Integrated Multidisciplinary Management of Diabetes Mellitus: Roles of Internal Medicine, Hematology, Nursing, Dental Care, Optometry, Health Informatics, Hospital Management, and Social Work
Abstract
Background: Diabetes Mellitus (DM) is a pervasive global metabolic disorder characterized by chronic hyperglycemia, resulting from defects in insulin secretion, action, or both. With Type 2 Diabetes (T2DM) constituting 90% of cases and its prevalence rising sharply, DM represents a major public health burden and the seventh leading cause of mortality. The disease's complexity and its associated microvascular and macrovascular complications necessitate a comprehensive management strategy.
Aim: This article synthesizes the essential components for the effective, multidisciplinary management of diabetes, emphasizing a holistic approach that extends beyond glycemic control to prevent long-term complications and improve patient quality of life.
Methods: The approach integrates patient education, lifestyle modification (diet and exercise), and pharmacologic therapy. Treatment is tailored to the diabetes subtype: insulin is essential for Type 1 Diabetes (T1DM), while management of T2DM progresses from metformin and lifestyle changes to other oral agents, GLP-1 receptor agonists, SGLT2 inhibitors, and potentially insulin. A coordinated interprofessional team—including physicians, nurses, diabetes educators, nutritionists, pharmacists, and various specialists—is crucial for providing comprehensive care, from diagnosis to complication screening.
Results: Effective management achieves glycemic targets (e.g., HbA1c <7%) and significantly reduces the risk of devastating complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Landmark trials (LEADER, EMPA-REG OUTCOME) confirm that newer agents offer cardiovascular and renal protection. Individualized patient education is proven to enhance outcomes more effectively than generic interventions.
Conclusion: Optimal diabetes care requires a sustained, patient-centered, and collaborative model that addresses the full spectrum of the disease, from pathophysiology to prevention of complications.
Full text article
References
Rajaei E, Jalali MT, Shahrabi S, Asnafi AA, Pezeshki SMS. HLAs in Autoimmune Diseases: Dependable Diagnostic Biomarkers? Current rheumatology reviews. 2019:15(4):269-276. doi: 10.2174/1573397115666190115143226.
Klein BE, Klein R, Moss SE, Cruickshanks KJ. Parental history of diabetes in a population-based study. Diabetes care. 1996 Aug:19(8):827-30
Barnett AH, Eff C, Leslie RD, Pyke DA. Diabetes in identical twins. A study of 200 pairs. Diabetologia. 1981 Feb:20(2):87-93
Diabetes Genetics Initiative of Broad Institute of Harvard and MIT, Lund University, and Novartis Institutes of BioMedical Research, Saxena R, Voight BF, Lyssenko V, Burtt NP, de Bakker PI, Chen H, Roix JJ, Kathiresan S, Hirschhorn JN, Daly MJ, Hughes TE, Groop L, Altshuler D, Almgren P, Florez JC, Meyer J, Ardlie K, Bengtsson Boström K, Isomaa B, Lettre G, Lindblad U, Lyon HN, Melander O, Newton-Cheh C, Nilsson P, Orho-Melander M, Råstam L, Speliotes EK, Taskinen MR, Tuomi T, Guiducci C, Berglund A, Carlson J, Gianniny L, Hackett R, Hall L, Holmkvist J, Laurila E, Sjögren M, Sterner M, Surti A, Svensson M, Svensson M, Tewhey R, Blumenstiel B, Parkin M, Defelice M, Barry R, Brodeur W, Camarata J, Chia N, Fava M, Gibbons J, Handsaker B, Healy C, Nguyen K, Gates C, Sougnez C, Gage D, Nizzari M, Gabriel SB, Chirn GW, Ma Q, Parikh H, Richardson D, Ricke D, Purcell S. Genome-wide association analysis identifies loci for type 2 diabetes and triglyceride levels. Science (New York, N.Y.). 