Term
| Microvascular Complications of DM |
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Definition
| retinopathy, neuropathy, nephropathy |
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Term
| Macrovascular Complications of DM |
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Definition
| Coronary Heart Dx, PVD, Cerebrovascular Dx |
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Term
| Diabetes Control & Complications Trial (DCCT) |
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Definition
1441 pts w/ Type 1 DM divided to study development & progression of chronic complications;
Divided into 2 groups:
1) conventional therapy: 1-2 insulin injections, infrequent SMBG, no change of therapy based on SMBG;
2) intensive therapy: 3+ injections/day, frequent SMBG & alteration of therapy based on SMBG, freq. contact w/ HCP;
Results:
- 2% difference in A1c;
- decrease in retinopathy, neuropathy, microabluminuria;
Conclusion: good glycemic control has advantage over what was previously considered conventional therapy;
Take home: intensive therapy can prevent complications & slow down progression of already established complications; |
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Term
| United Kingdom Prospective Diabetes Study (UKPDS) |
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Definition
>5000 pts w/ Type 2 DM & followed for >10 yrs;
Compared 2 groups:
- conventional: drug therapy only if FBG >270 mg/dL;
- Intensive: oral meds or insulin to keep FBG <108 mg/dL;
Results:
- A1c in intensive group lower than conventional group;
- no difference in mortality or amputations;
- BP control decreased risk of both macro & microvascular complications; |
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Term
| Risk Factors for Ocular Complications |
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Definition
hyperglycemia;
hypertension;
smoking; |
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Term
| Types of Ocular Complications |
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Definition
Retinopathy;
Cataracts/Glaucoma; |
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Term
| Prevention of Ocular Complications |
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Definition
compliance w/ glycemic & non-glycemic goals: tight glycemic control, aggressive BP control;
Smoking cessation/avoidance;
Routine dilated retinal exams |
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Term
| ADA Ocular Exam Screenings for Children (<10) w/ Type 1 DM |
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Definition
Initial: only if Sx occur;
Follow-up: none |
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Term
| ADA Ocular Exam Screenings for Adolescents (>10) and Adults w/ Type 1 DM |
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Definition
Initial: within 3-5 yrs after diagnosis;
Follow-up: annually |
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Term
| ADA Ocular Exam Screenings for Adults w/ Type 2 DM |
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Definition
Initial: shortly after diagnosis;
Follow-up: annually |
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Term
| Treatment of Ocular Complications |
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Definition
Achieve optimal glycemic control;
Laser photocoagulation surgery; |
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Term
| Risk Factors for Nephropathy |
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Definition
hyperglycemia;
HTN;
hyperlipidemia;
ethnicity: Native American, Hispanic American, African American;
smoking |
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Term
| Screening for Nephropathy |
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Definition
Routine UA each year:
- (+) protein --> 24 hr urine collection for protein;
- (-) protein --> microalbumin screening required;
Microalbumin Screening:
- Random Spot Collection: most common;
- 24-hr timed collection;
- Timed collection: 4 hr period;
Screen:
- Type 1 DM --> after 5 yrs dx duration & at puberty;
- Type 2 DM: at onset of diagnosis & during pregnancy;
Screening Time frame:
- (-): annually;
- (+): confirmed w/ pos. result in at least 2 of 3 tests within 6 month period |
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Term
| Factors affecting False Positive Microalbumin Screening Test |
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Definition
intense exercise;
recent UTIs;
marked HTN (>190 mmHg SBP);
short-term hyperglycemia;
HF;
acute febrile illness |
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Term
| Diagnosis of Nephropathy using Spot Collection Screen |
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Definition
Normal: <30 mcg/mg Cr
Microalbuminaria: 30-299 mcg/mg Cr
MACROalbuminaria: >=300 mcg/mg Cr |
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Term
| Prevention of Nephropathy |
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Definition
glucose control;
BP control;
ACE-Is, ARBs are 1st line;
appropriate treatment of dyslipidemia;
Protein restriction in any pt w/ any stage of CKD |
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Term
| Treatment of Type 1 DM Nephropathy |
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Definition
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Term
| Type 2 DM + HTN + microabluminuria |
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Definition
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Term
| Type 2 DM + HTN + MACROalbuminuria |
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Definition
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Term
| If pts unable to tolerate ACE-I or ARB in DM with nephropathy |
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Definition
| use non-dihydropyridine CCB (verapamil, diltiazem), diuretics, or Beta-Blockers |
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Term
|
Definition
dietary protein restriction (<=0.8 g/kg/day);
Dialysis;
Kidney transplant |
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Term
| Risk Factors for Neuropathy |
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Definition
hyperglycemia;
duration of DM;
presence of other microvascular complications;
smoking |
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Term
| Types of Autonomic Neuropathy |
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Definition
| hypoglycemic unawareness, gastroparesis, orthostatic hypotension, urinary incontinence, erectile dysfunction |
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Term
