Prevention and Management of DM Complications

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Transcript Prevention and Management of DM Complications

Shadi Al-Ahmadi
The Presentation will include:
 Hypertension
 Dyslipidemia
 CVD
 Type 2 Diabetes-Associated Retinopathy
 Diabetic Periphral Neuropathy
 Diabetic Nephropathy
Hypertension
Facts:
 Seventy-three percent of adults with diabetes have
a blood pressure level of 130/80 mm Hg or higher, or
take prescription drugs to manage hypertension.
 Concomitant hypertension augments the effects of
hyperglycemia in microvascular complications.
Hypertension
 The target blood pressure level goal for individuals
with type 2 diabetes should be less than 130/80 mm
Hg .
 Pharmacologic treatment:
- ACE inhibitor.
- When second drug is needed:
- GFR > 50 Ml/min  thiazide diuretic
- GFR < 50 Ml/min  loop diuretic
Dyslipidemia
 We should attempt to lower the LDL cholestrol level
to less than 100 mg/dL.
 For patients with overt CVD and diabetes, an LDL
cholesterol level of less than 70 mg/dL is
recommended.
Dyslipidemia
 The triglyceride level goal should be less than 150
mg/dL.
 The HDL cholesterol level goal should be:
-
> 40 mg/dL for men.
> 50 mg/dL for women.
 The statins are the drug class of choice for Lowering
lipid levels in the management of type 2 diabetes.
Cardiovascular Disease
 55% of adult patients with diabetes have CVD
 Annual assessment of Cardiovascular risk factors is
recommended.
 In asymptomatic patients older than 40 years type 2
diabetes and another risk factor for coronary heart
disease, treatment using a statin and aspirin is
recommended.
Cardiovascular Disease
 Secondary prevention of CVD in patients with type 2
diabetes include:
- optimizing control of diabetes, hypertension, body
weight, and lipid levels.
- ACE inhibitor
- aspirin
- statin
- Beta blockers
Type 2 Diabetes-Associate
Retinopathy
 Diabetic retinopathy (DR) is a leading cause of vision
loss in adults ages 20 to 74 years.
 The prevalence is directly related to the length of lime
a patient has diabetes.
 The majority of patients with type 2 diabetes exhibit
some degree of DR within 20 years of diagnosis.
Type 2 Diabetes-Associate
Retinopathy
 Although retinopathy typically develops approximately
5 years after hyperglycemia begins, many patients
with type 2 diabetes with DR are undiagnosed for long
periods.
 The initial examination should be performed at the
time of diabetes diagnosis. with subsequent
examinations annually.
Type 2 Diabetes-Associate
Retinopathy
 Laser Phototherapy is a widely used therapy to manage
DR.
 It was found to decrease the risk of proliferative
DR-induced vision loss from 15.9% to 6.4% in patients
with diabetes.
Diabetic Periphral Neuropathy
 Neuropathies are some of the most common long-
term diabetic complications, with up to 47% of
patients developing peripheral neuropathy (DPN).
 Screening for peripheral neuropathy should be
performed when the diagnosis of type 2 diabetes is
made.
 Patients should be screened annually thereafter.
Diabetic Periphral Neuropathy
 Current guidelines recommend an annual
comprehensive foot screening that should include:
- inspection and assessment of pulses.
- assessment of protective sensation using
monofilament + one of the following:
* 128-Hz tuning fork
* ankle reflex testing.
* pinprick sensation rest.
Diabetic Periphral Neuropathy
Management:
 Patients with DPN should receive enhanced education
regarding root care and special footwear.
 Two drugs are FDA-approved to manage chronic pain
associated with DPN .
Diabetic Periphral Neuropathy
 Duloxetine (Cymbalta) is a ser0tonin norepinephrine
reuptake inhibitor.
60 to 120 mg PO OD
 Pregabalin (Lyrica) is an anticonvulsant.
100 mg PO TID
Diabetic Nephropathy
 Diabetes is a leading cause of ESRD.
 Albuminuria is the earliest indicator of diabetic
nephropathy.
 Microalbuminuria is diagnosed when levels of urinary
albumin exceed 30 mg/day or 20 mcg/min.
Diabetic Nephropathy
 20% to 40%0 of those with type 2 diabetes and
microaIbuminuria develop nephropathy.
 But only 20% progress to ESRD within 20 years.
 The urinary albumin level should be measured
starting at diagnosis and then annually in patients
with newly diagnosed type 2 diabetes.
Diabetic Nephropathy
 Medical treatment include:
- ACE Inhibitor
- thiazide or loop diuretic.
 Annual measurement of serum creatinine level to
assess renal function and stage of chronic kidney
disease is recommended.
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