Diabetes mellitus type 2 physical examination

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]

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.

• Patients with diabetes mellitus type 2 usually have normal physical examination findings unless complications develop in these patients.^[1]

Patients are usually well-appearing.

• High blood pressure with normal pulse pressure may be seen.

• 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]

• The following skin disorders are reported more frequently in diabetic patients: ^[7]
  • Onychomycosis
  • Tinea pedis
  • Candidiasis
  • Non-candidal intertrigo
  • Eczema
  • Psoriasis
    

• Periorbital edema is a finding in patients with diabetic nephropathy.

• Carotid bruits may be auscultated unilaterally using the bell of the stethoscope, it is a sign suggestive of atherosclerosis.

• Pulmonary examination of patients with Diabetes mellitus type 2 is usually normal.

• Normal findings unless complications occur which may lead to heart failure with preserved EF (HFpEF).

• Abdominal examination of patients with Diabetes Mellitus is usually normal.

• Back examination of patients with Diabetes Mellitus is usually normal.

• Genitourinary examination of patients with Diabetes Mellitus is usually normal.

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

• Signs of pretibial myxedema or ankle edema are findings in late diabetes.