Prevention and Tx of Chronic DM complications Flashcards Preview

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

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


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


What interventions lower the risk of retinopathy

- glycemic control
- blood pressure control


6 risk factors that increase the risk of progression to ESRF

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


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


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


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

- for increases in serum creatinine
- changes in potassium


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


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


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


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


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


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)


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


Monitoring plan for pts on lipid lowering drugs



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


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


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

ASA (75-162 mg/day) for all


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



What to Rx if DM pt has acute coronary syndrome

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


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


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


What additional screening is recommended for T1DM

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

• 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