Cotton wool spots are produced by
Microinfarcts
Normal Vs abnormal vessel in retina
More than 1 branching point
Tortuous
Diabetic neuropathic cachexia
Amyotrophy and peripheral neuropathy
Rx for amyotrophy
Insulin
Pentoxyfylline
Low dose methyl prednisolone
Which SUR can be used in a pt with CVD
Glimepride
Why glimepride is cardiac safe?
It is specific for pancreatic beta cell K+ channel
Advantage of incretin mimetics in CVS
Inotropic
Switches metabolism from fatty acids to glucose
ACCORD trial
Action to Control Cardiovascular Risk in Diabetes
Results of ACCORD trial
- Aggressive blood pressure control to normal levels does not reduce cardiovascular mortality in DM2
- combination of statin and fibrates is not better than statin alone
- intensive blood glucose control(lower HbA1c to less than 6) was associated with higher mortality
Combined lipid therapy in accord trial was useful in
Pts with lowest HDL and highest triglycerides
UKPDS
United Kingdom Prospective Diabetes study
Target HbA1C in diabetics with risk factors for cardiovascular disease
7-7.9
Standard target level of systolic BP in diabetics with cardiovascular risk factors
Less than 140mm Hg
ACCORD EYE study
Intensive glycemic control,combination lipid therapy and not intensive blood pressure reduction decreased progression to diabetic retinopathy
UKPDS results
- reducing HbA1C to 7 reduced risk of all diabetic complications
- reduction of blood pressure to 142/82 reduced microvascular and macrovascular complications associated with diabetes
DCCT
Diabetes Control and Complications Trial
UGDP
University Group Diabetes program
ADVANCE trial
Action in Diabetes and Vascular disease
VADT trial
Veteran affairs diabetes trial
Which microvascular complication is significantly reduced in aggressive blood glucose control in DM2
Nephropathy
