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Endocrine Module > Chronic Complications of Diabetes > Flashcards

Chronic Complications of Diabetes Flashcards

1
Q

UKPDS Results

A

Decreased Glycemia = Decreased MICROvascular complication

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2
Q

UKPDS Follow Up

A

Decreased Glycemia = Decreased MACRO and MICROvascular complications

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3
Q

DCCT/EDIC Results

A

Decreased Glycemia = Prevention/Delay MICROvascular complications

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4
Q

DCCT/EDIC Follow Up Results

A

Decreased Glycemia = Prevention/Delay MACRO and MIRCOvascular complication

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5
Q

ACCORD Results

A

Decreased Glycemia = Increased MACROvascular complications

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6
Q

ADVANCE Results

A

Decreased Glycemia = Decreased MICROvascular complications

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7
Q

VADT Results

A

Decreased Glycemia = Decreased MICROvascular complications

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8
Q

How does hyperglycemia affect nephropathy?

A

Structural changes in the kidney at the glomerulus leads to inappropriate filtration of albumin (increased)

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9
Q

What are the microvascular complications of DM?

A

Nephropathy, Neuropathy, Retinopathy

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10
Q

What is the screening for nephropathy?

A

T2: at diagnosis
T1: within 5 yrs of diagnosis, or at diagnosis if they have HTN

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11
Q

What is the monitoring for nephropathy?

A

Annually, albumin/creatinine ratio, eGFR, and SCr

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12
Q

When do you monitor bi-annually for nephropathy?

A

If UA> 300 or GFR <60

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13
Q

What is diagnosis of albuminuria?

A

2 of 3 spot collections over a 3-6 month period

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14
Q

What is the treatment for nephropathy?

A

ACE or ARB

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15
Q

When do you NOT DC ACE/ARB in nephropathy?

A

Elevations in SCr <30%

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16
Q

What add on therapy can be used in nephropathy to achieve maximal blood pressure goals?

A

Diuretics, CCB, and BB

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17
Q

Should you restrict dietary protein in nephropathy?

A

Yes 0.8g/kg/day

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18
Q

When should you avoid ACE/ARB in nephropathy?

A

If there is NO microalbuminuria <30 or no HTN

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19
Q

Peripheral Neuropathy in DM affects what areas the most?

A

Lower limbs, hands, and fingers

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20
Q

What are the symptoms when SMALL nerve fibers are affected?

A

Burning, stabbing, electric shocks, cold and hot discrimination reduced, pinprick sensation

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21
Q

What are the symptoms when LARGE nerve fibers are affected?

A

Numbness, tingling, poor balance, and sensations

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22
Q

What are the cardiovascular symptoms of autonomic neuropathy?

A

Orthostatic hypotension, resting tachycardia >100, and exercise intolerance

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23
Q

What are the GI tract symptoms of autonomic neuropathy?

A

Constipation and Gastroparesis

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24
Q

What are the GU tract symptoms of autonomic neuropathy?

A

Erectile Dysfunction and Bladder Dysfunction

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25
Q

How is glucagon affected in autonomic neuropathy?

A

Failure in response to hypoglycemia, can no longer respond with glucagon naturally

26
Q

What is the screening for Neuropathy?

A

T2: at diagnosis
T1: within 5 years of diagnosis

27
Q

What is the monitoring for neuropathy?

A

Annually, pressure sensation using a 10g monofilament

28
Q

What are the 3 components of neuropathy monitoring with a monofilament?

A
  1. tests for pinprick sensation
  2. temperature
  3. vibration sensation
29
Q

How often should a foot exam be conducted?

A

Annually, however patients should visually check daily

30
Q

What is the visual inspection in a foot exam?

A

Dry skin, absence of hair, ingrown toenails, interspace maceration, ulceration, ulcers, corns or calluses, and deformities

31
Q

What is the vascular inspection of the foot exam?

