1 / 19

Prevention and Management of DM Complications

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:

raanan
Télécharger la présentation

Prevention and Management of DM Complications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prevention and Management of DM Complications Shadi Al-Ahmadi

  2. The Presentation will include: • Hypertension • Dyslipidemia • CVD • Type 2 Diabetes-Associated Retinopathy • Diabetic Periphral Neuropathy • Diabetic Nephropathy

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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 .

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. THANK YOU

More Related