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Therapeutics II > Diabetes Complications > Flashcards

Diabetes Complications Flashcards

1
Q

Long term complications of diabetes

A

-microvascular disease
-macrovascular disease
-periodontal diseases
-

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2
Q

Microvascular disease

A

-diabetic kidney disease nephropathy
-ocular complications
-neuropathy

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3
Q

Macrovascular disease

A

-cardiovascular disease
-stroke
-peripheral vascular disease

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4
Q

Diabetic kidney disease (neuropathy)

A

-proteinuria
-low GFR
-inc BP
-20-40% of pt w DM
-major cause of death in type 1

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5
Q

kidney disease monitoring

A

-screen for microalbuminuria
-optimize glucose control
-optimize blood pressure

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6
Q

microalbuminuria screening

A

-annual test to detect early kidney damage
-test all T2DM pt and pt w T1DM for over 5 years
-UACR and eGFR

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7
Q

goal UACR

A

<30mg/g
-urinary-albumin-to-creatinine ration

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8
Q

if UACR > 300mg/g or eGFR < 60mL/min/1.73m

A

-monitor twice a year
-ACEI or ARB tx (not for pregnant pts)

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9
Q

Optimizing glucose control in T2DM + kidney disease

A
  1. SGLT2I w evidence of low CKD progression is eGFR > 20mL and UACR > 200mg/g or if UACR is normal (jardiance)
  2. GLP-1 w CVD benefit if SGLT2 not tolerated/contraindicated
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10
Q

Optimizing BP control in diabetes w kidney disease

A

-goal: < 130/80
-dont discontinue ACEI or ARB for small increases in SCr (<30%)
-consider SGLT2, GLP-1, or nonsteroidal mc receptor antagonist
-goal is 30% reduction if UACR > 300 mg/g
-limit protein intake to 0.8mg/kg/day for non-dialysis pt

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11
Q

Ocular Complications (microvasc)

A

-blurred vision, cataracts, glaucoma
-retinopathy (most common)
-appears 15-20 years

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12
Q

Retinopathy

A

-most common cause of blindness
-pregnancy can make it worse
-appears in 15-20 years
-get eye exams

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13
Q

Retinopathy tx

A

-optimize glycemic control, BP, and lipid management

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14
Q

Retinopathy screening

A

-T1DM within 5 years of diagnosis
-T2DM at diagnosis
-exam every 1-2 years
-annually if retinopathy present

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15
Q

Neuropathy

A

-peripheral
-gastrointestinal

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16
Q

peripheral neuropathy tx

A

-annual monofilament test
-pregabalin, duloxetine, gabapentin

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17
Q

Gastrointestinal neuropathies

A

-gastroparesis
-diarrhea/constipation
-fecal incontinence

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18
Q

other microvascular complications

A

-urinary retention
-postural hypotension (drop BP when moving)
-erectile dysfunction

tx: optimize blood sugar

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19
Q

Macrovascular complications

A

-Artherosclerotic CVD
-heart failure

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20
Q

Atherosclerotic CVD

A

-coronary heeart disease
-cerebrovasc disease
-peipheral arterial disease
-leading cause of death in type 2 pt

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21
Q

Heart failure

A

-major cause of death
-hospitilizations are twice as high in DM pt

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22
Q

ASCVD or HF tx

A

-optimize tx of DM
-SGLT2
-GLP-1

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23
Q

CVD monitoring

A

-assess risk factors annually
-obesity, HTN, HLD, smoking, CKD
-metabolic syndrome: obesity, htn, hld

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24
Q

ADA BP goal (same as ACC)

A

< 130/80 for T2 or T1
-110-135/85 for DM + pregnancy

-<140 SBP ok for elderly

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25
Q

HTN tx in T2DM

A
  1. ACEIs or ARBs
    -slow progression of proteinuria
    -DO NOT USE BOTH in one pt
    -use at max tolerated dose
  2. HCTZ, chlorthalidone, amlodipine, MRAs next
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26
Q

ACEI and ARB combo

A

-dont combo
-hyperkalemia, syncope, renal dysfunction

27
Q

When to use statin for primary CV prevention

A

-low risk pt none to moderate statin dose
-over 40 w more than one risk factor = high intensity statin

28
Q

LDL target in primary prevention

A

-dec by more than 50%
-goal: < 70

29
Q

statin use for 2’ prevention

A

-high intensity + LSM
-ezetimibe or PCSK9 if LDL still high

30
Q

LDL target in 2’ prevention

A

-LDL < 55

31
Q

intolerant to statin therapy in 2’ prevention:

