Diabetes in Primary Care Flashcards

1
Q

What is diabetes mellitus?

A

Diabetes mellitus is a group of metabolic disorders in which persistent hyperglycaemia (random plasma glucose more than 11.1 mmol/L) is caused by deficient insulin secretion, resistance to the action of insulin, or both.

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2
Q

How is the diagnosis of diabetes made?

A

HbA1c of 48 mmol/mol (6.5%) or more.
Fasting plasma glucose level of 7.0 mmol/L or more.
Random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs of diabetes.

If the person is symptomatic, a single abnormal HbA1c or fasting plasma glucose level can be used, although repeat testing is sensible to confirm the diagnosis.

If the person is asymptomatic, arrange repeat testing, preferably with the same test, to confirm the diagnosis. If the repeat test result is normal, arrange to monitor the person for the development of diabetes.

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3
Q

What are the different types of diabetes?

A

Type 1 - autoimmune condition where the patient is unable to make sufficient amounts of insulin due to the body attacking the pancreatic cells.

Type 2 - condition where due to over-exposure to hyperglycaemia the pancreas is damaged and unable to produce sufficient amounts of insulin and the patient develops a peripheral resistance to insulin.

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4
Q

How might a patient present to the GP with type 2 diabetes?

A

Symptoms such as polydipsia, polyuria, blurred vision, unexplained weight loss, recurrent infections, and tiredness. Signs such as acanthosis nigricans.
Risk factors present.

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5
Q

What are some of the main risk factors for diabetes?

A

Have prediabetes.
Are overweight.
Are 45 years or older.
Have a parent, brother, or sister with type 2 diabetes.
Are physically active less than 3 times a week.
Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.

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6
Q

What are the microvascular complications of diabetes?

A

Diabetic retinopathy
Diabetic nephropathy
Diabetic neuropathy

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7
Q

What is diabetic retinopathy and how does it present?

A

Prolonged high levels of glucose in the blood can cause damage to the smaller vessels in the retina, the damaged blood vessels may leak protein exudates onto the retina or rupture and cause bleeding in the eye.
New vessels can also form which are very weak and prone to bleeding = proliferative retinopathy.
Symptoms (late onset): Blurry vision, floating spots in your vision, blindness.

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8
Q

What is diabetic nephropathy and how does it present?

A

Prolonged high levels of glucose in the blood can cause damage to the blood vessels supplying the kidney, which can lead to damage to the glomeruli. This damage can also occur due to repeated infections of the urinary tract which are also common in patients with diabetes.
Signs: increased protein in the urine, worsening blood pressure control.
Symptoms: swelling in the ankles, hands and feet.

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9
Q

What is diabetic neuropathy and how does it present?

A

Prolonged high levels of glucose in the blood causes damage to the peripheral nerves.
Symptoms: loss of sensation, tingling, paraesthesia, loss of pain and temperature sensation and loss of coordination.

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10
Q

What are the macrovascular complications of diabetes?

A

Coronary artery disease
Peripheral artery disease
Stroke

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11
Q

How are the microvascular and macrovascular complications of diabetes monitored and screened for?

A

Diabetic eye screening will be offered at diagnosis and:
Every 2 years for people at low risk of sight loss (no identified diabetic retinopathy on two successive screening tests).
At least annually for all other people with diabetes.

Ensure that people with type 2 diabetes have a foot check in primary care at diagnosis and at least once a year thereafter, or sooner if any foot problems arise.

Annual screening for diabetic nephropathy (kidney disease).

Ensure all people with type 2 diabetes have their cardiovascular risk factors assessed at least annually.

Annual assessment for peripheral neuropathy.

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12
Q

What are the important lifestyle changes that a patient with a new diagnosis of type 2 diabetes should be aware of?

A

Diet
Smoking
Alcohol
Exercise

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13
Q

What are the two educational programmes that can be offered to diabetic patients to help with their lifestyle management?

A

DESMOND
DAFNE

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14
Q

What are the management options for type 2 diabetes?

A

Diet and Lifestyle
Metformin
Other medications

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15
Q

What is the role of metformin in the management of type 2 diabetes?

A

Metformin exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation of glucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells.

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16
Q

What are the other drug options for the treatment of type 2 diabetes?

A

DPP4 Inhibitors - sitagliptin
Sulfonylureas - gliclazide
Glitazones (thiazolidinediones) - pioglitazone
SGLT-2 - dapagliflozin
GLP-1 receptor agonists - exenatide