Prevention and Management of DM Complications
description
Transcript of Prevention and Management of DM Complications
![Page 1: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/1.jpg)
Shadi Al-Ahmadi
![Page 2: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/2.jpg)
The Presentation will include:HypertensionDyslipidemiaCVDType 2 Diabetes-Associated RetinopathyDiabetic Periphral NeuropathyDiabetic Nephropathy
![Page 3: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/3.jpg)
HypertensionFacts: 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.
![Page 4: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/4.jpg)
HypertensionThe 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
![Page 5: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/5.jpg)
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.
![Page 6: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/6.jpg)
DyslipidemiaThe 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.
![Page 7: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/7.jpg)
Cardiovascular Disease55% of adult patients with diabetes have CVDAnnual 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.
![Page 8: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/8.jpg)
Cardiovascular DiseaseSecondary 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
![Page 9: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/9.jpg)
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.
![Page 10: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/10.jpg)
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.
![Page 11: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/11.jpg)
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.
![Page 12: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/12.jpg)
Diabetic Periphral NeuropathyNeuropathies 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.
![Page 13: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/13.jpg)
Diabetic Periphral NeuropathyCurrent 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.
![Page 14: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/14.jpg)
Diabetic Periphral NeuropathyManagement: 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 .
![Page 15: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/15.jpg)
Diabetic Periphral Neuropathy
Duloxetine (Cymbalta) is a ser0tonin norepinephrine reuptake inhibitor.
60 to 120 mg PO OD
Pregabalin (Lyrica) is an anti convulsant. 100 mg PO TID
![Page 16: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/16.jpg)
Diabetic NephropathyDiabetes 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.
![Page 17: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/17.jpg)
Diabetic Nephropathy20% 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.
![Page 18: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/18.jpg)
Diabetic NephropathyMedical 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.
![Page 19: Prevention and Management of DM Complications](https://reader035.fdocuments.us/reader035/viewer/2022062410/568159f3550346895dc73f25/html5/thumbnails/19.jpg)
THANK YOU