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A brief presentation referencing 2013 ADA guidelines
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T2 D
MREAL. DEADLY. NOT FUNNY.
by Christine Hortillosa
FAST FACTS
7th Leading Cause of Death, 2007
$174B Total Costin 2007
90% are withT2DM
25.8 MDiabetics in US
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.
OUTLINE
• Clinical Presentation• Diagnosis• Monitoring• Treatment Options• Other Considerations
– Immunization– Lifestyle Modification– Hypoglycemia Awareness
CLINICAL PRESENTATION
• Hallmark symptoms1. Polyuria2. Polydipsia3. 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
2. If did not meet first criteria, start at age 45 yo3. If results are normal, test Q3 years
DIAGNOSIS
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 OR3. 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.
THERAPEUTIC GOALS
Glycemic Target
ADA AACE
A1c <7% ≤6.5%
Preprandial 70-130 mg/dl
<110 mg/dl
Postprandial <180 mg/dl <140 mg/dl
TREATMENT OPTIONS
1. Individualized glycemic targets and glucose lowering therapies
2. Diet, education, and exercise 3. Metformin: first-line drug4. After metformin, combination therapy5. If failed oral agents, insulin 6. Involve the patient 7. Comprehensive cardiovascular reduction
• 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
• 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
IMMUNIZATION
• 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
LIFESTYLE MODIFICATION
• 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
I AM BARACK OBAMA AND I APPROVE THIS MESSAGE.
HYPOGLYCEMIA AWARENESS
• 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
PREVENTIVE CARE
• 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%
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.
2030 || 552 MILLIONDiabetics
Worldwide
Stop the Spread. Watch the Bread.
How ‘bout tortilla?
REFERENCES
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.