This document provides guidelines for the prevention, diagnosis, and management of diabetes and cardiovascular diseases. It addresses topics such as how diabetes is screened and diagnosed, how prediabetes is managed, glycemic treatment goals for diabetes, and how conditions like hypertension, dyslipidemia, and obesity are managed in patients with diabetes. The document also discusses management of diabetes in specific populations and contexts, such as in pregnancy, in children and adolescents, and in the hospital. It provides recommendations on monitoring blood glucose levels, using insulin therapy, and establishing a comprehensive diabetes care team.
This document provides guidelines and recommendations for the diagnosis, screening, and management of diabetes and prediabetes. It addresses criteria for diagnosing types of diabetes, recommendations for screening for prediabetes and types of diabetes, goals of nutrition therapy to manage blood glucose levels, and recommendations regarding hypoglycemia. The guidelines recommend individualized nutrition management, medical nutritional therapy, and insulin therapy when needed to help patients achieve targeted blood glucose, blood pressure, and lipid levels.
This document provides guidelines for screening, diagnosing, and managing diabetes and its complications. It recommends:
- Screening everyone over 40 every 3 years for diabetes using HbA1c, fasting plasma glucose, or oral glucose tolerance tests. Screen more often for those at high risk.
- Targeting an HbA1c of less than 7% for most patients. Consider a target of 7.1-8.5% for those with comorbidities or risk of hypoglycemia.
- Treating diabetes with lifestyle changes like nutrition therapy and exercise. If needed, add metformin and/or additional medications based on individual factors.
- Prescribing statins, ACE inhibitors or ARBs, and
The document summarizes recommendations from the 2016 American Diabetes Association guidelines. It provides criteria for diagnosing diabetes and prediabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance test results. It recommends screening for type 2 diabetes in asymptomatic adults aged 45 or older who are overweight or have additional risk factors, as well as screening children who are overweight and have certain risk factors. Guidelines for screening gestational diabetes and type 1 diabetes are also presented.
1) Adopting healthy lifestyle behaviors like following a nutritious diet low in saturated fat and high in fiber, engaging in regular exercise, managing stress, and avoiding tobacco can significantly reduce risk of cardiovascular disease.
2) Studies have shown that diets high in fruits and vegetables, whole grains, nuts and fish and adherence to a Mediterranean diet are associated with lower risk of heart disease deaths.
3) Engaging in at least 30 minutes of moderate physical activity daily and maintaining a healthy weight through a balanced calorie intake can lower blood pressure and risk of heart disease.
This document outlines ways to prevent diabetes, including maintaining a healthy diet and exercising regularly. It notes that a healthy lifestyle can help manage diabetes by lowering blood sugar and promoting weight loss. The document also emphasizes the importance of diabetes education to make informed lifestyle choices and properly manage the condition.
This document discusses a study on metabolic syndrome among young adults in Mumbai, India. The study aims to identify risk factors for metabolic syndrome such as family history, lifestyle habits, nutrition status and dietary patterns. Anthropometric measurements were taken for 200 participants aged 18-24 years old from various areas in Mumbai. Questionnaires assessed physical activity, lifestyle and dietary intake. Results found higher prevalence of obesity in participants with a family history of diseases. Obese participants consumed more non-vegetarian diets and were less physically active. Significant factors for metabolic syndrome risk among young adults in Mumbai were identified.
Here are my recommendations for the cases:
Case 1:
- Start metformin 1000mg bid along with lifestyle modification focusing on weight loss through diet and exercise
- Add DPP4i or SGLT2i as second agent if target not achieved in 3 months
- Refer to dietician and encourage weight loss through calorie restriction
- Start statin and advise to control other risk factors like smoking
Case 2:
- Switch from SU to DPP4i or SGLT2i to reduce risk of hypoglycemia
- Add GLP1RA if target not achieved to address obesity and heart failure
- Monitor kidney function and adjust doses based on eGFR
- Emphasize lifestyle changes
This document provides guidelines and recommendations for the diagnosis, screening, and management of diabetes and prediabetes. It addresses criteria for diagnosing types of diabetes, recommendations for screening for prediabetes and types of diabetes, goals of nutrition therapy to manage blood glucose levels, and recommendations regarding hypoglycemia. The guidelines recommend individualized nutrition management, medical nutritional therapy, and insulin therapy when needed to help patients achieve targeted blood glucose, blood pressure, and lipid levels.
This document provides guidelines for screening, diagnosing, and managing diabetes and its complications. It recommends:
- Screening everyone over 40 every 3 years for diabetes using HbA1c, fasting plasma glucose, or oral glucose tolerance tests. Screen more often for those at high risk.
- Targeting an HbA1c of less than 7% for most patients. Consider a target of 7.1-8.5% for those with comorbidities or risk of hypoglycemia.
- Treating diabetes with lifestyle changes like nutrition therapy and exercise. If needed, add metformin and/or additional medications based on individual factors.
- Prescribing statins, ACE inhibitors or ARBs, and
The document summarizes recommendations from the 2016 American Diabetes Association guidelines. It provides criteria for diagnosing diabetes and prediabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance test results. It recommends screening for type 2 diabetes in asymptomatic adults aged 45 or older who are overweight or have additional risk factors, as well as screening children who are overweight and have certain risk factors. Guidelines for screening gestational diabetes and type 1 diabetes are also presented.
1) Adopting healthy lifestyle behaviors like following a nutritious diet low in saturated fat and high in fiber, engaging in regular exercise, managing stress, and avoiding tobacco can significantly reduce risk of cardiovascular disease.
2) Studies have shown that diets high in fruits and vegetables, whole grains, nuts and fish and adherence to a Mediterranean diet are associated with lower risk of heart disease deaths.
3) Engaging in at least 30 minutes of moderate physical activity daily and maintaining a healthy weight through a balanced calorie intake can lower blood pressure and risk of heart disease.
