8: DM Complications

Question 1

What is cardiovascular dysmetabolic syndrome?

Answer 1

• It is associated with HTN, HLD, DMT2, obesity, and proteinuria (risk for CVD mortality).
• It includes abnormalities in thrombosis and fibrinolysis (increased platelet aggregability).

Question 2

What comorbidity results in 80% of DM mortality?

Answer 2

• CV complications
  
  • 75% from coronary atherosclerosis
  • 25% from cerebral or peripheral vascular disease

Question 3

HTN in DM leads to increased mortality, _____, and _____.

Answer 3

HTN in DM leads to increased mortality, ESRD**, and **CAD (including MI and CHF).

Question 4

What is a common comorbidity at time of DMT2 diagnosis?

Answer 4

CHD (50%)

Question 5

Who should take ASA therapy and at what dose?

Answer 5

1. Men 50+
2. Women 60+
3. DM CVD risk >10% + family hx of CAD, albuminuria, smoking, HTN, or HLD.
4. Consider in pts 30+ with multiple risk factors and CVD risk 5-10% (use clinical judgement)
5. 75-162 mg/day

Question 6

Which group of diabetics are not recommended to take ASA?

Answer 6

• Low risk for CVD (10-year risk <5%)
• Pts under age 21 (contraindicated)

Question 7

When would you do a stress test in DM?

Answer 7

• Cardiac symptoms
• Abnormal resting EKG
• History of PVD
• Sedentary lifestyle (over age 35 and plans for a vigorous exercise program)
• Persons with two or more risk factors

Question 8

How often are CAD risk factors assessed?

Answer 8

Yearly (minimum)

Question 9

If a diabetic has CVD and is allergic to ASA, what should be used?

Answer 9

75 mg/day Clopidogrel (Plavix)

Question 10

If a patient is diagnosed with DMT1, what common comorbidity would you look for?

Answer 10

• HTN
• Prevalence of HTN in Type 1 is 17% at baseline and 30% at 10 years.

Question 11

What is the goal BP in DM?

Answer 11

• <140/90
• Measure at every visit!

Question 12

In DMT2, who has an increased risk for HTN?

Answer 12

AA and Hispanics compared to Whites

Question 13

Over 75% of all hospitalizations for DM complications are d/t _____.

Answer 13

Over 75% of all hospitalizations for DM complications are d/t atherosclerosis.

Question 14

How much will your BP drop with:

• smoking cessation?
• moderation of alcohol consumption?
• sodium restriction of ~2,000 mg/day?
• moderate intense physical activity?
• weight loss?

Answer 14

• Smoking: 2-4 (after 1 week)
• Alcohol: 2-4
• Sodium: 2-8
• Physical activity: 4-9
• Weight: 5-20/10 kg

Question 15

These abnormalities are associated with what condition? Abnormalities in vascular endothelial function, such as: increased secretion of vasoconstrictors (thromboxanes) and decreased secretion of vasodilators (nitric oxide), which leads to decreased vasodilatory response to ischemia.

Answer 15

Cardiovascular Dysmetabolic Syndrome