Prevention and Management of DM Complications

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Prevention and Management of DM Complications

• Shadi Al-Ahmadi

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The Presentation will include

• Hypertension
• Dyslipidemia
• CVD
• Type 2 Diabetes-Associated Retinopathy
• Diabetic Periphral Neuropathy
• Diabetic Nephropathy

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Hypertension

• Facts
• Seventy-three percent of adults with diabetes
  have
• a blood pressure level of 130/80 mm Hg or higher,
  or take prescription drugs to manage
  hypertension.
• Concomitant hypertension augments the effects of
  hyperglycemia in microvascular complications.

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Hypertension

• The target blood pressure level goal for
  individuals with type 2 diabetes should be less
  than 130/80 mm Hg .
• Pharmacologic treatment
• - ACE inhibitor.
• - When second drug is needed
• - GFR gt 50 Ml/min ? thiazide
  diuretic
• - GFR lt 50 Ml/min ? loop diuretic

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Dyslipidemia

• We should attempt to lower the LDL cholestrol
  level to less than 100 mg/dL.
• For patients with overt CVD and diabetes, an LDL
  cholesterol level of less than 70 mg/dL is
  recommended.

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Dyslipidemia

• The triglyceride level goal should be less than
  150 mg/dL.
• The HDL cholesterol level goal should be
• - gt 40 mg/dL for men.
• - gt 50 mg/dL for women.
• The statins are the drug class of choice for
  Lowering lipid levels in the management of type 2
  diabetes.

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Cardiovascular Disease

• 55 of adult patients with diabetes have CVD
• Annual assessment of Cardiovascular risk factors
  is recommended.
• In asymptomatic patients older than 40 years
  type 2 diabetes and another risk factor for
  coronary heart disease, treatment using a statin
  and aspirin is recommended.

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Cardiovascular Disease

• Secondary prevention of CVD in patients with type
  2 diabetes include
• - optimizing control of diabetes,
  hypertension, body weight, and lipid levels.
• - ACE inhibitor
• - aspirin
• - statin
• - Beta blockers

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Type 2 Diabetes-Associate Retinopathy

• Diabetic retinopathy (DR) is a leading cause of
  vision loss in adults ages 20 to 74 years.
• The prevalence is directly related to the length
  of lime a patient has diabetes.
• The majority of patients with type 2 diabetes
  exhibit some degree of DR within 20 years of
  diagnosis.

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Type 2 Diabetes-Associate Retinopathy

• Although retinopathy typically develops
  approximately 5 years after hyperglycemia
  begins, many patients with type 2 diabetes with
  DR are undiagnosed for long periods.
• The initial examination should be performed at
  the time of diabetes diagnosis. with subsequent
  examinations annually.

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Type 2 Diabetes-Associate Retinopathy

• Laser Phototherapy is a widely used therapy to
  manage DR.
• It was found to decrease the risk of
  proliferative DR-induced vision loss from
  15.9 to 6.4 in patients with diabetes.

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Diabetic Periphral Neuropathy

• Neuropathies are some of the most common
  long-term diabetic complications, with up to 47
  of patients developing peripheral neuropathy
  (DPN).
• Screening for peripheral neuropathy should be
  performed when the diagnosis of type 2 diabetes
  is made.
• Patients should be screened annually thereafter.

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Diabetic Periphral Neuropathy

• Current guidelines recommend an annual
  comprehensive foot screening that should include
• - inspection and assessment of pulses.
• - assessment of protective sensation using
  monofilament one of the following
• 128-Hz tuning fork
• ankle reflex testing.
• pinprick sensation rest.

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Diabetic Periphral Neuropathy

• Management
• Patients with DPN should receive enhanced
  education regarding root care and special
  footwear.
• Two drugs are FDA-approved to manage chronic pain
  associated with DPN .

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Diabetic Periphral Neuropathy

• Duloxetine (Cymbalta) is a ser0tonin
  norepinephrine reuptake inhibitor.
• 60 to 120 mg PO OD
• Pregabalin (Lyrica) is an anticonvulsant.
• 100 mg PO TID

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Diabetic Nephropathy

• Diabetes is a leading cause of ESRD.
• Albuminuria is the earliest indicator of diabetic
  nephropathy.
• Microalbuminuria is diagnosed when levels of
  urinary albumin exceed 30 mg/day or 20 mcg/min.

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Diabetic Nephropathy

• 20 to 400 of those with type 2 diabetes and
  microaIbuminuria develop nephropathy.
• But only 20 progress to ESRD within 20 years.
• The urinary albumin level should be measured
  starting at diagnosis and then annually in
  patients with newly diagnosed type 2 diabetes.

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Diabetic Nephropathy

• Medical treatment include
• - ACE Inhibitor
• - thiazide or loop diuretic.
• Annual measurement of serum creatinine level to
  assess renal function and stage of chronic kidney
  disease is recommended.

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• THANK YOU