2007 Jun 1:316(5829):1331-6
Sladek R, Rocheleau G, Rung J, Dina C, Shen L, Serre D, Boutin P, Vincent D, Belisle A, Hadjadj S, Balkau B, Heude B, Charpentier G, Hudson TJ, Montpetit A, Pshezhetsky AV, Prentki M, Posner BI, Balding DJ, Meyre D, Polychronakos C, Froguel P. A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature. 2007 Feb 22:445(7130):881-5
Yasuda K, Miyake K, Horikawa Y, Hara K, Osawa H, Furuta H, Hirota Y, Mori H, Jonsson A, Sato Y, Yamagata K, Hinokio Y, Wang HY, Tanahashi T, Nakamura N, Oka Y, Iwasaki N, Iwamoto Y, Yamada Y, Seino Y, Maegawa H, Kashiwagi A, Takeda J, Maeda E, Shin HD, Cho YM, Park KS, Lee HK, Ng MC, Ma RC, So WY, Chan JC, Lyssenko V, Tuomi T, Nilsson P, Groop L, Kamatani N, Sekine A, Nakamura Y, Yamamoto K, Yoshida T, Tokunaga K, Itakura M, Makino H, Nanjo K, Kadowaki T, Kasuga M. Variants in KCNQ1 are associated with susceptibility to type 2 diabetes mellitus. Nature genetics. 2008 Sep:40(9):1092-7. doi: 10.1038/ng.207.
Zeggini E, Scott LJ, Saxena R, Voight BF, Marchini JL, Hu T, de Bakker PI, Abecasis GR, Almgren P, Andersen G, Ardlie K, Boström KB, Bergman RN, Bonnycastle LL, Borch-Johnsen K, Burtt NP, Chen H, Chines PS, Daly MJ, Deodhar P, Ding CJ, Doney AS, Duren WL, Elliott KS, Erdos MR, Frayling TM, Freathy RM, Gianniny L, Grallert H, Grarup N, Groves CJ, Guiducci C, Hansen T, Herder C, Hitman GA, Hughes TE, Isomaa B, Jackson AU, Jørgensen T, Kong A, Kubalanza K, Kuruvilla FG, Kuusisto J, Langenberg C, Lango H, Lauritzen T, Li Y, Lindgren CM, Lyssenko V, Marvelle AF, Meisinger C, Midthjell K, Mohlke KL, Morken MA, Morris AD, Narisu N, Nilsson P, Owen KR, Palmer CN, Payne F, Perry JR, Pettersen E, Platou C, Prokopenko I, Qi L, Qin L, Rayner NW, Rees M, Roix JJ, Sandbaek A, Shields B, Sjögren M, Steinthorsdottir V, Stringham HM, Swift AJ, Thorleifsson G, Thorsteinsdottir U, Timpson NJ, Tuomi T, Tuomilehto J, Walker M, Watanabe RM, Weedon MN, Willer CJ, Wellcome Trust Case Control Consortium, Illig T, Hveem K, Hu FB, Laakso M, Stefansson K, Pedersen O, Wareham NJ, Barroso I, Hattersley AT, Collins FS, Groop L, McCarthy MI, Boehnke M, Altshuler D. Meta-analysis of genome-wide association data and large-scale replication identifies additional susceptibility loci for type 2 diabetes. Nature genetics. 2008 May:40(5):638-45. doi: 10.1038/ng.120.
Fajans SS, Bell GI, Polonsky KS. Molecular mechanisms and clinical pathophysiology of maturity-onset diabetes of the young. The New England journal of medicine. 2001 Sep 27:345(13):971-80
Shields BM, Hicks S, Shepherd MH, Colclough K, Hattersley AT, Ellard S. Maturity-onset diabetes of the young (MODY): how many cases are we missing? Diabetologia. 2010 Dec:53(12):2504-8. doi: 10.1007/s00125-010-1799-4.
