1 / 89

DM2

DM2. Outpatient Glycemic Control. DM. Inpatient Glycemic control. Criteria for the Diagnosis of Diabetes. ADA. I. Classification and Diagnosis. Diabetes Care 2011;34(suppl 1):S13. Table 2. Components of the Comprehensive Diabetes Evaluation:.

thao
Télécharger la présentation

DM2

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. DM2 Outpatient Glycemic Control

  2. DM Inpatient Glycemic control

  3. Criteria for the Diagnosis of Diabetes ADA. I. Classification and Diagnosis. Diabetes Care 2011;34(suppl 1):S13. Table 2.

  4. Components of the Comprehensive Diabetes Evaluation: *See appropriate referrals for these categories. ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.

  5. Components of the Comprehensive Diabetes Evaluation: *See appropriate referrals for these categories. ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.

  6. Initial Metabolic Evaluation Referrales

  7. ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.

  8. ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.

  9. Target HbA1C A -B -C –D- E

  10. Correlation of A1C with Estimated Average Glucose (eAG) These estimates are based on ADAG data of ~2,700 glucose measurements over 3 months per A1C measurement in 507 adults with type 1, type 2, and no diabetes. The correlation between A1C and average glucose was 0.92. A calculator for converting A1C results into estimated average glucose (eAG), in either mg/dl or mmol/l, is available at http://professional.diabetes.org/GlucoseCalculator.aspx.

  11. Considering: Age Body weight GFR

  12. Outpatient Management: Bp control Lipid management Cigar discontinuous Glycemic control

  13. Early and aggressive insulin therapy: Reduces long-term vascular risk and potentially may prolong B-cell lifespan and Function. .

  14. initiating combination therapy or insulin immediately for all patients with A1C ≥9% at diagnosis.;

  15. Recent clinical treatment guidelines, suggest that these agents may be less effective as add-on therapy for patients with an A1C ≥ 9.5% and therefore recommend the initiation of insulin in all patients with an A1C > 10%.

  16. Indication for insulin therapy:

  17. ketosis-prone type 2 diabetes: At presentation, they have markedly impaired insulin secretion and insulin action, but aggressive management with insulin improves insulin secretion and action to levels similar to those of patients with type 2 diabetes without DKA.

  18. Recently, it has been reported that the nearnormoglycemic remission is associated with a greater recovery of basal and stimulated insulin secretion and that 10 years after diabetes onset, 40% of patients are still non-insulin dependent.

  19. Fasting C-peptide levels of >1.0 ng/dl (0.33 nmol/1) and stimulated C-peptide levels >1.5 ng/dl (0.5 nmol/1) are predictive of long-term normoglycemic remission in patients with a history of DKA.

  20. Barriers to insulin initiation and intensification: • The steps involved in insulin therapy: • Initiation • Optimisation • Intensification

  21. Patient barriers:

  22. Physician barriers: • Low motivation • Education barriers

More Related