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OU Module Endo Fall 2018 > Diabetes Chronic Complications Exam 2 > Flashcards

Diabetes Chronic Complications Exam 2 Flashcards

1
Q

UKPDS clinical trials

A

↓ glycemia = ↓ MICROvascular complications

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2
Q

DCCT/EDIC clinical trials

A

↓ glycemia = prevention/delay MICROvascular complications

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3
Q

UKPDS Follow-Up clinical trials

A

↓ glycemia = ↓ MACRO and MICROvascular complications

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4
Q

ACCORD clinical trials

A

↓ glycemia = Increased MACROvascular complications

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5
Q

ADVANCE clinical trials

A
  • No difference in macrovascular events for intense group (P=0.32)
  • No difference in death from CV cause (P=0.12)
  • Difference for nephropathy (microvascular) (4.1% vs. 5.2%; P=0.0006)
  • ↓ glycemia = decreased MICROvascular complications
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6
Q

VADT clinical trials

A

↓ glycemia = ↓ MICROvascular complications

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7
Q

DCCT/EDIC Follow-Up clinical trials

A

↓ glycemia = prevention/delay MACRO and MICROvascular complications

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8
Q

Microvascular Complications

A
  • Nephropathy (kidneys)
  • Neuropathy (nerves)
  • Retinopathy (eyes)
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9
Q

Macrovascular Complications

A
  • HTN
  • Lipid management
  • Antiplatelet
  • Think: CVD, CAD, PAD
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10
Q

What are other chronic complications other than the micro / macro - vascular complications?

A
  • Dental care
  • Celiac
  • Thyroid disorders
  • Immunizations
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11
Q

Screening requirements for diabetic kidney disease

A
  • DM II: at diagnosis
  • DM I: within 5 years of diagnosis
  • DM I WITH HTN: at diagnosis
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12
Q

Explain the monitoring for diabetic kidney disease

A

Annually

  • urine test to measure albumin/Cr ratio (measures albuminuria)
  • eGFR
  • SCr
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13
Q

What can cause a albumin/Cr ratio to be high?

A
  • short term hyperglycemia
  • exercise
  • UTI
  • marked HTN
  • CHF
  • acute febrile illness
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14
Q

spot collections in relation to albuminuria

A

two out of three spot collections over 3-6 month period must show elevations

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15
Q

What are the goals for albuminuria?

A

< 30 mg/g creatinine

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16
Q

What is the treatment for diabetic kidney disease?

A
  • first line: ACEI or ARB (ACEI decreases progression to albuminuria by 55%)
  • if ACEI or ARB maxed, may add on these therapies to achieve BP goal: diuretics, CCB, BB
  • Restrict dietary protein 0.8g/kg body weight/day
  • Optimize blood pressure and glycemic control
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17
Q

What are the prevention measures from diabetic kidney disease?

A
  • glycemic control
  • BP controll
  • don’t smoke
  • early intervention with ACEI or ARB but do not add if there is no sign of HTN or microalbuminuria
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18
Q

Symptoms of Peripheral Neuropathy

A
  • pain described as burning, stabbing, electric shocks
  • protective sensation gone
  • cold and hot discrimination reduced / absent
  • pinprick sensation reduced / absent
  • numbness, tingling
  • poor balance
  • sensations reduced / absent
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19
Q

Symptoms of Autonomic Neuropathy

A
  • Orthostatic hypotension
  • resting tachycardia (>100 bpm)
  • exercise intolerance
  • Constipation
  • Gastroparesis
  • Erectile dysfunction
  • Bladder dysfunction (UTIs, pyelonephritis, incontinence)
  • Autonomic failure in response to hypoglycemia (lack of glucagon response)
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20
Q

Screening requirements for Neuropathy

A
  • DM II: at diagnosis

- DM I: within 5 years of diagnosis

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21
Q

Explain the monitoring for Neuropathy

A

Annually

  • pressure sensation using a 10-g monofilament AND
  • tests of pinprick sensation OR
  • temperature OR
  • vibration sensation
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22
Q

What are the components of a foot exam?

A
  • Visual Inspection

- Vascular Inspection

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23
Q

Foot Exam: Visual Inspection

A

Presence of:

  • dry skin
  • absence of hair
  • ingrown toenails
  • interspace maceration
  • ulceration
  • ulcers
  • corns or calluses
  • deformities (prominent metatarsal heads, hammertoes, claw toes)
  • ill-fitting shoes
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24
Q

Foot Exam: Vascular Inspection

A

Palpation of dorsalis pedis and posterior tibial pulses and ankle-brachial index (ABI < 0.9 is consistent with peripheral arterial disease)

25
Q

When should neuropathy be treated?

A

if pt is experiencing symptoms

26
Q

What is the treatment for Neuropathy?

