Diabetes Chronic Complications Exam 2 Flashcards

1
Q

UKPDS clinical trials

A

↓ glycemia = ↓ MICROvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DCCT/EDIC clinical trials

A

↓ glycemia = prevention/delay MICROvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

UKPDS Follow-Up clinical trials

A

↓ glycemia = ↓ MACRO and MICROvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ACCORD clinical trials

A

↓ glycemia = Increased MACROvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ADVANCE clinical trials

A
  • No difference in macrovascular events for intense group (P=0.32)
  • No difference in death from CV cause (P=0.12)
  • Difference for nephropathy (microvascular) (4.1% vs. 5.2%; P=0.0006)
  • ↓ glycemia = decreased MICROvascular complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

VADT clinical trials

A

↓ glycemia = ↓ MICROvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DCCT/EDIC Follow-Up clinical trials

A

↓ glycemia = prevention/delay MACRO and MICROvascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Microvascular Complications

A
  • Nephropathy (kidneys)
  • Neuropathy (nerves)
  • Retinopathy (eyes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Macrovascular Complications

A
  • HTN
  • Lipid management
  • Antiplatelet
  • Think: CVD, CAD, PAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are other chronic complications other than the micro / macro - vascular complications?

A
  • Dental care
  • Celiac
  • Thyroid disorders
  • Immunizations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Screening requirements for diabetic kidney disease

A
  • DM II: at diagnosis
  • DM I: within 5 years of diagnosis
  • DM I WITH HTN: at diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain the monitoring for diabetic kidney disease

A

Annually

  • urine test to measure albumin/Cr ratio (measures albuminuria)
  • eGFR
  • SCr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause a albumin/Cr ratio to be high?

A
  • short term hyperglycemia
  • exercise
  • UTI
  • marked HTN
  • CHF
  • acute febrile illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

spot collections in relation to albuminuria

A

two out of three spot collections over 3-6 month period must show elevations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the goals for albuminuria?

A

< 30 mg/g creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment for diabetic kidney disease?

A
  • first line: ACEI or ARB (ACEI decreases progression to albuminuria by 55%)
  • if ACEI or ARB maxed, may add on these therapies to achieve BP goal: diuretics, CCB, BB
  • Restrict dietary protein 0.8g/kg body weight/day
  • Optimize blood pressure and glycemic control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the prevention measures from diabetic kidney disease?

A
  • glycemic control
  • BP controll
  • don’t smoke
  • early intervention with ACEI or ARB but do not add if there is no sign of HTN or microalbuminuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of Peripheral Neuropathy

A
  • pain described as burning, stabbing, electric shocks
  • protective sensation gone
  • cold and hot discrimination reduced / absent
  • pinprick sensation reduced / absent
  • numbness, tingling
  • poor balance
  • sensations reduced / absent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms of Autonomic Neuropathy

A
  • Orthostatic hypotension
  • resting tachycardia (>100 bpm)
  • exercise intolerance
  • Constipation
  • Gastroparesis
  • Erectile dysfunction
  • Bladder dysfunction (UTIs, pyelonephritis, incontinence)
  • Autonomic failure in response to hypoglycemia (lack of glucagon response)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Screening requirements for Neuropathy

A
  • DM II: at diagnosis

- DM I: within 5 years of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Explain the monitoring for Neuropathy

A

Annually

  • pressure sensation using a 10-g monofilament AND
  • tests of pinprick sensation OR
  • temperature OR
  • vibration sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the components of a foot exam?

