Complications of Diabetes- Pales Flashcards

Question

Factors affecting Glycohemoglobin

Answer 1

Conditions that shorten erythrocyte life span will decrease Hemoglobin A1C - Hemolytic anemia - Hypersplenism - Frequent transfusions Diseases in which lack of new reticulocytes entering the pool results in aged RBCs being in circulation will cause hemoglobin A1C to progressively rise - Aplastic anemia

Answer 2

Quite new and not well studied yet method Done over 72 hours or combined with insulin pumps Not very reliable for a precision of individual numbers, but useful to follow trends

Answer 3

A ten-year study of 1,441 type 1 patients in 29 centers Intensive therapy (patients’ average HbA1c was 7.2) versus conventional therapy (patients’ average HbA1c was 9.0) Retinopathy decreased by up to 76 % Nephropathy decreased by up to 56 % Neuropathy decreased by up to 60 %

Answer 4

5,102 patients with Type II DM in 23 centers in the U.K. New diabetics Duration -- 15 years ``` Intensive vs. conventional treatment -> HbA1c 7.9 to 7.0 Microalbuminuria down 33%, Sensory neuropathy decreases 40% 1 point less in HbA1c --> decreases of: 17% in All-Cause Mortality 18% in MI 15% in CVA 35% in all Microvascular Endpoints 18% in Cataract extraction 23% in All Diabetes related endpoints ``` Annual incidence of major hypoglycemic events in patients treated with insulin----- 2.3% patients/year One death from hypoglycemia out of 27,000 patient-years of intensive therapy No increase in CV. events with sulfonuria or with insulin

Answer 5

Over 10000 DM pts. ages 40-79 (mean 62)who had cardiovascular disease or had evidence of significant atherosclerosis, albuminuria, or LVH or at least two additional risk factors for cardiovascular disease (dyslipidemia, hypertension, current status as a smoker, or obesity). 2 randomized groups - Targeting HbA1c of 7-8 (achieved average of 7.5) - Targeting HbA1c of 6 (achieved average of 6.4) Baseline Hb A1c was 8.1 Physicians could use any oral or injectable diabetic medications in any combination Trial stopped earlier Intervention group had a relative increase in mortality of 22% and an absolute increase of 1.0% after a mean of 3.5 years. Equivalent to one extra death for every 95 patients Patients in both groups had lower mortality than reported in epidemiologic studies of similar patients. Cause of increased mortality is unknown

Answer 6

A randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes ``` Inclusion criteria Type 2 diabetes mellitus Age 55 years or older Additional risk of vascular event Age ≥ 65 years History of major macrovascular disease History of major microvascular disease First diagnosis of diabetes >10 years prior to entry Other major risk factor Any level of blood pressure Any level of glucose control but no definite indication for long-term insulin ``` Intensive control arm Gliclazide MR (sulfonylurea) in all participants Unrestricted additional therapy to achieve target HbA1c≤6.5% Standard control arm Sulfonylurea other than Gliclazide MR Unrestricted additional therapy according to standard local guidelines All other treatment at discretion of treating physician Intensive glucose control strategy More frequent visits Emphasis on lifestyle management Drug titration at physician’s discretion based on HbA1c and FBG levels:

Answer 7

``` Hemoglobin A1c at final visit 7.3 vs. 6.5 Combined primary outcomes of Major macro or microvascular event Relative risk reduction--10%, p=0.013 Major macrovascular events Relative risk reduction--6%, p=0.32 Major microvascular events Relative risk reduction--14%, p=0.015 All-cause mortality Relative risk reduction - 7%: p=0.28 ``` Intensive glucose control resulted in: 10% reduction in combined primary outcome 14% reduction in microvascular events 21% reduction in nephropathy No significant effects on macrovascular events No significant effects on all-cause or cardiovascular mortality Consistent treatment effects in patient subgroups Conclusions on safety: Intensive glucose lowering was safe No excess mortality No weight gain No excess of serious sequelae from hypoglycemia Death or disability Cognitive function

Answer 8

1791 patients from age 50 to 69 years with type 2 diabetes Standard (HbA1c 8.4%) vs intensive glucose control(HbA1c 6.9%) 97% of the subjects were men. Only macrovascular complications were measured No significant difference in the primary outcome Subgroup of patients with low coronary calcium score showed a reduced number of cardiovascular events with intensive therapy.

Answer 9

Intensive control of diabetes mellitus has a definite positive effect on the rate of microvascular complications Intensive control of diabetes mellitus has a modest positive effect on the rate of macrovascular complications only in a newly diagnosed diabetics and those with no or early macrovascular complications Effect of hypoglycemia (including occult hypoglycemia) is unclear Goal of Hb A1c of 7 remains the goal for most patients Multifaceted approach to prevention of complication including glucose, blood pressure and lipids control is more appropriate for this multifaceted disease

Answer 10

Optimize glycemic and blood pressure control | Yearly retinal exam

Answer 11

Optimize glycemic control | Annual foot exam (including monofilament) and visual inspection at every visit

Answer 12

Optimize glucose and blood pressure control Annual serum Creatinine/GFR calculation and microalbuminuria determination Limit protein intake to 0.8-1.0 g/kg in earlier stages, and 0.8 g/kg in later stages

Answer 13

Aspirin for patients over 40 or those with more than 1 risk factor Smoking Cessation Manage HTN and Hyperlipidemia Assess for PVD with pedal pulses and ABI ACEI/ARBS with HTN or without if over 55 Silent ischemia may be a problem, so may need to be proactive with cardiac testing

Answer 14

Statement of short- and long-term goals Individualized nutrition recommendations and instructions, preferably by a registered dietitian Recommendations for appropriate lifestyle changes Medications Regular lab workups. Blood glucose monitoring instructions Consultations for specialized services Agreement on continuing support, follow up and return appointments

Complications of Diabetes- Pales Flashcards

(38 cards)