920 likes | 1.27k Vues
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:.
E N D
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: *See appropriate referrals for these categories. ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.
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.
Initial Metabolic Evaluation Referrales
ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.
ADA. V. Diabetes Care. Diabetes Care 2011;34(suppl 1):S17. Table 8.
Target HbA1C A -B -C –D- E
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.
Considering: Age Body weight GFR
Outpatient Management: Bp control Lipid management Cigar discontinuous Glycemic control
Early and aggressive insulin therapy: Reduces long-term vascular risk and potentially may prolong B-cell lifespan and Function. .
initiating combination therapy or insulin immediately for all patients with A1C ≥9% at diagnosis.;
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%.
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.
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.
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.
Barriers to insulin initiation and intensification: • The steps involved in insulin therapy: • Initiation • Optimisation • Intensification
Physician barriers: • Low motivation • Education barriers