| Prevention & Treatment of Hypoglycemic Unawareness |
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Definition
glycemic control: avoid frequent hypoglycemia;
smoking cessation;
None available;
Frequent SMBG testing;
Keep glucagon kit on hand |
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Term
| Symptoms of Gastroparesis |
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Definition
delayed gastric emptying;
constipation or diarrhea, abdominal fullness, abdominal cramping, N/V, dysphagia, early satiety |
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Term
| Prevention & Treatment of Gastroparesis |
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Definition
Tight glycemic control, smoking cessation;
Agents that increase GI motility:
- metoclopramide
- erythromycin;
Liquid diet, meal replacement drinks, traditional anti-diarrheals (loperamide) or anticholinergics |
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Term
| Prevention & Treatment of Orthostatic Hypotension |
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Definition
decrease in SBP of 20-30 mmHg upon standing;
Tight glycemic control, smoking cessation;
Volume repletion (if needed), increased salt intake, mineralocorticoids (fludrocortisone) |
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Term
| Symptoms of Urinary Incontinence |
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Definition
| dribbling, infrequent urination, incomplete/difficult bladder emptying, overflow incontinence |
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Term
| Prevention & Treatment of Urinary Incontinence |
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Definition
tight glycemic control, smoking cessation;
scheduled voiding, catheterization, infrequent pharmacotherapy needed |
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Term
| Prevention & Treatment of ED |
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Definition
Tight glycemic control, smoking cessation;
Conventional treatments may or may not work (i.e. Viagra, Cialis);
Be cautious of pts on alpha-blockers and nitrates if usine PDE-5 inhibitors |
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Term
| Symptoms of Peripheral Neuropathy |
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Definition
| burning, tingling, sensation of wearing a sock or glove, sensation of foreign object "rock" in shoe, loss of sensation to painful stimuli or temperature |
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Term
| Complications of Peripheral Neuropathy |
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Definition
injury --> foot ulcers;
charcot foot --> deformity of foot, disintegration & malformation of bones |
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Term
| Screening for Peripheral Neuropathy |
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Definition
foot exam at each PCP visit;
monofilament exam annually |
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Term
| Prevention of Peripheral Neuropathy |
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Definition
tight glycemic control;
smoking cessation;
daily foot care by pt (clean & inspect, trim nails, always wear sock & fitted shoes) |
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Term
| Treatment of Peripheral Neuropathy |
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Definition
symptomatic;
Psychotropic agents: duloxetine (Cymbalta), pregabalin (Lyrica), TCAs, SSRIs;
Anticonvulsants: carbamazepine (Trileptal), gabapentin (Neurontin), topiramate (Topamax);
Capsaicin cream;
analgesics, anti-inflammatory agents |
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Term
| Risk Factors for Macrovascular Complications |
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Definition
| family hx of CVD, hyperglycemia, HTN, hyperlipidemia, smoking, obesity, physical inactivity, metabolic syndrome |
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Term
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Definition
Goal: <130/80 mmHg;
Lifestyle modifications: reducing sodium to <1500 mg/day, weight loss, EtOH moderation, increased physical activity;
Pharmacological:
- ACE-I or ARB first line;
- diuretic (thiazide or loop) added if goal not met;
- multiple drugs generally required for most pts |
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Term
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Definition
Measure FLPs yearly;
Goal: LDL <100 (<70 optional), HDL >50, TG <150;
Treatment:
Lifestyle mods - reduce intake of sat. fats, trans fats, & cholesterol; increase fiber intake, weight loss, increase physical activity;
Pharmacology:
- statin therapy REGARDLESS of baseline lipid levels in DM pts w/ or w/o CVD >40 yrs old |
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Term
| Recommendations for Aspirin use in pts w/ DM |
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Definition
Primary Prevention:
- Type 1 or Type 2 DM w/ increased risk of CV risk;
- men >50 and women >60 yrs w/ 1 additional major risk factor;
Secondary Prevention:
- pts w/ CVD (MI, CVA, TIA, PVD, CABG) |
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Term
| Contraindications for Aspirin Use |
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Definition
| aspirin allergy, anticoagulation therapy, recent or current GI bleeding, active liver dx |
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Term
| Prevention of Infections in pts w/ DM |
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Definition
| tight glycemic control, comprehensive dental exam q6 months, influenza vaccine annually for all DM pts, pneumococcal vaccine for all adult DM pts repeated once >65 old if prev vaccine >5 years ago |
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Term
| Risk Factors for Development of Foot Ulcers |
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Definition
age >= 40 yrs;
smoking;
DM >10 yrs;
decreased peripheral pulses;
PVD;
neuropathy;
history of previous ulcers;
presence of deformity |
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Term
| Patient Education against Foot Ulcers |
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Definition
Never go barefoot or let feet become too hot or too cold;
Check feet daily for abnormalities;
Wash feet daily with lukewarm water and mild soap, dried well especially between toes;
Non-medicated powder to keep feet dry;
Calluses or corns should be cut by someone other than pt |
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