1056/NEJMcp1103643. PMID 22873534.
- ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID 29465926.
- ↑ "Skin Manifestations of Diabetes Mellitus case courtesy by Jordan Rosen, BS".
- ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID 29465926.
- ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A; et al. (2000). "Endotext". PMID 29465926.
- ↑ "Skin Manifestations of Diabetes Mellitus case courtesy by Jordan Rosen, BS".
- ↑ 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.