Kühl C. Etiology and pathogenesis of gestational diabetes. Diabetes care. 1998 Aug:21 Suppl 2():B19-26
Felner EI, Klitz W, Ham M, Lazaro AM, Stastny P, Dupont B, White PC. Genetic interaction among three genomic regions creates distinct contributions to early- and late-onset type 1 diabetes mellitus. Pediatric diabetes. 2005 Dec:6(4):213-20
Writing Group for the SEARCH for Diabetes in Youth Study Group, Dabelea D, Bell RA, D'Agostino RB Jr, Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B. Incidence of diabetes in youth in the United States. JAMA. 2007 Jun 27:297(24):2716-24
Gale EA, Gillespie KM. Diabetes and gender. Diabetologia. 2001 Jan:44(1):3-15
Mamoulakis D, Galanakis E, Bicouvarakis S, Paraskakis E, Sbyrakis S. Epidemiology of childhood type I diabetes in Crete, 1990-2001. Acta paediatrica (Oslo, Norway : 1992). 2003 Jun:92(6):737-9
Tuomilehto J. The emerging global epidemic of type 1 diabetes. Current diabetes reports. 2013 Dec:13(6):795-804. doi: 10.1007/s11892-013-0433-5.
Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G, EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet (London, England). 2009 Jun 13:373(9680):2027-33. doi: 10.1016/S0140-6736(09)60568-7.
Vehik K, Hamman RF, Lezotte D, Norris JM, Klingensmith G, Bloch C, Rewers M, Dabelea D. Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth. Diabetes care. 2007 Mar:30(3):503-9
Rush T, McGeary M, Sicignano N, Buryk MA. A plateau in new onset type 1 diabetes: Incidence of pediatric diabetes in the United States Military Health System. Pediatric diabetes. 2018 Aug:19(5):917-922. doi: 10.1111/pedi.12659.
Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature reviews. Endocrinology. 2018 Feb:14(2):88-98. doi: 10.1038/nrendo.2017.151.
Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes care. 1998 Apr:21(4):518-24
Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Annals of internal medicine. 1996 Aug 1:125(3):221
Schulz LO, Bennett PH, Ravussin E, Kidd JR, Kidd KK, Esparza J, Valencia ME. Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the U.S. Diabetes care. 2006 Aug:29(8):1866-71
Unger RH, Orci L. Paracrinology of islets and the paracrinopathy of diabetes. Proceedings of the National Academy of Sciences of the United States of America. 2010 Sep 14:107(37):16009-12. doi: 10.1073/pnas.1006639107.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2010 Jan:33 Suppl 1(Suppl 1):S62-9. doi: 10.2337/dc10-S062.
American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes care. 2012 Jan:35 Suppl 1(Suppl 1):S11-63. doi: 10.2337/dc12-s011.
Selph S, Dana T, Bougatsos C, Blazina I, Patel H, Chou R. Screening for Abnormal Glucose and Type 2 Diabetes Mellitus: A Systematic Review to Update the 2008 U.S. Preventive Services Task Force Recommendation. 2015 Apr
Karagiannis T, Bekiari E, Manolopoulos K, Paletas K, Tsapas A. Gestational diabetes mellitus: why screen and how to diagnose. Hippokratia. 2010 Jul:14(3):151-4
Umpierre D, Ribeiro PA, Kramer CK, Leitão CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011 May 4:305(17):1790-9. doi: 10.1001/jama.2011.576.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine. 2002 Feb 7:346(6):393-403
de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, Rossing P, Zoungas S, Bakris G. Diabetes and Hypertension: A Position Statement by the American Diabetes
American Diabetes Association. Aspirin therapy in diabetes. Diabetes care. 2000 Jan:23 Suppl 1():S61-2
Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, Jinnouchi H, Sugiyama S, Saito Y, Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008 Nov 12:300(18):2134-41. doi: 10.1001/jama.2008.623.
Saito Y, Morimoto T, Ogawa H, Nakayama M, Uemura S, Doi N, Jinnouchi H, Waki M, Soejima H, Sugiyama S, Okada S, Akai Y, Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes Trial Investigators. Low-dose aspirin therapy in patients with type 2 diabetes and reduced glomerular filtration rate: subanalysis from the JPAD trial. Diabetes care. 2011 Feb:34(2):280-5. doi: 10.2337/dc10-1615.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. The New England journal of medicine. 2008 Oct 9:359(15):1577-89. doi: 10.1056/NEJMoa0806470.
