Prevention and Tx of Chronic DM complications Flashcards Preview

Endocrine 1 > Prevention and Tx of Chronic DM complications > Flashcards

Flashcards in Prevention and Tx of Chronic DM complications Deck (23):
1

Retinopathy screening for T1DM and T2DM

- Type 1
• Adults and children ≥ 10 years old
• 5 years after onset of DM
- Type 2
• Adults at time of dx

2

Retinopathy screening for women who want to get pregnant and have pre-existing retinopathy

• Before pregnancy/1st trimester
• Monitor every trimester for one year postpartum
• Pregnancy accelerates onset of retinopathy

3

What interventions lower the risk of retinopathy

optimize
- glycemic control
- blood pressure control

4

6 risk factors that increase the risk of progression to ESRF

- HTN
- Albuminuria or proteinuria
- Poor glycemic control
- Smoking
- Possibly high dietary intake of protein
- Possibly hyperlipidemia

5

What are interventions that will prevent or delay progression to overt nephropathy

- Optimize glycemic control
- Optimize blood pressure control
- Limit dietary intake of protein (non-dialysis dependent pts) to 0.8 g/kg

6

ACE inhibitors and ARB recommendations for DM pts
- when recommended
- when not recommended

- NOT recommended as primary prevention of kidney disease in pts with DM and normal blood pressure and normal UACR(<30 mg/g)
- Is recommended for non-pregnant pt with modestly elevated UACR (30-299 mg/day) and is recommended for thos with urinary albumin excretion >300 mg/day
• Continue to monitor UACR to assess reponse to treatment and progression of DM kidney disease

7

If pt is on an ACE inhibitor, ARB, or diuretic, what should be monitored

- for increases in serum creatinine
- changes in potassium

8

What needs to happen when eGFR < 60 and <30

- When eGFR < 60, eval and manage potential complications of CKD
- Refer for renal replacement eval if eGFR < 30

9

What are the microalbumin screening guidelines for T1DM and T2DM

Type 1 DM
• Adults and children ≥ 10 years old
• 5 years after onset of DM
• Annual f/u
- T2DM
• Adults shortly after dx
• Annual f/u

10

What is the testing requirement on microalbumin before can consider a patient to have albuminuria?

D/t to variability in urinary albumin excretion, 2-3 specimens collected over 3-6 month period should be abnl

11

ADR/CI of ACE inhibitors and ARBS (3)

- May exacerbate hyperkalemia (monitor serum Cr and K+)
- Dry nonproductive cough
- ACEi CI during pregnancy, no data on ARBs but recommend don’t use during pregnancy

12

What interventions lower risk of neuropathy

- Tight glycemic control started early in course of DM
- Foot care education: inspect feet daily and practice good foot care

13

What are the diagnostic criteria required to diagnose DPN

≥ 2 abnormalities:
- sensory loss assessed by pinprick, temperature, vibration perception
- Loss of pressure sensation (Sennes-Weinstein monofilament)
- Achilles reflex (not sure what happens with it, I'm assuming it is decreased? It wasn't stated in the packet)

14

What are appropriate lipid lowering drugs for different DM patient situations

- DM + atherosclerotic CVD = high intensity statin + lifestyle changes
- DM <40 yo with atherosclerotic CVD risk factors = consider moderate-intensity statin + lifestyle changes
- DM age 40+ without atherosclerotic CVD = moderate-intensity statin + lifestyle
- Statins CI during pregnancy

15

Monitoring plan for pts on lipid lowering drugs

???

16

What are the LDL, HDL, and TG goals for people with DM

- LDL level of < 100 mg/dl
- HDL levels > 40 mg/dl for men and > 50 mg/dl for women
- TG levels < 150 mg/dl

17

How to prescribe ASA for primary prevention of CVD in pts with DM

- T1DM or T2DM who are at increased CVD risk (Framingham 10 year risk is >10%)
** Data is mostly for people >50, not much data of people < 40

18

How to prescribe ASA for secondary prevention of CVD in DM pts with established heart disease

ASA (75-162 mg/day) for all

19

What to Rx if patient has atherosclerotic CVD and documented ASA allergy

Clopidogrel

20

What to Rx if DM pt has acute coronary syndrome

use dual antiplatelet therapy (ASA + PsY12 inhibitor) for up to a year

21

What are bp goals for pt with DM

- <140/90 mmHg
- <130/80 mmHg may be appropriate if at high risk of CVD and can be achieved without undue tx burden

22

What immunizations should DM pt receive?

- Influenza yearly
- Prevnar 13 to adults 65 and older (not at the same time as Pneumovax)
- HepB for all 19-59 and considered in those >59

23

What additional screening is recommended for T1DM

Celiac
• Screen soon after Dx.
• Repeat test is sx occur (diarrhea, weight loss, etc)

Hypothyroidism
• Anti-TPO and anti-TG screening at Dx
• Monitor TSH after metabolic control is established. If abnl, order T4
• Check ever 1-2 years, esp if pt monitors sx of thyroid dysfunction, thyromegaly, abnl growth rate