A
  • Visual Inspection

- Vascular Inspection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Foot Exam: Visual Inspection

A

Presence of:

  • dry skin
  • absence of hair
  • ingrown toenails
  • interspace maceration
  • ulceration
  • ulcers
  • corns or calluses
  • deformities (prominent metatarsal heads, hammertoes, claw toes)
  • ill-fitting shoes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Foot Exam: Vascular Inspection

A

Palpation of dorsalis pedis and posterior tibial pulses and ankle-brachial index (ABI < 0.9 is consistent with peripheral arterial disease)

25
When should neuropathy be treated?
if pt is experiencing symptoms
26
What is the treatment for Neuropathy?
- Pregabalin (Lyrica) - Duloxetine (Cymbalta) - Tapentadol
27
What are the prevention measures from neuropathy ?
- glycemic controls | - foot care education
28
Symptoms of Retinopathy
``` – Blurry vision – Floaters – Fluctuating vision – Distorted vision – Dark areas in vision – Poor night vision – Impaired color vision – Partial or total loss of vision ```
29
Screening requirements for Retinopathy
- DM II: at diagnosis AND after BS stabilizes | - DM I: within 5 years of diagnosis
30
Explain the monitoring for Retinopathy
- if no retinopathy, repeat every 2 years - if retinopathy present, repeat every year - if retinopathy worsens, monitor more frequently
31
What are the goals for Retinopathy?
- Prevent the progression of diabetic retinopathy and vision loss - provides an opportunity to treat when vision loss can still be prevented or reversed
32
What is the treatment for Retinopathy?
- Laser photocoagulation surgery | - Anti–vascular endothelial growth factor injections (Anti VEGF)
33
Retinopathy: Laser photocoagulation surgery
– Disadvantages: Destructive, peripheral vision loss, night vision loss, does not restore vision loss – Advantages: less expensive, 1 or 2 treatments
34
Retinopathy: Anti VEGF
– Drugs: Ranibizumab, Bevacizumab, Aflibercept – Advantages: Highly effective, superior visual outcomes in head to head trials – Disadvantages: Expensive, invasive, fear
35
What are the prevention measures from HTN?
- BP control - glycemic control - improved lipid profile
36
Screening requirements for HTN
at every routine visit
37
What are the goals for HTN?
- target | - <140/<90 mmHg per ADA and JNC 8 Recommendations
38
What are lifestyle treatments that can help in blood pressure reduction
- Weight loss - DASH diet - Physical activity - Sodium restriction - Alcohol consumption
39
Average SBP Reduction in Weight Loss
5-20 mmHg
40
Average SBP Reduction in the DASH diet
8-14 mmHg
41
Average SBP Reduction in Physical Activity
2-8 mmHg
42
Average SBP Reduction in Sodium Restriction
4-9 mmHg
43
Average SBP Reduction in Alcohol Consumption
2-4 mmHg
44
What is the treatment for HTN?
- ACEI or ARB if concomitant increased urinary albumin excretion (>30) - reduce CV risk in patients with diabetes (thiazide diuretics, ACEI, ARB, non-DHP CCB) if no albuminuria
45
What are the prevention measures from HTN?
- maintain BP control | - UKPDS: 10mmHg decrease = risk and event of complications, deaths related to DM, reduction in MI
46
Screening requirements for Dyslipidemia
at diagnosis for both types
47
Explain the monitoring for Dyslipidemia
- annual lipid profile for ages 40-75 | - if age <40 and lipid panel normal and not initiating statin, reassess every 5 years
48
What are the high-intensity lipid therapies?
- atorvastatin | - rosuvastatin
49
What are the moderate-intensity lipid therapies?
- atorvastatin - rosuvastatin - simvastatin - pravastatin - lovastatin - fluvastatin - pitavastatin
50
What are the prevention measures from Dyslipidemia?
– Weight loss – Increased physical activity – Medical nutrition therapy
51
Celiac disease
- Screen children at diagnosis | - If normal, don’t recheck unless symptomatic
52
Hypothyroidism
- Screen children at diagnosis | - If normal, recheck every 1-2 years
53
Dental Care
- Periodontal disease is more severe, not necessarily more prevalent - Dental exam every 6-12 months
54
immunization recommendations
- Hepatitis B - Pneumonia - Influenza
55
Hepatitis B
Series is 3 injections total given at 0, 1 and 6 months
56
Pneumonia
- PPSV23 before 65 - PCV13 after 65 - PPSV23 after 65 - PPSV23 5 years apart - PPSV23 and PCV13 12 months apart
57
Influenza
- start at 6 months of age | - two doses in pt's under 9 years old
58
Overall Prevention
- Glycemic Control - Reduce Complications - Control Blood Pressure