This document outlines ways to prevent diabetes, including maintaining a healthy diet and exercising regularly. It notes that a healthy lifestyle can help manage diabetes by lowering blood sugar and promoting weight loss. The document also emphasizes the importance of diabetes education to make informed lifestyle choices and properly manage the condition.
This document discusses a study on metabolic syndrome among young adults in Mumbai, India. The study aims to identify risk factors for metabolic syndrome such as family history, lifestyle habits, nutrition status and dietary patterns. Anthropometric measurements were taken for 200 participants aged 18-24 years old from various areas in Mumbai. Questionnaires assessed physical activity, lifestyle and dietary intake. Results found higher prevalence of obesity in participants with a family history of diseases. Obese participants consumed more non-vegetarian diets and were less physically active. Significant factors for metabolic syndrome risk among young adults in Mumbai were identified.
Here are my recommendations for the cases:
Case 1:
- Start metformin 1000mg bid along with lifestyle modification focusing on weight loss through diet and exercise
- Add DPP4i or SGLT2i as second agent if target not achieved in 3 months
- Refer to dietician and encourage weight loss through calorie restriction
- Start statin and advise to control other risk factors like smoking
Case 2:
- Switch from SU to DPP4i or SGLT2i to reduce risk of hypoglycemia
- Add GLP1RA if target not achieved to address obesity and heart failure
- Monitor kidney function and adjust doses based on eGFR
- Emphasize lifestyle changes
The document discusses approaches to preventing cardiovascular disease, including primary and secondary prevention. It outlines various risk factors and strategies for prevention at both the population level and for high-risk individuals. These include promoting smoking cessation, controlling blood pressure and lipids, increasing physical activity, maintaining a healthy diet and weight, and using medication like aspirin to reduce the risk of cardiovascular events.
Lifestyle modification in the prevention of type 2 diabetes: The experience w...My Healthy Waist
The document summarizes findings from the Diabetes Prevention Program (DPP) and its follow-up study, the Diabetes Prevention Program Outcomes Study (DPPOS). The DPP found that lifestyle modification reduced the risk of developing type 2 diabetes by 58% compared to placebo, while metformin reduced risk by 31%. Follow-up in the DPPOS found risk reductions of 34% with lifestyle and 18% with metformin were maintained over 10 years.
Executive summary-standards of Medical care in Diabetes 2014Suneth Weerarathna
1. The document provides guidelines on the diagnosis and management of diabetes and prediabetes from the American Diabetes Association. It discusses classification of diabetes, diagnostic criteria, screening recommendations, prevention of type 2 diabetes, glycemic targets, and management of complications.
2. Testing and screening recommendations are provided for both types of diabetes as well as gestational diabetes. Lifestyle and medical interventions are recommended for preventing or delaying type 2 diabetes in those with prediabetes.
3. The guidelines cover medical nutrition therapy, diabetes self-management education, physical activity, hypoglycemia management, and immunization for patients with diabetes. Control of cardiovascular risk factors is emphasized for preventing diabetes complications.
1. The study aimed to compare the blood glucose lowering effects of the traditional Indian plant Vijayasar (Pterocarpus marsupium) and the pharmaceutical agent tolbutamide in managing diabetes.
2. A total of 365 newly diagnosed type 2 diabetes patients were randomized to receive either Vijayasar or tolbutamide for 36 weeks.
3. The results showed that Vijayasar was as effective as tolbutamide in lowering blood glucose with no significant differences in effects on lipids or safety profiles.
The document provides guidelines for diagnosing and managing type 2 diabetes, including criteria for testing asymptomatic adults, components of comprehensive evaluations, glycemic and treatment recommendations, and prevention and management of complications such as heart disease, kidney disease, and neuropathy. It recommends individualizing treatment based on factors like age and comorbidities, and emphasizes lifestyle changes including nutrition, exercise and smoking cessation in addition to medication management.
This document is the second edition of the book "Indian Foods: AAPI’s Guide to Nutrition, Health & Diabetes" edited by Ranjita Misra. It contains 20 chapters contributed by various authors on topics related to the epidemiology, risks, and complications of diabetes; preventing heart disease; regional Indian cuisines; low fat cooking; choosing healthy snacks; desserts; managing menus in Indian restaurants; carbohydrate counting; weight management; exchange lists; the role of Indian spices in health; and managing diabetes through diet. The book is intended to help Asian Indians, especially Indian Americans, better manage and prevent conditions like diabetes, hypertension, obesity, and hyperlipidemia.
This document discusses cardiometabolic risk, which refers to the risks associated with metabolic changes that can lead to cardiovascular disease. It defines cardiometabolic risk and identifies both non-modifiable and modifiable risk factors such as obesity, dyslipidemia, hypertension, smoking, and physical inactivity. The document emphasizes the importance of early identification and management of risk factors through comprehensive patient assessment and targeted intervention to prevent diseases like cardiovascular disease and diabetes.
This document discusses pre-diabetes, including its definition, prevalence, health risks, diagnostic criteria, and treatment options. Some key points:
- Pre-diabetes is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Left untreated, pre-diabetes often progresses to type 2 diabetes.
- Studies like the Diabetes Prevention Program showed that modest lifestyle changes like 5-10% weight loss and moderate physical activity can prevent or delay the onset of diabetes in those with pre-diabetes.
- In addition to lifestyle changes, pharmacologic treatments like metformin may be considered for high-risk individuals to prevent the progression from pre-diabetes to diabetes. However,
This document provides an overview of diabetes and its various types and treatments. It discusses type 1 and type 2 diabetes, including their symptoms, causes, and pathophysiology. Gestational diabetes and prediabetes are also covered. The document reviews screening recommendations and treatment goals for diabetes. It describes various oral medications and insulin therapies used to treat diabetes. Lifestyle modifications like nutrition, physical activity, and diabetes self-management education are emphasized.
