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Content Update

July 21, 2023

Tirzepatide: a first-in-class medication to lower blood sugar and treat type 2 diabetes mellitus In 2022, the U.S. Food and Drug Administration (FDA) approved tirzepatide (Mounjaro), a novel glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonist, as an adjunct treatment with diet and exercise for patients with type 2 diabetes mellitus (T2DM). The SURPASS trials have demonstrated significant improvements with tirzepatide as compared to various antidiabetic treatment regimens for the primary outcome of reduced hemoglobin A1c (HbA1c). Additional studies, as a part of the SURPASS study program, are pending.

Content Update

May 23, 2022

Inclusion of Finerenone (Kerendia) in the 2022 American Diabetes Association Guidelines for Diabetes and Chronic Kidney Disease In 2021, the U.S. Food and Drug Administration (FDA) approved finerenone (Kerendia), a mineralocorticoid receptor antagonist (MRA), to reduce the risk of kidney disease progression, kidney failure, nonfatal heart attacks, cardiovascular death, and hospitalization for heart failure in adults with diabetic chronic kidney disease (CKD). The Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD) clinical trial demonstrated significant differences with finerenone compared to placebo in the primary composite outcome of kidney failure, decrease in estimated glomerular filtration rate (eGFR) and death from renal causes. The 2022 American Diabetes Association (ADA) guidelines now include finerenone as an option for patients with type 2 diabetes and CKD who cannot tolerate a sodium-glucose cotransporter-2 inhibitor (SGLT2i).



Upon completion of the chapter, the reader will be able to:

  1. Discuss the incidence of diabetes mellitus (DM).

  2. Distinguish clinical differences in type 1, Latent Autoimmune Diabetes of Adulthood, type 2, and gestational diabetes.

  3. List screening and diagnostic criteria for DM.

  4. Discuss therapeutic goals for blood glucose (BG) and blood pressure (BP) for a patient with diabetes.

  5. Recommend nonpharmacologic therapies, including meal planning and physical activity, for patients with diabetes.

  6. Compare oral agents used in treating diabetes by their mechanisms of action, time of action, side effects, contraindications, and effectiveness.

  7. Select appropriate insulin therapy based on onset, peak, and duration of action.

  8. Discuss the signs, symptoms, and treatment of hypoglycemia.

  9. Define diabetic ketoacidosis and discuss treatment goals.

  10. Develop a comprehensive therapeutic monitoring plan for a patient with diabetes based on patient-specific factors.


Diabetes mellitus (DM) describes a group of chronic metabolic disorders. image DM is characterized by hyperglycemia that may result in long-term microvascular and neuropathic complications that contribute to DM being the leading cause of (a) new cases of blindness among adults, (b) end-stage renal disease, and (c) nontraumatic lower limb amputations. Macrovascular complications (coronary artery disease, peripheral vascular disease, and stroke) are also associated with DM.


DM affects an estimated 34.2 million persons in the United States, or 10.5% of ...

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