A

ABI < 0.9 is consistent with peripheral arterial disease

32
Q

What is first line therapy for neuropathy?

A

Pregabalin/Lyrica, Gabapentin/Neurontin, and Duloxetine/Cymbalta

33
Q

What are the symptoms of retinopathy?

A

Blurry vision, floaters, dark areas, poor night vision, impaired color vision
Asymptomatic in early stages

34
Q

With the progession of retinopathy what happens?

A

Breakdown of endothelial tissue, increased vascular endothelial growth factors VEGF, and increase of advanced glycation end-products AGE

35
Q

What is the screening for retinopathy?

A

T2: at diagnosis and after BS stabilizes
T1: within 5 years of diagnosis

36
Q

What is the monitoring for retinopathy?

A

No retinopathy for one or more annual eye exams, then repeat every 2 years
If retinopathy present, ANNUAL

37
Q

What are the two forms of retinopathy treatment?

A
  1. Laser photocoagulation surgery
  2. Anti-Vascular endothelial growth factor injections up to 12 months ANTI-VEGF
38
Q

What are the Macrovascular complications of DM?

A

CVD, CAD, PAD

39
Q

When should hypertension be screened/monitored in DM?

A

Every single routine visit

40
Q

What is the HTN BP Goal for individuals WITH DM and HTN at high CV risk (ASCVD >15% or have ASCVD)

41
Q

What is the HTN BP Goal for individuals WITH DM and HTN at low CV risk (ASCVD <15%)

42
Q

What are lifestyle changes that should be made for patients with HTN and DM?

A

Weight loss, DASH diet, physical activity, sodium restriction, and alcohol consumption

43
Q

If a patient has Albuminuria or CAD what is the first line agent started for kidney protection?

A

ACE or ARB

44
Q

What is the treatment for a patient with HTN, DM, and NO albuminuria?

A

Thiazides, ACE, ARB, Non-DHP CCB

45
Q

Why is an ACE/ARB always started first in CAD/Albuminuria?

A

Kidney Protection

46
Q

What is the screening for lipid management for patients with DM?

A

T2: at diagnosis
T1: at diagnosis

47
Q

For patients with DM and ASCVD or Risk >20% what is the treatment?

A

HIGH intensity statin

48
Q

For patients with DM and Multiple ASCVD risk factors what is the treatment?

A

HIGH Intensity Statin

49
Q

For patients with DM, age 40-75, W/O ASCVD what is the treatment?

A

MODERATE intensity statin

50
Q

For patients with DM, age <40, with CVD what is the treatment?

A

Consider statin

51
Q

For patients with LDL >70 despite max tolerated statin what is the treatment?

A

Consider PCSK9-1 or Ezetimibe

52
Q

What is the range of ASA for Primary Prevention?

A

75-162 for those at INCREASED CV risk
>50 yrs with DM with 1 major risk factor: FH premature ASCVD, HTN, dyslipidemia, and smoking

53
Q

What is the range of ASA in Secondary Prevention?

A

75-162 for patients WITH history of ASCVD

54
Q

If you cannot use ASA for antiplatelet therapy in DM, what should be considered?

A

Clopidogrel 75 mg/day

55
Q

Dental Concerns with DM?

A

Periodontal Disease

56
Q

Celiac Concerns with DM?

A

Screen at diagnosis
If normal, do not recheck unless symptomatic

57
Q

Thyroid Disorder Concerns with DM?

A

Screen at diagnosis
If normal, recheck every 1-2 yrs

58
Q

When do you give Hepatitis B vaccines?

A

Unvaccinated adults age 19-59, after that its a conversation with provider

59
Q

When do you give Pneumonia vaccines?

A

PCV15 or PCV20, if PCV15 is used follow with PPSV23 1 yr later

60
Q

When should patients with DM get the influenza vaccine?

A

> 6 months of age, yearly
2 doses for children <9yrs

Endocrine Module (16 decks)

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