Zeller M, Danchin N, Simon D, Vahanian A, Lorgis L, Cottin Y, Berland J, Gueret P, Wyart P, Deturck R, Tabone X, Machecourt J, Leclercq F, Drouet E, Mulak G, Bataille V, Cambou JP, Ferrieres J, Simon T, French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction investigators. Impact of type of preadmission sulfonylureas on mortality and cardiovascular outcomes in diabetic patients with acute myocardial infarction. The Journal of clinical endocrinology and metabolism. 2010 Nov:95(11):4993-5002. doi: 10.1210/jc.2010-0449.
Chang CS, Tsai PJ, Sung JM, Chen JY, Ho LC, Pandya K, Maeda N, Tsai YS. Diuretics prevent thiazolidinedione-induced cardiac hypertrophy without compromising insulin-sensitizing effects in mice. The American journal of pathology. 2014 Feb:184(2):442-53. doi: 10.1016/j.ajpath.2013.10.020.
Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2009 Jan 6:180(1):32-9. doi: 10.1503/cmaj.080486.
Willemen MJ, Mantel-Teeuwisse AK, Straus SM, Meyboom RH, Egberts TC, Leufkens HG. Use of dipeptidyl peptidase-4 inhibitors and the reporting of infections: a disproportionality analysis in the World Health Organization VigiBase. Diabetes care. 2011 Feb:34(2):369-74. doi: 10.2337/dc10-1771.
Aschner P, Katzeff HL, Guo H, Sunga S, Williams-Herman D, Kaufman KD, Goldstein BJ, Sitagliptin Study 049 Group. Efficacy and safety of monotherapy of sitagliptin compared with metformin in patients with type 2 diabetes. Diabetes, obesity & metabolism. 2010 Mar:12(3):252-61. doi: 10.1111/j.1463-1326.2009.01187.x.
Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital Infections with Sodium Glucose Cotransporter-2 Inhibitors: Occurrence and Management in Patients with Type 2 Diabetes Mellitus. Indian journal of endocrinology and metabolism. 2018 Nov-Dec:22(6):837-842. doi: 10.4103/ijem.IJEM_159_17.
Heron M. Deaths: Leading Causes for 2015. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2017 Nov:66(5):1-76
Albers JW, Herman WH, Pop-Busui R, Feldman EL, Martin CL, Cleary PA, Waberski BH, Lachin JM, Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications Research Group. Effect of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. Diabetes care. 2010 May:33(5):1090-6. doi: 10.2337/dc09-1941.
. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet (London, England). 1998 Sep 12:352(9131):837-53
Perreault L, Pan Q, Mather KJ, Watson KE, Hamman RF, Kahn SE, Diabetes Prevention Program Research Group. Effect of regression from prediabetes to normal glucose regulation on long-term reduction in diabetes risk: results from the Diabetes Prevention Program Outcomes Study. Lancet (London, England). 2012 Jun 16:379(9833):2243-51. doi: 10.1016/S0140-6736(12)60525-X.
Yamazaki D, Hitomi H, Nishiyama A. Hypertension with diabetes mellitus complications. Hypertension research : official journal of the Japanese Society of Hypertension. 2018 Mar:41(3):147-156. doi: 10.1038/s41440-017-0008-y.
Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Archives of internal medicine. 2011 Mar 14:171(5):404-10. doi: 10.1001/archinternmed.2011.2.
Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, Whincup PH, Mukamal KJ, Gillum RF, Holme I, Njølstad I, Fletcher A, Nilsson P, Lewington S, Collins R, Gudnason V, Thompson SG, Sattar N, Selvin E, Hu FB, Danesh J, Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. The New England journal of medicine. 2011 Mar 3:364(9):829-841. doi: 10.1056/NEJMoa1008862.
