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Endocrinology > Diabetes - Complication 1 - Intro, retinopathy & nephropathy > Flashcards

Diabetes - Complication 1 - Intro, retinopathy & nephropathy Flashcards

1
Q

What are the 2 initial treatment aims for Diabetes Mellitus?

A
  • Control and treat symptoms of diabetes
  • Minimise the occurrence of hypoglycaemia
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2
Q

What is the longer term treatment aim for Diabetes Mellitus?

A
  • Prevent development or slow the progression of complications associated with the disease.
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3
Q

What are the 2 major categories of diabetic complications?

A
  • Caused by Micro-vascular disease
  • Secondary to Macro-vascular disease
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4
Q

Which type of diabetes are caused by Micro-vascular Disease?

A
  • Retinopathy (Eyes)
  • Nephropathy (Kidneys)
  • Neuropathy (Nerves)
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5
Q

Which complications of DM are secondary to Macro-vascular Disease?

A
  • Hypertension (Blood pressure)
  • Hyperlipidaemia (Blood lipids)
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6
Q

How common is Retinopathy in diagnosis of Type 2 diabetes? (percentage wise)

A

21%

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7
Q

How common is Nephropathy in diagnosis of Type 2 diabetes? (percentage wise)

A

18.1%

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8
Q

How common is Erectile dysfunction in diagnosis of Type 2 diabetes? (percentage wise)

A

20%

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9
Q

How common is Absent foot pulses, in diagnosis of Type 2 diabetes? (percentage wise)

A

13%

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10
Q

How common is Ischaemic skin changes (foot), in diagnosis of Type 2 diabetes? (percentage wise)

A

6%

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11
Q

How common is abnormal vibration threshold (foot), in diagnosis of Type 2 diabetes? (percentage wise)

A

7%

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12
Q

What percentage of Type 2 diabetics are prevalent to Cerebrovascular disease and what is the risk associated?

A
  • 7%
  • 2-3 x increased risk of fatal stroke
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13
Q

What percentage of Type 2 diabetics are prevalent to abnormal ECG and what is the risk associated?

A
  • 18%
  • 2-4 x increased risk of fatal heart disease
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14
Q

What percentage of Type 2 diabetics are prevalent to hypertension and what is the risk associated?

A
  • 35%
  • 2-4 x increased risk of fatal heart disease
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15
Q

What percentage of Type 2 diabetics are prevalent to intermittent claudication and what is the risk associated?

A
  • 4.5%
  • 15 x increased risk of amputation
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16
Q

What does evidence show about management of diabetes?

A

Good diabetes care reduces risk of complications & delays rate of progression of complications

Two major trials:
- The Diabetes Control & Complications Trial (DCCT)
- The United Kingdom Prospective Diabetes Study (UKPDS)

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17
Q

What are the 2 major controllable risk factors?

A
  • Uncontrolled (raised) blood glucose (Persistent hyperglycaemia)
  • Uncontrolled (raised) blood pressure (Persistent hypertension)
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18
Q

Why are the eyes, kidneys and nerves vulnerable to damage? (Microvascular Complications)

A

Because the endothelial cells of the retina, kidney and peripheral nervous system allow glucose to enter the cells even in the absence of insulin.

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19
Q

What are the 4 main symptoms of Diabetic Eye Disease?

A
  • Blurred vision (diplopia=double vision)
  • Cataracts (lens of the eye becomes progressively opaque) at an earlier age than usual
  • Glaucoma (raised pressure of fluid inside the eye) which is resistant to treatment
  • Retinopathy (disease of the retina)
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20
Q

Diabetic Retinopathy is the most common cause of blindness in people aged 25-45 in the UK. True or False

A

False
- Aged 30-65

21
Q

Diabetic Retinopathy can be present in 1 in ____ of newly diagnosed type 2 diabetics.

A

3

22
Q

Within 20 years of diagnosis of diabetes, diabetic retinopathy is present in almost all type ____ diabetic patients.

A

Type 1

23
Q

Within 20 years of diagnosis of diabetes, diabetic retinopathy is present in ____% of Type 2 diabetic patients.

A

60%

24
Q

How does Diabetic Retinopathy start and progress?