Nutrition therapy work shop dawly second part 2017FarragBahbah
This document provides information on nutrition for patients with chronic kidney disease (CKD) and those undergoing dialysis. It discusses recommendations for calories, protein, carbohydrates, fat, sodium, fluids, phosphorus, calcium, potassium and micronutrients. It notes that dialysis can impact nutrition by causing losses of certain nutrients and affecting appetite and food intake. Dietary goals for patients on dialysis include managing blood pressure and glucose as well as intake of minerals and fluids.
Ramazan Fasting in Those with Diabetes 2015 Dr. Ammar Raza
1) The document discusses guidelines for diabetics fasting during Ramadan, including who can and cannot fast safely. It recommends those with uncontrolled diabetes, heart disease, or other illnesses should not fast.
2) It provides precautions diabetics should take when fasting, such as adjusting medications under doctor's guidance and monitoring blood sugar levels regularly before and after meals. Diet is also important, avoiding overeating and focusing on balanced, nutritious meals.
3) The risks of low or high blood sugar during the fast are discussed. Fasting diabetics should break their fast immediately if they experience signs of low blood sugar and seek medical help promptly.
Metabolic syndrome is a clustering of at least three of five medical conditions that increase the risk of cardiovascular disease and diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Metabolic syndrome affects over 47 million Americans and is caused by risk factors such as obesity, physical inactivity, genetics, and age. Managing metabolic syndrome involves making lifestyle changes focused on diet, exercise, and stress reduction as well as medication to treat individual risk factors as needed.
The document discusses updates on diabetes management from 2020. It covers topics such as classification and diagnosis of diabetes, pathophysiology, management through lifestyle modifications and pharmacologic approaches, glycemic targets, assessment of control, common comorbidities, and cardiovascular risk management. The major components of diabetes treatment are lifestyle modification through medical nutrition therapy and exercise, oral antihyperglycemic medications, and injectable therapies like insulin and incretin mimetics. Glycemic targets are individualized based on patient factors.
The document discusses guidelines for caring for elderly patients with diabetes in primary care. It recommends regularly assessing patients' functional status and adjusting glycemic targets higher for elderly patients. Treatment should be individualized, avoid complex regimens, and focus on preventing hypoglycemia. Close monitoring is needed for diabetes complications while considering other common geriatric issues.
A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
Type 2 diabetes is a condition where the body cannot effectively control blood sugar levels. It develops over many years as the body becomes resistant to the effects of insulin. Prediabetes occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. The best way to prevent type 2 diabetes is through lifestyle changes like regular physical activity and modest weight loss. Maintaining a healthy lifestyle can significantly reduce risk of developing diabetes and its serious health complications.
This document discusses the comprehensive management of type 2 diabetes mellitus (T2DM), including education, lifestyle modifications, glycemic control, management of cardiovascular risk factors, and treatment options. It covers diabetes self-management education, medical nutrition therapy, exercise, weight loss, pharmacological therapies like metformin, sulfonylureas, thiazolidinediones, as well as newer agents and insulin. The goals of management are to control symptoms and blood glucose levels to prevent diabetes complications through a multifaceted approach.
Type 2 diabetes is a major public health issue costing the NHS billions each year. It is caused by a combination of genetic and environmental factors and results in insufficient insulin production and ineffective use of insulin by the body. Treatment involves lifestyle changes like diet and exercise as well as drug therapies targeting blood glucose, blood pressure, and cholesterol levels. Recent evidence shows that intensive lifestyle interventions can help achieve remission of type 2 diabetes in some patients through significant weight loss.
This document provides guidelines for screening, diagnosing, and managing diabetes and prediabetes. It outlines risk factors for developing type 2 diabetes and recommends criteria for testing asymptomatic adults. It describes normal, prediabetic, and diabetic ranges for blood glucose levels and A1C. The document recommends lifestyle changes like medical nutrition therapy, physical activity, and smoking cessation to prevent and treat diabetes. It provides guidelines for foot care, treating complications, immunizations, and managing related conditions like hypertension and dyslipidemia.
The document discusses approaches to preventing cardiovascular disease, including primary and secondary prevention. It outlines various risk factors and strategies for prevention at both the population level and for high-risk individuals. These include promoting smoking cessation, controlling blood pressure and lipids, increasing physical activity, maintaining a healthy diet and weight, and using medication like aspirin to reduce the risk of cardiovascular events.
Lifestyle modification in the prevention of type 2 diabetes: The experience w...My Healthy Waist
The document summarizes findings from the Diabetes Prevention Program (DPP) and its follow-up study, the Diabetes Prevention Program Outcomes Study (DPPOS). The DPP found that lifestyle modification reduced the risk of developing type 2 diabetes by 58% compared to placebo, while metformin reduced risk by 31%. Follow-up in the DPPOS found risk reductions of 34% with lifestyle and 18% with metformin were maintained over 10 years.
Executive summary-standards of Medical care in Diabetes 2014Suneth Weerarathna
1. The document provides guidelines on the diagnosis and management of diabetes and prediabetes from the American Diabetes Association. It discusses classification of diabetes, diagnostic criteria, screening recommendations, prevention of type 2 diabetes, glycemic targets, and management of complications.
2. Testing and screening recommendations are provided for both types of diabetes as well as gestational diabetes. Lifestyle and medical interventions are recommended for preventing or delaying type 2 diabetes in those with prediabetes.
3. The guidelines cover medical nutrition therapy, diabetes self-management education, physical activity, hypoglycemia management, and immunization for patients with diabetes. Control of cardiovascular risk factors is emphasized for preventing diabetes complications.
1. The study aimed to compare the blood glucose lowering effects of the traditional Indian plant Vijayasar (Pterocarpus marsupium) and the pharmaceutical agent tolbutamide in managing diabetes.
