Prevention and Tx of Chronic DM complications Flashcards
Retinopathy screening for T1DM and T2DM
- Type 1 • Adults and children ≥ 10 years old • 5 years after onset of DM - Type 2 • Adults at time of dx
Retinopathy screening for women who want to get pregnant and have pre-existing retinopathy
- Before pregnancy/1st trimester
- Monitor every trimester for one year postpartum
- Pregnancy accelerates onset of retinopathy
What interventions lower the risk of retinopathy
optimize
- glycemic control
- blood pressure control
6 risk factors that increase the risk of progression to ESRF
- HTN
- Albuminuria or proteinuria
- Poor glycemic control
- Smoking
- Possibly high dietary intake of protein
- Possibly hyperlipidemia
What are interventions that will prevent or delay progression to overt nephropathy
- Optimize glycemic control
- Optimize blood pressure control
- Limit dietary intake of protein (non-dialysis dependent pts) to 0.8 g/kg
ACE inhibitors and ARB recommendations for DM pts
- when recommended
- when not recommended
- NOT recommended as primary prevention of kidney disease in pts with DM and normal blood pressure and normal UACR(<30 mg/g)
- Is recommended for non-pregnant pt with modestly elevated UACR (30-299 mg/day) and is recommended for thos with urinary albumin excretion >300 mg/day
• Continue to monitor UACR to assess reponse to treatment and progression of DM kidney disease
If pt is on an ACE inhibitor, ARB, or diuretic, what should be monitored
- for increases in serum creatinine
- changes in potassium
What needs to happen when eGFR < 60 and <30
- When eGFR < 60, eval and manage potential complications of CKD
- Refer for renal replacement eval if eGFR < 30
What are the microalbumin screening guidelines for T1DM and T2DM
Type 1 DM • Adults and children ≥ 10 years old • 5 years after onset of DM • Annual f/u - T2DM • Adults shortly after dx • Annual f/u
What is the testing requirement on microalbumin before can consider a patient to have albuminuria?
D/t to variability in urinary albumin excretion, 2-3 specimens collected over 3-6 month period should be abnl
ADR/CI of ACE inhibitors and ARBS (3)
- May exacerbate hyperkalemia (monitor serum Cr and K+)
- Dry nonproductive cough
- ACEi CI during pregnancy, no data on ARBs but recommend don’t use during pregnancy
What interventions lower risk of neuropathy
- Tight glycemic control started early in course of DM
- Foot care education: inspect feet daily and practice good foot care
What are the diagnostic criteria required to diagnose DPN
≥ 2 abnormalities:
- sensory loss assessed by pinprick, temperature, vibration perception
- Loss of pressure sensation (Sennes-Weinstein monofilament)
- Achilles reflex (not sure what happens with it, I’m assuming it is decreased? It wasn’t stated in the packet)
What are appropriate lipid lowering drugs for different DM patient situations
- DM + atherosclerotic CVD = high intensity statin + lifestyle changes
- DM <40 yo with atherosclerotic CVD risk factors = consider moderate-intensity statin + lifestyle changes
- DM age 40+ without atherosclerotic CVD = moderate-intensity statin + lifestyle
- Statins CI during pregnancy
Monitoring plan for pts on lipid lowering drugs
???