A

-PCSK9 inhibitor therapy w mAb tx
-bempedoic acid therapy
-PCSK9 therapy w inslisinan siRNA

32
Q

more generally, recommendation for DM pt 40-75

A

-primary prevention: moderate to high intensity statin
-secondary prevention: high intensity statin and goal LDL < 70 (?) (ACC guidelines prob not updated)

33
Q

High intensity statin recs

A

-atorvastatin 40-80 mg/day
-Rosuvastatin 20-40 mg/day

34
Q

Moderate intensity statin recs

A

-atorvastatin 10-20
-rosuvastatin 5-10
-simvastatin 20-40
-pravastatin 40-80
-lovastatin 40
-fluvastatin 80
-pitavastatin 1-4

35
Q

rx for statin intolerance

A

-bempedoic acid

36
Q

statin dosing tips

A

-muscle pain
-start at low dose and titrate up

37
Q

Stroke tx

A

-keep BP under control
-smoking cessation

38
Q

Peripheral vascular disease

A

-amputations
-leg pain, cold feet, absent pulses

39
Q

peripheral vascular disease tx

A

-correct risk factors
-exercise
-surgery

40
Q

Periodontal disease

A

-sugar damage to teeth

41
Q

Use of antiplatelet agents (2’ prevention)

A

-aspirin 75-162mg/day in DM + ASCVD
-clopidogrel 75 if allergy
-sometimes combine aspirin and P2Y12 inhibitor (bleeding risk)

42
Q

aspirin + rivaroxaban therapy

A

-for pt w stable coronary or peripheral artery disease and low bleeding risk
-prevent limb and CV events

43
Q

Consider aspirin for primary prevention if

A

-over 50 w risk factor that are not at increased risk of bleeding
-d/c over 70
-dont use if low CVD risk not worth it

44
Q

DM monitoring parameters

A

-signs and sx
-blood glucose tests
-glycosylated hemoglobin

45
Q

Blood glucose tests

A

-fasting target 80-130 mg/dL**
-after meal: <180 or <140
-bedtime glucose 90-150mg/dL

46
Q

Self-monitoring blood glucose (SMBG)

A

-intensive insulin regimens
-basal insulin +/- non-insulin meds
-non-insulin regimens

47
Q

Intensive insulin regimens (self monitoring)

A

-prior to meals and bedtime
-prior to snacks or activity
-suspicion of hypoglycemia and after tx

48
Q

basal insulin +/- noninsulin regimen self-monitoring

A

-once daily while fasting

49
Q

non-insulin regimen self-monitoring

A

as needed

50
Q

Continuous Glucose Monitoring (CGM)

A

-decrease hypoglycemia and improve A1c readings

51
Q

CGM goals

A

-generally 70-80
-idk man

52
Q

Glycosylated hemoglobin (A1c)

A

-normal 4-6%
-DM might be 10-15%
-target less than 7%!!
-target 6% in pregnancy
-reflects average blood glucose over the past 8-12 weeks

53
Q

benefits of A1c reduction DCCT type 1

A

-60% reduction in retinopathy, nephropathy, neuropathy
-42% reduction in CVD
-57% reduction in MI, stroke, CVD death

-A1c 9 to 7
-type 1

54
Q

benefits of A1c lowering type 2 (UKPDS)

A

-25% reduction in microvasc complications
-16% reduction in fatal or nonfatal MI and sudden death
-every 1% drop = 18% reduction in CVD risk

55
Q

ACCORD trial

A

-ended study early

56
Q

VADT trial

A

-

57
Q

bottom line of a1c trials

A

-more aggressive therapy for newly diagnosed, no severe hypoglycemia, no CVD

-caution for severe hypoglycemia, CVD, advanced disease

58
Q

A1c to eAG ratio

A

-1% A1c = 28.7 inc in blood glucose

59
Q

Advantages of A1c monitoring

A

-can measure w/o fasting
-levels not subject to acute changes in insulin dosing, exercise, diet

60
Q

Disadvantages of A1c monitoring

A

-does NOT replace SMBG or CGM
-its an average of all numbers
-conditions that affect RBC turnover will impact results

61
Q

when to check A1c

A

-twice a year if meeting goals
-4 times if not

62
Q

PPG contribution to A1c

A

-when A1c is high, fasting BG is contributing most
-closer to 7%: target postprandial BG

63
Q

Monitoring parameters

A

-urine tests
-BUN/SCr
-fasting lipid profile
-BP
-electrolytes

64
Q

Urine tests

A

-urine glucose
-urine ketones (esp type 1)
-microalbuminuria

Therapeutics II (38 decks)

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