2. A total of 365 newly diagnosed type 2 diabetes patients were randomized to receive either Vijayasar or tolbutamide for 36 weeks.
3. The results showed that Vijayasar was as effective as tolbutamide in lowering blood glucose with no significant differences in effects on lipids or safety profiles.
The document provides guidelines for diagnosing and managing type 2 diabetes, including criteria for testing asymptomatic adults, components of comprehensive evaluations, glycemic and treatment recommendations, and prevention and management of complications such as heart disease, kidney disease, and neuropathy. It recommends individualizing treatment based on factors like age and comorbidities, and emphasizes lifestyle changes including nutrition, exercise and smoking cessation in addition to medication management.
This document is the second edition of the book "Indian Foods: AAPI’s Guide to Nutrition, Health & Diabetes" edited by Ranjita Misra. It contains 20 chapters contributed by various authors on topics related to the epidemiology, risks, and complications of diabetes; preventing heart disease; regional Indian cuisines; low fat cooking; choosing healthy snacks; desserts; managing menus in Indian restaurants; carbohydrate counting; weight management; exchange lists; the role of Indian spices in health; and managing diabetes through diet. The book is intended to help Asian Indians, especially Indian Americans, better manage and prevent conditions like diabetes, hypertension, obesity, and hyperlipidemia.
This document discusses cardiometabolic risk, which refers to the risks associated with metabolic changes that can lead to cardiovascular disease. It defines cardiometabolic risk and identifies both non-modifiable and modifiable risk factors such as obesity, dyslipidemia, hypertension, smoking, and physical inactivity. The document emphasizes the importance of early identification and management of risk factors through comprehensive patient assessment and targeted intervention to prevent diseases like cardiovascular disease and diabetes.
This document discusses pre-diabetes, including its definition, prevalence, health risks, diagnostic criteria, and treatment options. Some key points:
- Pre-diabetes is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Left untreated, pre-diabetes often progresses to type 2 diabetes.
- Studies like the Diabetes Prevention Program showed that modest lifestyle changes like 5-10% weight loss and moderate physical activity can prevent or delay the onset of diabetes in those with pre-diabetes.
- In addition to lifestyle changes, pharmacologic treatments like metformin may be considered for high-risk individuals to prevent the progression from pre-diabetes to diabetes. However,
This document provides an overview of diabetes and its various types and treatments. It discusses type 1 and type 2 diabetes, including their symptoms, causes, and pathophysiology. Gestational diabetes and prediabetes are also covered. The document reviews screening recommendations and treatment goals for diabetes. It describes various oral medications and insulin therapies used to treat diabetes. Lifestyle modifications like nutrition, physical activity, and diabetes self-management education are emphasized.
Nutrition therapy work shop dawly second part 2017FarragBahbah
This document provides information on nutrition for patients with chronic kidney disease (CKD) and those undergoing dialysis. It discusses recommendations for calories, protein, carbohydrates, fat, sodium, fluids, phosphorus, calcium, potassium and micronutrients. It notes that dialysis can impact nutrition by causing losses of certain nutrients and affecting appetite and food intake. Dietary goals for patients on dialysis include managing blood pressure and glucose as well as intake of minerals and fluids.
Ramazan Fasting in Those with Diabetes 2015 Dr. Ammar Raza
1) The document discusses guidelines for diabetics fasting during Ramadan, including who can and cannot fast safely. It recommends those with uncontrolled diabetes, heart disease, or other illnesses should not fast.
2) It provides precautions diabetics should take when fasting, such as adjusting medications under doctor's guidance and monitoring blood sugar levels regularly before and after meals. Diet is also important, avoiding overeating and focusing on balanced, nutritious meals.
3) The risks of low or high blood sugar during the fast are discussed. Fasting diabetics should break their fast immediately if they experience signs of low blood sugar and seek medical help promptly.
Metabolic syndrome is a clustering of at least three of five medical conditions that increase the risk of cardiovascular disease and diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Metabolic syndrome affects over 47 million Americans and is caused by risk factors such as obesity, physical inactivity, genetics, and age. Managing metabolic syndrome involves making lifestyle changes focused on diet, exercise, and stress reduction as well as medication to treat individual risk factors as needed.
The document discusses updates on diabetes management from 2020. It covers topics such as classification and diagnosis of diabetes, pathophysiology, management through lifestyle modifications and pharmacologic approaches, glycemic targets, assessment of control, common comorbidities, and cardiovascular risk management. The major components of diabetes treatment are lifestyle modification through medical nutrition therapy and exercise, oral antihyperglycemic medications, and injectable therapies like insulin and incretin mimetics. Glycemic targets are individualized based on patient factors.
The document discusses guidelines for caring for elderly patients with diabetes in primary care. It recommends regularly assessing patients' functional status and adjusting glycemic targets higher for elderly patients. Treatment should be individualized, avoid complex regimens, and focus on preventing hypoglycemia. Close monitoring is needed for diabetes complications while considering other common geriatric issues.
A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
Type 2 diabetes is a condition where the body cannot effectively control blood sugar levels. It develops over many years as the body becomes resistant to the effects of insulin. Prediabetes occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. The best way to prevent type 2 diabetes is through lifestyle changes like regular physical activity and modest weight loss. Maintaining a healthy lifestyle can significantly reduce risk of developing diabetes and its serious health complications.
This document discusses the comprehensive management of type 2 diabetes mellitus (T2DM), including education, lifestyle modifications, glycemic control, management of cardiovascular risk factors, and treatment options. It covers diabetes self-management education, medical nutrition therapy, exercise, weight loss, pharmacological therapies like metformin, sulfonylureas, thiazolidinediones, as well as newer agents and insulin. The goals of management are to control symptoms and blood glucose levels to prevent diabetes complications through a multifaceted approach.