Stern MP. Do non-insulin-dependent diabetes mellitus and cardiovascular disease share common antecedents? Annals of internal medicine. 1996 Jan 1:124(1 Pt 2):110-6
Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiological reviews. 2013 Jan:93(1):137-88. doi: 10.1152/physrev.00045.2011.
Tseng CH. Diabetes and risk of bladder cancer: a study using the National Health Insurance database in Taiwan. Diabetologia. 2011 Aug:54(8):2009-15. doi: 10.1007/s00125-011-2171-z.
Yin M, Zhou J, Gorak EJ, Quddus F. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. The oncologist. 2013:18(12):1248-55. doi: 10.1634/theoncologist.2013-0111.
Murphy HR, Steel SA, Roland JM, Morris D, Ball V, Campbell PJ, Temple RC, East Anglia Study Group for Improving Pregnancy Outcomes in Women with Diabetes (EASIPOD). Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabetic medicine : a journal of the British Diabetic Association. 2011 Sep:28(9):1060-7. doi: 10.1111/j.1464-5491.2011.03333.x.
Martínez E, Portillo N, Lizarralde E, Grau G, Vela A, Rodríguez A, Rica I. For Debate: Paediatric T1DM: DKA is Still a Problem. Pediatric endocrinology reviews : PER. 2018 Dec:16(2):233-239. doi: 10.17458/per.vol16.2018.mpr.fd.t1dmdka.
Karslioglu French E, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ (Clinical research ed.). 2019 May 29:365():l1114. doi: 10.1136/bmj.l1114.
Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, Hanson A, Lavin-Tompkins J, Glasrud P, Davis H, Adams K, Parsons W, Spain CV. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Archives of internal medicine. 2011 Dec 12:171(22):2001-10. doi: 10.1001/archinternmed.2011.507.
Wang TJ, Larson MG, Vasan RS, Cheng S, Rhee EP, McCabe E, Lewis GD, Fox CS, Jacques PF, Fernandez C, O'Donnell CJ, Carr SA, Mootha VK, Florez JC, Souza A, Melander O, Clish CB, Gerszten RE. Metabolite profiles and the risk of developing diabetes. Nature medicine. 2011 Apr:17(4):448-53. doi: 10.1038/nm.2307.
Lent-Schochet D, Silva R, McLaughlin M, Huet B, Jialal I. Changes to trimethylamine-N-oxide and its precursors in nascent metabolic syndrome. Hormone molecular biology and clinical investigation. 2018 Apr 18:35(2):. pii: /j/hmbci.2018.35.issue-2/hmbci-2018-0015/hmbci-2018-0015.xml. doi: 10.1515/hmbci-2018-0015.
Reddy P, Leong J, Jialal I. Amino acid levels in nascent metabolic syndrome: A contributor to the pro-inflammatory burden. Journal of diabetes and its complications. 2018 May:32(5):465-469. doi: 10.1016/j.jdiacomp.2018.02.005.
Shim K, Gulhar R, Jialal I. Exploratory metabolomics of nascent metabolic syndrome. Journal of diabetes and its complications. 2019 Mar:33(3):212-216. doi: 10.1016/j.jdiacomp.2018.12.002
Ramakrishanan N, Denna T, Devaraj S, Adams-Huet B, Jialal I. Exploratory lipidomics in patients with nascent Metabolic Syndrome. Journal of diabetes and its complications. 2018 Aug:32(8):791-794. doi: 10.1016/j.jdiacomp.2018.05.014.
Authors
Copyright (c) 2025 Hussain Mohammed Hussain Alwabari, Noura Ahmad Jaber Almalki, Hanady Fahad Ayed Alhumaidani, Ibrahim Ahmed Khabrani, Ahed Fallah Jadaan Al Dhafiri, Abrar Ali Khormi, Mohammed Saad Alhelal, Norah Mesfer Alqahtani, Mohammed Hameed Alhelali, Abdulaziz Jaad Saqr Al Osaimi
This work is licensed under a Creative Commons Attribution 4.0 International License.