A
  • Pregabalin (Lyrica)
  • Duloxetine (Cymbalta)
  • Tapentadol
27
Q

What are the prevention measures from neuropathy ?

A
  • glycemic controls

- foot care education

28
Q

Symptoms of Retinopathy

A 
– Blurry vision 
– Floaters 
– Fluctuating vision 
– Distorted vision 
– Dark areas in vision 
– Poor night vision 
– Impaired color vision 
– Partial or total loss of vision
29
Q

Screening requirements for Retinopathy

A
  • DM II: at diagnosis AND after BS stabilizes

- DM I: within 5 years of diagnosis

30
Q

Explain the monitoring for Retinopathy

A
  • if no retinopathy, repeat every 2 years
  • if retinopathy present, repeat every year
  • if retinopathy worsens, monitor more frequently
31
Q

What are the goals for Retinopathy?

A
  • Prevent the progression of diabetic retinopathy and vision loss
  • provides an opportunity to treat when vision loss can still be prevented or reversed
32
Q

What is the treatment for Retinopathy?

A
  • Laser photocoagulation surgery

- Anti–vascular endothelial growth factor injections (Anti VEGF)

33
Q

Retinopathy: Laser photocoagulation surgery

A

– Disadvantages: Destructive, peripheral vision loss, night vision loss, does not restore vision loss
– Advantages: less expensive, 1 or 2 treatments

34
Q

Retinopathy: Anti VEGF

A

– Drugs: Ranibizumab, Bevacizumab, Aflibercept
– Advantages: Highly effective, superior visual outcomes in head to head trials
– Disadvantages: Expensive, invasive, fear

35
Q

What are the prevention measures from HTN?

A
  • BP control
  • glycemic control
  • improved lipid profile
36
Q

Screening requirements for HTN

A

at every routine visit

37
Q

What are the goals for HTN?

A
  • target

- <140/<90 mmHg per ADA and JNC 8 Recommendations

38
Q

What are lifestyle treatments that can help in blood pressure reduction

A
  • Weight loss
  • DASH diet
  • Physical activity
  • Sodium restriction
  • Alcohol consumption
39
Q

Average SBP Reduction in Weight Loss

A

5-20 mmHg

40
Q

Average SBP Reduction in the DASH diet

A

8-14 mmHg

41
Q

Average SBP Reduction in Physical Activity

A

2-8 mmHg

42
Q

Average SBP Reduction in Sodium Restriction

A

4-9 mmHg

43
Q

Average SBP Reduction in Alcohol Consumption

A

2-4 mmHg

44
Q

What is the treatment for HTN?

A
  • ACEI or ARB if concomitant increased urinary albumin excretion (>30)
  • reduce CV risk in patients with diabetes (thiazide diuretics, ACEI, ARB, non-DHP CCB) if no albuminuria
45
Q

What are the prevention measures from HTN?

A
  • maintain BP control

- UKPDS: 10mmHg decrease = risk and event of complications, deaths related to DM, reduction in MI

46
Q

Screening requirements for Dyslipidemia

A

at diagnosis for both types

47
Q

Explain the monitoring for Dyslipidemia

A
  • annual lipid profile for ages 40-75

- if age <40 and lipid panel normal and not initiating statin, reassess every 5 years

48
Q

What are the high-intensity lipid therapies?

A
  • atorvastatin

- rosuvastatin

49
Q

What are the moderate-intensity lipid therapies?

A
  • atorvastatin
  • rosuvastatin
  • simvastatin
  • pravastatin
  • lovastatin
  • fluvastatin
  • pitavastatin
50
Q

What are the prevention measures from Dyslipidemia?

A

– Weight loss
– Increased physical activity
– Medical nutrition therapy

51
Q

Celiac disease

A
  • Screen children at diagnosis

- If normal, don’t recheck unless symptomatic

52
Q

Hypothyroidism

A
  • Screen children at diagnosis

- If normal, recheck every 1-2 years

53
Q

Dental Care

A
  • Periodontal disease is more severe, not necessarily more prevalent
  • Dental exam every 6-12 months
54
Q

immunization recommendations

A
  • Hepatitis B
  • Pneumonia
  • Influenza
55
Q

Hepatitis B

A

Series is 3 injections total given at 0, 1 and 6 months

56
Q

Pneumonia

A
  • PPSV23 before 65
  • PCV13 after 65
  • PPSV23 after 65
  • PPSV23 5 years apart
  • PPSV23 and PCV13 12 months apart
57
Q

Influenza

A
  • start at 6 months of age

- two doses in pt’s under 9 years old

58
Q

Overall Prevention

A
  • Glycemic Control
  • Reduce Complications
  • Control Blood Pressure

OU Module Endo Fall 2018 (27 decks)

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