Type 2 diabetes is a major public health issue costing the NHS billions each year. It is caused by a combination of genetic and environmental factors and results in insufficient insulin production and ineffective use of insulin by the body. Treatment involves lifestyle changes like diet and exercise as well as drug therapies targeting blood glucose, blood pressure, and cholesterol levels. Recent evidence shows that intensive lifestyle interventions can help achieve remission of type 2 diabetes in some patients through significant weight loss.
This document provides guidelines for screening, diagnosing, and managing diabetes and prediabetes. It outlines risk factors for developing type 2 diabetes and recommends criteria for testing asymptomatic adults. It describes normal, prediabetic, and diabetic ranges for blood glucose levels and A1C. The document recommends lifestyle changes like medical nutrition therapy, physical activity, and smoking cessation to prevent and treat diabetes. It provides guidelines for foot care, treating complications, immunizations, and managing related conditions like hypertension and dyslipidemia.
This document discusses weight control strategies for patients with metabolic syndrome. It defines metabolic syndrome as a constellation of risk factors that promote cardiovascular disease. Weight loss through diet and exercise is the first-line treatment, aiming for 7-10% weight loss in the first year. Bariatric surgery may be considered for patients with a BMI over 40 or over 35 with comorbidities if medical treatment fails. The risks and types of bariatric surgeries are outlined, noting that surgery provides the greatest sustainable weight loss for treating metabolic syndrome and reducing cardiovascular risk factors.
Dr Vivek Baliga - Chronic Disease Management In Heart Failure And DiabetesDr Vivek Baliga
Dr Vivek Baliga, Consultant Internal Medicine at Baliga Diagnostics discusses the management of 2 common problems in medical practice - heart failure and type 2 diabetes, including the link between the two. For more articles for patients, visit http://heartsense.in/author/dr-vivek-baliga-b/. For scientific articles and short reviews, visit http://drvivekbaliga.net/
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
This document provides an overview of obesity including its definition, prevalence, health consequences, assessment, treatment approaches, and guidelines. Some key points:
- Obesity is defined as a BMI of 30 or higher. It affects over 60 million US adults and rates have doubled globally in the last 30 years.
- It increases the risk of diseases like diabetes, heart disease, and cancer. Treatment involves diet, exercise, behavior change and sometimes medication or surgery.
- The Edmonton Obesity Staging System complements BMI by assessing medical complications, functional limitations, and quality of life across 5 stages from no risk factors to end-stage disease.
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
- Type 2 diabetes accounts for over 90% of diabetes cases worldwide and is associated with obesity, lack of exercise, and poor diet. It is managed through lifestyle modifications including diet, exercise, oral hypoglycemic medications, and sometimes insulin therapy.
- The main treatment approaches involve dietary changes to control blood sugar and weight, regular physical activity, oral medications like metformin and sulfonylureas, and potentially insulin therapy if blood sugar levels remain uncontrolled.
- Close monitoring of blood sugar levels through self-testing and HbA1c levels helps guide treatment adjustments and ensure proper management of the disease.
This document provides an overview of obesity, including its definition, measurement, prevalence, causes, evaluation, treatment approaches, and a case study. It defines obesity as a BMI over 30 kg/m2 and notes the increased prevalence in the US and worldwide. The evaluation of patients with obesity involves taking a history, physical exam, assessing comorbidities, fitness, and readiness to change. Treatment options include lifestyle management, pharmacotherapy, and surgery. A case study is then presented and discussed in terms of appropriate treatment goals.
Diabetes in pregnancy can have risks for both mother and baby. It is important to screen and diagnose diabetes during pregnancy through tests like OGTT. Women at high risk should be screened early. Prenatal care includes managing blood sugar levels through diet, exercise, oral medications or insulin as needed. Close monitoring of mother and baby is also important to watch for complications. The goal is optimizing outcomes safely for both.
The document discusses management of type 2 diabetes patients in primary care. It notes that the majority of diabetic patients receive care from primary care physicians rather than specialists. A large study found little advantage for patients under the care of endocrinologists compared to family practitioners, except for improved foot care and lower infection risk. Overall health status and mortality were similar between the two groups. Effective management of type 2 diabetes requires addressing multiple factors including glycemic control, blood pressure, lipids, weight, and lifestyle changes.
This document discusses non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancers and respiratory diseases. It notes that NCDs are the leading cause of death in Sri Lanka, accounting for 47% of all deaths. The document outlines key risk factors for NCDs including unhealthy diet, physical inactivity, tobacco use, alcohol consumption and heredity. It recommends screening those over 35 or younger individuals with additional risk factors in order to detect diseases early when interventions are most effective. The document focuses on diabetes, describing diagnosis, gestational diabetes, management through lifestyle modifications and medications.
(1) Obesity is defined as excess body fat and is measured using body mass index (BMI). A BMI over 30 is considered obese. Abdominal fat distribution is more strongly linked to health risks than overall adiposity.
(2) Causes of obesity include genetic, behavioral, and environmental factors. Key treatments involve lifestyle changes like diet, exercise, and behavior therapy. Medications and surgery may be used for more severe obesity.
(3) Bariatric surgery can effectively treat severe obesity but requires lifelong management of nutritional deficiencies due to malabsorption. Restrictive procedures carry fewer risks than restrictive-malabsorptive bypass procedures.
This document discusses diabetes mellitus (DM) and new developments in its management. It begins by defining DM according to the WHO and describing its global prevalence and projected increase. It then classifies the main types of DM and discusses testing and diagnosis criteria. The document outlines recommendations for lifestyle modifications, medical nutrition therapy, physical activity, weight management, and smoking cessation. It also reviews oral medications and insulin therapy as well as recommendations for self-monitoring and A1C testing.
