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Diabetes

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A brief presentation referencing 2013 ADA guidelines

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Diabetes

  1. 1. T2 DMREAL. DEADLY. NOT FUNNY.by Christine Hortillosa
  2. 2. 25.8 M 90% are with $174B Total Cost 7th Leading Cause Diabetics in US T2DM in 2007 of Death, 2007 FAST FACTSRef: 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. 3. • Clinical Presentation• Diagnosis• Monitoring• Treatment Options• Other Considerations – Immunization – Lifestyle Modification – Hypoglycemia Awareness OUTLINE
  4. 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. 5. 1. Fasting Plasma Glucose (FPG) ≥ 126 mg/dl. Fasting is defined as no caloric intake for at least 8 hours OR2. HbA1c ≥6.5% in a laboratory OR3. In patient with classic symptoms, random plasma glucose ≥ 200mg/dl OR4. Using an Oral Glucose Tolerance Test (OGTT), with a 75 gram glucose load, a 2 hour plasma glucose ≥ 200 mg/dl. DIAGNOSIS
  6. 6. Glycemic ADA AACE TargetA1c <7% ≤6.5%Preprandial 70-130 mg/dl <110 mg/dlPostprandial <180 mg/dl <140 mg/dl THERAPEUTIC GOALS
  7. 7. 1. Individualized glycemic targets and glucose lowering therapies2. Diet, education, and exercise3. Metformin: first-line drug4. After metformin, combination therapy5. If failed oral agents, insulin6. Involve the patient7. Comprehensive cardiovascular reduction TREATMENT OPTIONS
  8. 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. 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. 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. 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. 12. I AM BARACK OBAMA AND IAPPROVE THIS MESSAGE.
  13. 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 recurrenceHYPOGLYCEMIA AWARENESS
  14. 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 CARERef: 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. 15. 2030 || 552 MILLION Diabetics Worldwide Stop the Spr ead. How ‘bout tortilla? Watch the Br ead.
  16. 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

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