Lecture 6: Macrovascular Complications of Diabetes

Question 1

What are the three MACROvascular diabetic complications?

Answer 1

1. Coronary artery disease
2. Cerebrovascular disease
3. Peripheral vascular disease

Question 2

What accounts for 75% of all deaths in diabetics?

Answer 2

Cardiovascular disease

Question 3

How much does diabetes increase risk for CV mortality?

Answer 3

The same amount of risk as someone who has had prior MI

Question 4

What are the risk factors for cardiovascular disease?

Answer 4

1. age
2. duration of diabetes
3. poor glucose control
4. hypertension
5. dyslipidemia
6. alibuminuria and kidney disease
7. women > men
8. obesity, sendentary lifestyle
9. smoking

Question 5

For a person with type 1 diabetes, what is the risk for macrovascular disease?

Answer 5

DURATION of diabetes is most important factor
Higher risk after 20-25 years
Type 2 diabetes are different in that 5-% have EXISTING CVD at time of diagnosis

Question 6

How does insulin resistance lead to atherosclerosis?

Answer 6

1. Increased TG
2. hypertension
3. obesity
4. hyperglycemia
5. hypercoagulability

Question 7

How do you prevent macrovascular disease in diabetes?

Answer 7

1. glucose control
2. BP control
3. lipid control
4. reduction of microalbuminuria
5. Weight loss and exercise
6. Smoking cessation
7. Aspirin (in some patients)

Question 8

What are musculoskeltal and skin complicatiosn that happen with diabetes mellitus?

Answer 8

1. Dupuytren’s contracture (flexion contracture)
2. Trigger finger
   
   • catching, snapping or locking of flexor tendon
3. Carpal tunnel syndrome
   
   • median nerve entrapment
4. Necrobiosis lipoidica diabeticorum
   
   • yellowish-brown plaques, central atrophy, ulceration, fat deposition
5. Diabetic Dermopathy
   
   • shin spots
6. Acanthosis nigricans
   
   • velvety thickening and hyperpigmentation
   • happens on the neck and knuckles and axilla

Question 9

What were the conclusions of the Diabetes Control and Complications Trial (DCCT)?

Answer 9

Intensive therapy vs. Conventional therapy
Intensive is much better
Type I diabetes
Earlier intervention led to 42% risk reduction in combined cardiovascular outcome

Question 10

What re the conclusions of UKPDS?

Answer 10

Type 2 diabetes
Decreased HbA1c from 7.9 to 7%
Intensive therapy does not reduce the risk of microvascular and macrovascular symptoms of diabetes as much as for type 1 diabetes but it nevertheless does reduce shit

Question 11

What is intensive therapy?

Answer 11

Multiple daily injections and/or insulin pump
Conventional therapy is ONLY 2 injections
DCCT
Decreased retinopathy, nephropathy, neuropathy
Not cardiovascular though
T1D

Question 12

What is difference between DCCT and EDIC?

Answer 12

DCCT showed intensive therapy was better but did not show CV reduction
EDIC showed risk reduction in MI, stroke and CV death
T1D

Question 13

How do you screen for retinopathy?

Answer 13

1. Annual dilated eye examination
   Type 1 = start within 5 years
   Type 2 = start immediately
2. Women if they are pregnant or planning pregnancy
   -comprehensive eye exam and counseling on risk progression

Question 14

How do you screen for nephropathy?

Answer 14

1. Annual urine microalbumin and creatinine
   Type 1 = within 5 years
   Type 2 = immediately
2. Confirm abnormal test
   -at least 2 abnormal tests 3-6 months apart
   -initiate ACE inhibitor for microalbuminuria
3. Annual serum creatinine

Question 15

How do you screen for neuropathy and foot care?

Answer 15

1. annual exam (with same guidelines for type 1 and type 2)
2. screen for signs and symptoms of cardiovascular autonomic neuropathy
3. peripheral neuropathyand foot care

Question 16

What is PLAGUE-F?

Answer 16

Mnemonic for screening for diabetes
Pressure
Lipids
Aspirin
Glucose
Urine (creatinine, albumin)
Eyes
Feet

Question 17

What is the screening mnemonic?

Answer 17

PLAGUE-F
Pressure (BP)
Lipids (LDL <7%)
Urine (microalbumine, creatinine)
Eyes 
Feet