This document provides information on inpatient management of hyperglycemia and glycemic control in hospitalized patients. It defines diabetes and its classifications. The prevalence and healthcare impact of diabetes are increasing dramatically. The document reviews considerations on patient admission, glycemic targets, and the risks of both hyperglycemia and hypoglycemia. It describes options for subcutaneous insulin therapy including basal, bolus, and correction components. Insulin is the preferred treatment in hospitals, while orals have limited roles.
This document discusses obesity and its treatment through drug therapy. It begins by defining obesity as a body mass index (BMI) of 30 or higher. Various factors that contribute to obesity are discussed, including genetics, hormones like leptin that regulate appetite, and an imbalance between calorie intake and expenditure. Several drug treatments for obesity are then outlined, including orlistat which inhibits fat absorption, cannabinoid receptor antagonists, and other centrally-acting drugs that suppress appetite by altering neurotransmitters. Side effects and use considerations are provided for each treatment option. The goal of treatment is long-term weight management through lifestyle changes and medication if needed.
This document provides guidelines for the primary and secondary prevention of cardiovascular disease (CVD) in Malaysia. It finds that CVD is the leading cause of death in Malaysia. The population has high rates of CVD risk factors like smoking, obesity, hypertension, and diabetes. The guidelines recommend assessing individual CVD risk and treating modifiable risk factors through lifestyle changes and medication. Lifestyle changes involve a healthy diet, regular exercise, smoking cessation, and maintaining a healthy weight. Pharmacotherapy is suggested for those at high risk. The guidelines provide recommendations for risk assessment, lifestyle interventions, obesity management, and anticoagulation therapy to prevent primary and secondary CVD.
Weight gain and physical activity in mid life world menopause dayManinder Ahuja
it is for awareness about Role of exercise and life style modifications in Healthy Aging. This would prevent metabolic syndromes and Diabetes, Hypertension , CHD , Cancers and many problems of mid life beyond years.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is increasing globally. Risk factors include family history of diabetes, obesity, older age, and certain ethnic backgrounds. GDM increases risks for both mother and fetus, including preeclampsia, macrosomia, and neonatal complications. Screening involves a 50g glucose challenge test between 24-28 weeks, followed by a 100g oral glucose tolerance test for those who fail. Treatment focuses on medical nutrition therapy, blood glucose monitoring, and may include insulin to achieve targeted glucose levels and prevent complications.
This document discusses colorectal cancer (CRC) prevention and early detection in Puerto Rico. It provides statistics on CRC incidence and mortality rates in Puerto Rico from 2000-2016. CRC is the second leading cause of cancer in men and women in Puerto Rico. The document reviews CRC screening guidelines and risk factors. It also presents data on CRC stage at diagnosis and survival rates in Puerto Rico compared to the US. The economic impact of cancer in Puerto Rico is also discussed.
This document provides information on cardiovascular risk factors and interventions for prevention and treatment. It discusses modifiable risk factors like smoking, diabetes, diet, physical activity, and alcohol intake. It reviews evidence for nonpharmacological interventions like weight loss, dietary modifications, exercise, and moderation of alcohol. It also summarizes several clinical trials demonstrating the benefits of statin therapy in primary and secondary prevention of cardiovascular events.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
This document discusses obesity, including its definitions, classifications, prevalence, physiology, and management. It provides guidelines for clinicians on their role in weight loss, including counseling strategies to promote behavior change. New guidelines for obesity management are presented, along with selecting appropriate medications based on a patient's comorbidities. Surgical and non-surgical procedures for obesity are outlined, along with expected weight loss and vitamin deficiencies. The role of nutrition, physical activity, behavior therapy, and medical therapy in obesity treatment is also examined.
This document discusses vaccination standards and immunization schedules for adults and pediatrics in the United States for 2019. It was authored by Dr. Luis J. Lugo Vélez and covers information from the Advisory Committee on Immunization Practices (ACIP) such as their role in developing vaccination recommendations and meeting schedule. It also includes the recommended vaccination schedules for children/adolescents and notes from various schedules. Additionally, it discusses diseases prevented by vaccines and compares morbidity rates pre-and-post widespread vaccination.
Basado en la información proporcionada, el aumento del ESR en este paciente con enfermedad de Kawasaki después del tratamiento inicial no es motivo de alarma. El ESR no es un marcador sensible para seguir cambios agudos en la inflamación. Dado que el paciente ya no tiene fiebre y no hay otros hallazgos preocupantes, no recomendaría dar otro pulso de esteroides al momento. Se debe continuar el monitoreo clínico.
This document presents the 2017 adult and pediatric immunization schedule as recommended by the Advisory Committee on Immunization Practices and approved by the Centers for Disease Control and Prevention. It consists of recommendations for routine vaccines for adults by age and medical condition/indication, including important footnotes on vaccine-specific considerations. The schedule aims to provide healthcare professionals with current evidence-based guidance on immunization for adults and children.
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1. PREVENCION,DIAGNOSTICO Y MANEJO
DE DIABETES;
PREVENCION,DIAGNOSTICO Y MANEJO
DE ENFERMEDADES
CARDIOVASCULARES E HIPERTENSION
MARIELBA AGOSTO MUJICA, MD,FACE
ENDOCRINOLOGY DIABETES AND
METABOLISM
2. GUIDELINES QUESTIONS…
1. How is diabetes screened and diagnosed?
2. How is prediabetes managed?
3. What are glycemic treatment goals of DM?
4. How are glycemic targets achieved for T2D?
5. How should glycemia in T1D be managed?
6. How is hypoglycemia managed?
7. How is hypertension managed in patients with diabetes?
8. How is dyslipidemia managed in patients with diabetes?
8. How is CVD managed in patients with diabetes?
9. How is obesity managed in patients with diabetes?
14.What is the role of sleep medicine in the care of the patient with diabetes?
15.How is diabetes managed in the hospital?
