A brief presentation referencing 2013 ADA guidelines

1. T2
DM
REAL. DEADLY. NOT FUNNY.
by Christine Hortillosa

2. 25.8 M 90% are with $174B Total Cost 7th Leading Cause
Diabetics in US T2DM in 2007 of Death, 2007
FAST FACTS
Ref: Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. 2011. CDC.

3. • Clinical Presentation
• Diagnosis
• Monitoring
• Treatment Options
• Other Considerations
– Immunization
– Lifestyle Modification
– Hypoglycemia Awareness
OUTLINE

4. • Hallmark symptoms
1. Polyuria
2. Polydipsia
3. Polyphagia
• Criteria for testing for DM in asymptomatic adults
1. Overweight (BMI ≥ 25) and have at least one of the
following:
• Physical inactivity
• 1st-degree relative with DM
• High-risk race
• Women delivering a baby >9 lbs
• Hypertension
• Women with PCOS
• History of CVD
• HDL < 35 and/or TG >250 mg/dl
1. If did not meet first criteria, start at age 45 yo
2. If results are normal, test Q3 years
CLINICAL PRESENTATION

5. 1. Fasting Plasma Glucose (FPG) ≥ 126
mg/dl. Fasting is defined as no caloric
intake for at least 8 hours OR
2. HbA1c ≥6.5% in a laboratory OR
3. In patient with classic symptoms, random
plasma glucose ≥ 200mg/dl OR
4. Using an Oral Glucose Tolerance Test
(OGTT), with a 75 gram glucose load, a 2
hour plasma glucose ≥ 200 mg/dl.
DIAGNOSIS

6. Glycemic ADA AACE
Target
A1c <7% ≤6.5%
Preprandial 70-130 mg/dl <110 mg/dl
Postprandial <180 mg/dl <140 mg/dl
THERAPEUTIC GOALS

7. 1. Individualized glycemic targets and glucose lowering
therapies
2. Diet, education, and exercise
3. Metformin: first-line drug
4. After metformin, combination therapy
5. If failed oral agents, insulin
6. Involve the patient
7. Comprehensive cardiovascular reduction
TREATMENT OPTIONS

8. • Diabetes Complications:
– Macrovascular (i.e. CVD)
– Microvascular (retinopathy, nephropathy, neuropathy)
• CVD Risk Factors:
– Hypertension
– Dyslipidemia
• ADA Recommendations
– Routine BP monitoring (new goal: 140/80)
– Annual lipid screening
• Goals: LDL <100, TG <150, HDL >40 (men), HDL >50
(women)
– Aspirin as 1o prevention for select patients
OTHER CONSIDERATIONS

9. • ADA Recommendations cont.
– Dilated eye exam upon diagnosis and annually after
– Screen for increased urinary albumin excretion
yearly
– Screen for diabetic peripheral neuropathy starting at
diagnosis and yearly after
OTHER CONSIDERATIONS

10. • Annual influenza vaccine (> 6 months of age)
• PPV (> 2yo and then after 64 yo with 5 years
between 2 vaccination)
• Hepatitis B (19- 59 yo)
• Others: Tetanus and Pertussis
IMMUNIZATION

11. • Medical nutrition therapy
• Moderate weight loss (7% body weight)
• Limit alcoholic drinks (1/day for women,
2/day for men)
• Moderate intensity aerobic exercise 50
min/day x 3 days a week
• Smoking cessation
LIFESTYLE MODIFICATION

12. I AM BARACK OBAMA AND I
APPROVE THIS MESSAGE.

13. • Hypoglycemia can cause falls, MVA, and other
injuries
• Preferred treatment:
– 15 to 20 g of glucose then
– BG check after 15 minutes
– Consume a meal to prevent recurrence
HYPOGLYCEMIA AWARENESS

14. • Impact on Diabetes Management:
Complication targeted Intervention Risk Reduction
Microvascular Glucose control 40%
Amputations Comprehensive foot care exams 45%-85%
Vision Loss Laser screening for eye disease 50%-60%
Loss of kidney function HTN screening + treatment 30%-70%
Proteinuria HTN screening + treatment 35%
CV disease HTN screening + treatment 33%-50%
PREVENTIVE CARE
Ref: Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. 2011. CDC.

15. 2030 || 552 MILLION
Diabetics Worldwide
Stop the Spr ead. How ‘bout
tortilla?
Watch the Br ead.

16. 1. Centers for Disease Control and Prevention.
National diabetes fact sheet: national
estimates and general information on diabetes
and prediabetes in the United States. 2011.
CDC.
2. American Diabetes Association. Standards of
medical care in diabetes 2013. Diabetes Care
2013; 36(Suppl1); S11-S66.
3. Hilaire ML. Woods TM. Type 2 Diabetes: A
focus on new guidelines. Formulary 48: 55-
67, 2013.
REFERENCES