Macrovascular and Other Complications of Diabetes Flashcards
Examples of macrovascular complications of diabetes.
Atherosclerosis
MI
Stroke
Peripheral vascular disease
Heart failure
Cardiovascular death
Pathogenesis of atherosclerotic vascular disease in diabetes.
Occur at an earlier age and more rapidly in diabetic patients.
Hypertension, dyslipidaemia, low HDL and high TAG, obesity, hyperinsulinaemia, proteinuria and microalbuminuria all contribute to atherosclerotic vascular disease.
Management of atherosclerotic cardiovascular risk
Tight glycaemic control
If CV disease is established SGLT2 and GLP-1 receptor agonists are recommended.
Anti-hypertensives such as ACEi and ARBs.
Statins are recommended to diabetics > 40 yo
Ezetimibe or PCSK9i if statins are not tolerated.
Smoking cessation
Aspirin (benefits outweigh the bleeding risks)
Ideal target goals for cardiovascular risk factor management of people with diabetes.
HbA1c
BP
Total cholesterol
LDL
HDL
TAGs
HbA1c < 53 mmol/mol
BP < 130/80
Total chol < 4.0
LDL < 2.0
HDL > 1.1
TAGs < 1.7
Which heart failures are common in diabetes?
Preserved ejection volume and reduced ejection volume.
Which diabetes medications might precipitate heart failure?
Pioglitazone
Saxagliptin
Give examples of other complications of diabetes.
Non-alcoholic liver disease
Malabsorption
Infections
Cancer
Skin and joint problems
Why might NAFLD happen in diabetes?
Intrahepatic fat accumulation with hepatic inflammation and fibrosis.
Associated with central obesity and insulin resistance.
Management of NAFLD in diabetes?
Weight loss
Exercise
Pioglitazone may also reduce intrahepatic fat
Why might malabsorption happen in diabetes?
Chronic exocrine pancreatic insufficiency
T1DM also have a higher prevalence of coeliac disease.
Treatment of malabsorption in diabetes.
Pancreatic enzymes.
Give examples of microorganisms more prevalent in hyperglycaemic environments.
Klebsiella
Burkholderia pseudomallei
What other infections are more common in diabetes?
UTIs
Asymptomatic bacteruria
Mycotic genital infections
TB
Hep C
Certain types of cancers more common in T2DM.
Carcinoma of uterus (double)
Pancreatic (double)
20-50% increased risk of colorectal and breast cancer.
What is diabetic cheiroarthropathy?
Joint contractures in the hands as a result of long-standing diabetes.