16.How is a comprehensive diabetes care plan established in children and adolescents?
17.How should diabetes in pregnancy be managed?
18.When and how should glucose monitoring be used?
19.When and how should insulin pump therapy be used?
20.What is the imperative for education and team approach in DM management?
21.What vaccinations should be given to patients with diabetes?
22.How should depression be managed in the context of diabetes?
23.What is the association between diabetes and cancer?
24.Which occupations have specific diabetes management requirements?
4. Criteria for Screening for T2D and
Prediabetes in Asymptomatic Adults
• Age ≥45 years without other risk factors
• Family history of T2D
• CVD
• Overweight
• BMI ≥30 kg/m2
• BMI 25-29.9 kg/m2 plus other risk
factors*
• Sedentary lifestyle
• Member of an at-risk racial or ethnic
group: Asian, African American, Hispanic,
Native American, and Pacific Islander
• Dyslipidemia
• HDL-C <35 mg/dL
• Triglycerides >250 mg/dL
• IGT, IFG, and/or metabolic syndrome
• PCOS, acanthosis nigricans, NAFLD
• Hypertension (BP >140/90 mm Hg or
therapy for hypertension)
• History of gestational diabetes or delivery
of a baby weighing more than 4 kg (9 lb)
• Antipsychotic therapy for schizophrenia
and/or severe bipolar disease
• Chronic glucocorticoid exposure
• Sleep disorders† in the presence of
glucose intolerance
• Screen at-risk individuals with glucose values in the normal range every 3 years
• Consider annual screening for patients with 2 or more risk factors
7. AACE Recommendations for A1C Testing
• A1C should be considered an additional optional
diagnostic criterion, not the primary criterion for diagnosis
of diabetes
• When feasible, AACE/ACE suggest using traditional
glucose criteria for diagnosis of diabetes
• A1C is not recommended for diagnosing type 1 diabetes
• A1C is not recommended for diagnosing gestational
diabetes
8. AACE Recommendations for A1C Testing
• A1C levels may be misleading in several ethnic
populations (for example, African Americans)
• A1C may be misleading in some clinical settings
• Hemoglobinopathies
• Iron deficiency
• Hemolytic anemias
• Thalassemias
• Spherocytosis
• Severe hepatic or renal disease
• AACE/ACE endorse the use of only standardized,
validated assays for A1C testing
9. Diagnosing Type 1 Diabetes (T1D)
• Usually characterized by insulin deficiency and
dependency
• Document levels of insulin and C-peptide
• Test for autoantibodies*
• Insulin
• Glutamic acid decarboxylase
• Pancreatic islet b cells (tyrosine phosphatase IA-2)
• Zinc transporter (ZnT8)
• May occur in overweight or obese as well as lean
individuals
30. Insulin Regimens
• Insulin is required for survival in T1D
• Physiologic regimens using insulin analogs should be
used for most patients
31. INSULIN IN TID
• Multiple daily
injections (MDI)
• 1-2 injections basal
insulin per day
• Prandial insulin
injections before
each meal
• Continuous
subcutaneous insulin
infusion (CSII)
• Insulin pump using
rapid acting insulin
analog
33. Principles of Insulin Therapy in T1D
• Starting dose based on weight
• Range: 0.4-0.5 units/kg per day
• Daily dosing
• Basal
• 40% to 50% TDI
• Given as single injection of basal analog or 2 injections of NPH per
day
• Prandial
• 50% to 60% of TDI in divided doses given 15 min before each meal
• Each dose determined by estimating carbohydrate content of meal
• Higher TDI needed for obese patients, those with
sedentary lifestyles, and during puberty
43. Lipid Management
• Elevated LDL-C, non-HDL-C,
TG, TC/HDL-C ratio, ApoB,
LDL particles
• Statin = treatment of choice
• Add bile acid sequestrant,
niacin, and/or cholesterol
absorption inhibitor if target
not met on maximum-
tolerated dose of statin
• Use bile acid sequestrant,
niacin, or cholesterol
absorption inhibitor instead of
statin if contraindicated or not
tolerated
• LDL-C at goal but non-HDL-C
not at goal
(TG ≥200 mg/dL
and/or low HDL-C)
• May use fibrate, niacin, or
high-dose omega-3 fatty acid
to achieve non-HDL-C goal
• TG ≥500 mg/dL
• Use high-dose omega-3 fatty
acid, fibrate, or niacin to
reduce TG and risk of
pancreatitis
45. Comprehensive Management of CV Risk
• Manage CV risk factors
• Weight loss
• Smoking cessation
• Optimal glucose, blood pressure, and lipid control
• Use low-dose aspirin for secondary prevention of CV
events in patients with existing CVD
• May consider low-dose aspirin for primary prevention of
CV events in patients with 10-year CV risk >10%
• Measure coronary artery calcification or use coronary
imaging to determine whether glucose, lipid, or blood
pressure control efforts should be intensified
46. Statin Use
• Majority of patients with
T2D have a high
cardiovascular risk
• People with T1D are at
elevated cardiovascular
risk
• LDL-C target: <70
mg/dL—for the majority of
patients with diabetes who
are determined to have a
high risk
● Use a statin regardless of
LDL-C level in patients
with diabetes who meet
the following criteria:
● >40 years of age
● ≥1 major ASCVD risk factor
● Hypertension
● Family history of CVD
● Low HDL-C
● Smoking
47. Diagnosis of Obesity and Staging of for
Management
• Diagnose obesity according to body mass index (BMI)
• Overweight: BMI 25-29.9 kg/m2
• Obese*: BMI ≥30 kg/m2
• Consider waist circumference measurement for patients
with BMI between 25 and 35 kg/m2
• Larger waist circumference = higher risk for metabolic
disease
• Men: >102 cm (40 in)
• Women: >88 cm (35 in)
• Evaluate patients for obesity-related complications to
determine disease severity and appropriate management
49. Diagnosis of Obesity and Staging of for
Management
