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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:.

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DM2

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  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

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