Chronic Complications- Microvascular

Question 1

Microvascular complications

Answer 1

Retinopathy, nephropathy, neuropathy

Question 2

Nephropathy treatment

Answer 2

Optimize glucose and blood pressure control

Consider use of SGLT2i or GLP-1 RA in patients with T2DM and CKD

Assess urinary albumin once a year

ACEi/ARB is recommended when urinary albumin-to-creatinine ratio is ≥300mg/g (macroalbuminuria) and/or eGFR is <60 mL/min (basically Stage 3a, 3b, 4, 5 CKD)

Question 3

A1C goal for hyperglycemia

Answer 3

<6.5%

Question 4

Management recommendation for hyperglycemia in CKD

Answer 4

Avoid metformin in moderate-severe CKD

Consider dose reductions in other antidiabetic medications for risk of hypoglycemia and other renal-related ADEs

Question 5

BP goal for hypertension

Answer 5

<130/80 or <140/90 if diabetic with HTN but low CV risk

Question 6

Management recommendation for HTN in CKD

Answer 6

ACEi/ARB and other agents as needed

Question 7

Proteinuria treatment in CKD

Answer 7

ACEi/ARB

Question 8

LDL goals for dyslipidemia treatment

Answer 8

LDL <100, LDL <70 for patients at high risk

Question 9

Dyslipidemia treatment in CKD

Answer 9

Statin recommended, fibrate dose reduction may be required

Question 10

Retinopathy treatment

Answer 10

Optimize glycemic control, blood pressure, and lipid control to reduce risk and slow progression

T1DM: eye exam within 5 years of onset of DM

T2DM: eye exam at time of diagnosis of DM

Patients should get yearly eye exams

Question 11

Neuropathy treatment

Answer 11

Annual foot exams

Pharmacological therapy options exist like antidepressants (TCAs, SSRIs, SNRIs, etc.), opioids, and anticonvulsants (gabapentin) exist, but they only help with symptoms and not the progression of the disease

The earlier you catch this, the better!