Risk Factor Modification in DM

Question 1

What are some of the modifiable RF for DM?

Answer 1

HTN
CVS disease
High cholesterol

Question 2

What can we offer to a patient with existing CVS disease?

if they don’t have pre-existing CVS disease should we offer them the above medication?

Answer 2

Antiplatelet - clopidogrel or aspirin

NO

Question 3

what do NICE recommend as the BP target in diabetics?

Answer 3

<140/80mmHg or 130/80mmHg if they have end organ damage (retinopathy, nephropathy)

Question 4

1) what is 1st line medication for treating HTN in diabetic?
2) what is 2nd line medication for HTN in T1DM patient?
3) what is 2nd line medication for HTN in T2DM patients/black ppl?
4) why should beta blockers be avoided? especially in combination with thiazide?

Answer 4

1) ACE-inhibitors: Ramipril/
as they are renoprotective

2) angiotensin receptor antagonist (candesartan/losartan) but don’t combine with ACE-inhibitor -use on it’s own
3) ACE inhibitor + diuretic/Ca channel blocker (amlodipine)
4) they increase insulin resistance

Question 5

following NICE guidelines who should be offered a statin?

1ST LINE?

To whom do you offer just 20mg atorvastatin?

To whom do you offer 80mg atorvastatin?

Answer 5

patients with 10 year CVS risk >10% using QRISK2

Atorvastatin

20mg = 10 year CVS risk >10% using QRISK2, all T1DM patients

80mg = secondary prevention - if they have known IHD, CVD or PAD