A
  1. Starts with small haemorrhages and abnormal spots of hardened exudates (leaked fluids)
  2. Progresses to infraction of the retina => areas with little or no blood supply
  3. Eventually, new blood vessels form but they are fragile
  4. Tend to bleed and destroy the retina unless they are treated early enough
25
Q

What are the risk factors for diabetic retinopathy?

A
  • Hyperglycaemia
  • Hypertension
  • Duration of diabetes
  • Diabetic nephropathy
  • Raised blood triglycerides (hyper-triglyceridaemia)
  • Pregnancy
  • Smoking
  • Rapid improvement in control of blood sugar
    - In sight-threatening disease, must stabilise the retina before improving glycaemic control
26
Q

How can the development or progression of diabetic retinopathy be prevented?

A
  • Good glycaemic control (blood glucose)
  • Effective management of hypertension
  • Avoidance of smoking
27
Q

What are the treatment options for Diabetic Retinopathy?

A
  • Development/progression can be prevented by good glycaemic control, effective management of hypertension and avoidance of smoking
  • Regular screening
  • Laser treatment to seal off the leaking blood vessels
28
Q

What is Diabetic Nephropathy?

A

Kidney damage caused by diabetes

29
Q

Diabetic nephropathy is the leading cause of end-stage renal failure in the western world. True or False

A

True

30
Q

After how many years does nephropathy occur after onset of diabetes?

A

15-25 years

31
Q

Diabetic nephropathy is responsible for more than 1 in how many patients starting renal replacement therapy (dialysis)?

A

1 in 3 patients

32
Q

Once dialysis is required for diabetic nephropathy, what other complications would most patients also have?

A
  • Retinopathy
  • Neuropathy
  • Autonomic dysfunction
33
Q

What is Proteinuria?

A
  • Presence of protein (mainly albumin) in urine.
  • A common sign of renal disease
34
Q

What is Microalbuminauria?

A

Presence of small amount of albumin in urine.

35
Q

How is proteinuria detected?

A

Presence is detected using a urine dipstick (e.g. Combur-3 Test). If a repeated positive occurs for significant proteinuria, a 24-hour urine collection should be done.

36
Q

How is Microalbuminauria detected?

A

Detected with specialist dipsticks (e.g. microalbustix) / radioimmunoassay

37
Q

Microalbuminauria is an early indicator of diabetic ______________.

A

Nephropathy

38
Q

For men what albumin:creatinine ratio (ACR) suggests clinically significant microalbuminuria?

A

Men > 2.5mg/mmol

39
Q

For women what albumin:creatinine ratio (ACR) suggests clinically significant microalbuminuria?

A

Women > 3.5mg/mmol

40
Q

What percentage of patients with Type 1 diabetes for over 30 years develop microalbuminuria?

A

40%

41
Q

What percentage of patients with type 1 diabetes for over 25 years develop proteinuria?

A

20%

42
Q

Approximately what percentage of type 2 diabetics develop some degree of nephropathy?

A

25-30%

43
Q

What percentage of patients with microalbuminuria who survive for 10 years will develop proteinuria?

A

20%

44
Q

For both type 1 and type 2 diabetes, what are the treatment options for diabetic nephropathy?

A
  • Improve control of diabetes to slow progression
    - Aim for HbA1c of <7%, target <6%
  • Aggressive control of blood pressure
    - Type 1: NICE target <130/80
    - Type 2: NICE target <140/90 (<80yrs)
    <150/90 (>80yrs)
45
Q

For diabetic nephropathy what additional treatment option should be considered for type 2 diabetics?

A

Treat any other risk factors for coronary heart disease aggressively (e.g. smoking cessation advice)

46
Q

Aggressive control of blood pressure is a treatment option for diabetic nephropathy. How is this achieved?

A
  • Usually required multiple drug therapy
  • START WITH ACE-I - Reno-protective
  • If tragedy BP is not achieved, add further drugs e.g. CCB or diuretic
  • CCB - use amlodipine or felodipine (Reno-protective action)
  • Restrict dietary sodium intake to less than 100mmol Na+ per day
47
Q

Who showed that Captopril prevented or delayed progression of renal disease in patients with Type I diabetes?

A

Lewis et al (1993)

48
Q

What is Captopril?

A

Captopril is an FDA-approved medication used in the management of hypertension, left ventricular dysfunction after myocardial infarction, and diabetic nephropathy.

Endocrinology (14 decks)

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