• Diagnose obesity according to body mass index (BMI)
• Overweight: BMI 25-29.9 kg/m2
• Obese*: BMI ≥30 kg/m2
• Consider waist circumference measurement for patients
with BMI between 25 and 35 kg/m2
• Larger waist circumference = higher risk for metabolic
disease
• Men: >102 cm (40 in)
• Women: >88 cm (35 in)
• Evaluate patients for obesity-related complications to
determine disease severity and appropriate management
54. Glucose Screening and Monitoring
• Laboratory blood glucose testing on admission,
regardless of DM history
• Known DM: assess A1C if not measured in past 3 months
• No history of DM: assess A1C to identify undiagnosed
cases
• Bedside glucose monitoring for duration of hospital stay
• Diagnosed DM
• No DM but receiving therapy associated with
hyperglycemia
• Corticosteroids
• Enteral or parenteral nutrition
56. Glucose Control
Hyperglycemia
● Critically ill/ICU patients
● Regular insulin by
intravenous infusion
● Noncritically ill
● Insulin analogs by
scheduled subcutaneous
basal, nutritional, and
correctional components
● Synchronize dosing with
meals or enteral or
parenteral nutrition
● Exclusive use of sliding scale
insulin is discouraged
Hypoglycemia
● Establish plan for treating
hypoglycemia in each
insulin-treated patient
● Document each episode of
hypoglycemia in medical
record
DISCHARGE PLANS
● Include appropriate
provisions for glucose
control in the outpatient
setting
57. HOW IS A COMPREHENSIVE
CARE PLAN ESTABLISHED IN
CHILDREN AND
ADOLESCENTS?
59. Management of DM
T1D
● Use MDI or CSII insulin
● In children younger than 4
years, bolus insulin may be
given after, rather than
before, meals due to
variable carbohydrate
intake
● Higher insulin-to-
carbohydrate ratios may be
needed during puberty
● Pubescent girls may
require 20% to 50%
increases in insulin dose
during menstrual periods
T2D
● Lifestyle modification is
first-line therapy
● Metformin, alone or in
combination with insulin, is
approved by the FDA to
treat T2D in pediatric
patients
● Rosiglitazone and
glimepiride have also been
studied in pediatric patients
with T2D
62. Treatment of DM During Pregnancy
• All women with T1D, T2D, or previous GDM should
receive preconception care to ensure adequate nutrition
and glucose control before conception, during pregnancy,
and in the postpartum period
• Use insulin to treat hyperglycemia in T1D and T2D and
when lifestyle measures do not control glycemia in GDM
• Basal insulin: NPH or insulin detemir
• Prandial insulin: insulin analogs preferred, but regular
insulin acceptable if analogs not available
64. Self-monitoring of Blood Glucose (SMBG)
Noninsulin Users
● Introduce at diagnosis
● Personalize frequency of
testing
● Use SMBG results to inform
decisions about whether to
target FPG or PPG for any
individual patient
Insulin Users
● All patients using insulin
should test glucose
● ≥2 times daily
● Before any injection of
insulin
● More frequent SMBG (after
meals or in the middle of the
night) may be required
● Frequent hypoglycemia
● Not at A1C target
Testing positively affects glycemia in
T2D when the results are used to:
• Modify behavior
• Modify pharmacologic treatment
66. Continuous Glucose Monitoring (CGM)
Uses
● onsider for T1D patients (and
insulin-using T2D patients) to
improve A1C and reduce
hypoglycemia
● Features
● “Real-time” glucose values
(but 7- to 15-minute lag
between plasma and
interstitial glucose and
receiver display)
● Hypo- and hyperglycemia
alarms
● Wireless interfaces with
downloadable/printable data
Limitations
● Invasive (worn like a pump)
● Requires daily calibration
with fingerstick SMBG
● Lengthy data download
time
● Requires highly
motivated/informed patients
and healthcare support
team
● Must be able to interpret
data trends rather than
data points
67. WHEN AND HOW SHOULD
INSULIN PUMP THERAPY BE
USED?
68. Continuous Subcutaneous Insulin Infusion
(CSII)
• Consider for
• T1D patients
• Insulinopenic T2D patients unable to achieve optimal
glucose control with multiple daily injections of insulin
• All patients should be motivated and well educated in DM
self-management as well as CSII use
• Prescribing physicians should have expertise in CSII
• CSII devices with a threshold-suspend function may be
considered
74. DM and Depression
• Screen all adults with DM for depression
• Untreated comorbid depression can have serious
clinical implications for patients with DM
• Consider referring patients with depression to mental
health professionals who are knowledgeable about DM
75. DM and Cancer
• Screen obese individuals with DM more frequently and
rigorously for certain cancers
• Endometrial, breast, hepatic, bladder, pancreatic, colorectal
cancers
• Increased BMI (≥25 kg/m2) also increases risk of some
cancers
• Strong associations: endometrial, gall bladder, esophageal , renal,
thyroid, ovarian, breast, and colorectal cancer
• Weaker associations: leukemia, malignant and multiple
melanoma, pancreatic cancer, non-Hodgkin lymphoma
• To date, no definitive relationship has been established
between specific hyperglycemic agents and increased risk of
cancer or cancer-related mortality
• Consider avoiding medications considered disadvantageous to
specific cancers in individuals at risk for or with a history of that
cancer
76. DM and Occupational Hazards
• Commercial drivers at high risk for developing T2D
• Screen as appropriate
• Encourage healthy lifestyle change
• Be aware of management requirements and use agents
with reduced risk of hypoglycemia in patients with
occupations that could put others at risk, such as (not
inclusive):
• Commercial drivers
• Pilots
• Anesthesiologists
• Commercial or recreational divers