1 / 36

Current Management of Diabetes

Current Management of Diabetes. Introduction to Primary Care: a course of the Center of Post Graduate Studies i n FM. PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847. Aim. having information on assessing symptoms and signs. developing management plans for diabetes. Objectives.

mimi
Download Presentation

Current Management of Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Current Management of Diabetes Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847

  2. Aim • having information on assessing symptoms and signs. • developing management plans for diabetes.

  3. Objectives At the end of this session, the trainees should be able to:- • list diagnostic criteria for DM • describe how to differentiate Type I & II DM • explain symptoms and signs of diabetes • discuss the evidence for lifestyle changes • describe the indications, contraindications, and side effects of antidiabetic agents

  4. DM in Saudi Arabia Lifestyle Changes : Social & cultural changes Prevalence : • Diabetes mellitus as a health problem in Saudi Arabia • prevalence of DM is 23.7 % according to Dr. Al Nozha study (SMJ 2004) • 1 / 4 of adults > 30 yr are diabetics. • 36 Foot Amputation / day, at Riyadh.

  5. D.M in Saudi Arabia cont….. Cost & Impacts . • Psychological impact. • Family & Social impact . • Decreased Productivity . • Sick leaves. • Work Absence . • Economical Costs .

  6. Etiologic classification of diabetes mellitus I- Type 1 diabetes: II- Type 2 diabetes. III- Other specific types. IV- Gestational diabetes mellitus.

  7. Etiologic Classification of Diabetes Mellitus • Type 1: • b-cell destruction with lack of insulin . • has absolute insulin deficiency • predisposed to develop ketoacidosis • insulin is required for survival.

  8. Etiologic Classification of Diabetes Mellitus • Type 2 • has relative insulin deficiency combined with defects in insulin action. • is the most common form of diabetes, accounting for 90–95% of the disease • is most often found in overweight individuals. Narayan K, Boyle J, Thompson T, Sorensen S, Williamson D (2003). "Lifetime risk for diabetes mellitus in the United States". JAMA 290 (14): 1884–90. doi:10.1001/jama.290.14.1884.

  9. Risk Factors for Type 2 DM • Non- Modifiable • Family history • Age • Gender • History of GDM • Polycystic ovary syndrome (PCO) • Modifiable • Overweight and obesity • Sedentary lifestyle • Previously identified IGT and IFG • Metabolic syndrome • Diatery factors • Intrauterine environment • Inflamation

  10. Symptoms & Signs • Classical symptoms • Unusual thirst (Polydipsia) • Frequent urination (Polyuria) • Unusual weight loss • Other symptoms • Extreme fatigue or lack of energy • Unusually hungry • Moody & irritable • Blurred vision • Have recurrent infections • Wounds and bruises that are slow to heal • Get a lot of yeast infections • Have tingling or numbness in the hands and/or feet • Patients may present with a variety of symptoms or even symptomless

  11. Criteria to diagnosis diabetes • FPG >126 mg/dl (7.0 mmol/l) (Fasting is defined as no caloric intake for at least 8 h)OR • Symptoms of diabetes and a casual plasma glucose > 200 mg/dl (11.1 mmol/l) OR • 2-h plasma glucose >200 mg/dl (11.1 mmol/l) during an OGTT. (The test should be performed as described by theW H O (using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water)).

  12. Diagnosis of Diabetes :Plasma Glucose Cutoff Points * If without symptoms, there should be more than one measurement in order to diagnose. .

  13. Diagnosis of gestational DM

  14. First visit evaluation History taking and clinical assessment Physical examination • Height and weight measurement . • Blood pressure determination . • Fundoscopic examination • Oral examination • Thyroid palpation • Cardiac examination

  15. First visit evaluation Physical examination • Abdominal examination (e.g., for hepatomegaly) • Evaluation of pulses by palpation • Hand/finger examination • Foot examination • Skin examination • Neurological examination • Signs of diseases that can cause secondary diabetes (e.g., hemochromatosis, pancreatic disease)

  16. First visit evaluation Laboratory evaluation • HBA1c • Fasting lipid profile • Test for microalbuminuria • Serum creatinine in adults . • Thyroid-stimulating hormone (if indicated) • Electrocardiogram in adults (if indicated) • Urinalysis for ketones and protein

  17. Management Goals • Annual visits and examinations should be done regularly • Eliminate symptoms and improve well-being • Prevent and retard microvascularcomplications • optimize glycemic control • target blood pressure levels • Reduce macrovascular events • optimize glycemiccontrol • target blood pressure levels • target lipid levels

  18. Summary of recommendations for adults with Diabetes Parameter Target Value • HbA1c< 7% • pre-prandial plasma glucose 70 -130 mg/dL • post-prandial plasma glucose < 180 mg/dL • Blood pressure < 130/80 mmHg • LDL- cholesterol < 100 mg/dL (<2.6 mmol/l) • HDL- cholesterol > 40 mg/dL (1 mmol/l) for men> 50 mg/dL (1.3 mmol/l) for wom. • Triglycerides < 150 mg/dL (17 mmol/l) ADA 2009

  19. Key concepts in setting glycemic goals Goals should be individualized based on: ● duration of diabetes ● pregnancy status ● age ● co-morbid conditions ● hypoglycemia unawareness ● individual patient considerations

  20. Follow up

  21. Things to keep in mind during management of Diabetes • Type 2: Deterioration of beta cells over time • Increasing prevalence with increasing risk factors, e.g obesity • Hyperglycemia affects morbidity, mortality and resources • Tight glycemic control with insulin may reduce costly complications • 30% to 40% of patients ultimately require insulin

  22. Non-pharmacologic Therapy for DMLifestyle therapeutic modifications • Diet • Improved food choices • Spacing meals • Individualized carbohydrate content • Moderate calorie restriction • Exercise • improve blood glucose control • reduce cardiovascular risk factors • contribute to weight loss. • improve well-being.

  23. Nutritional recommendations for DM patients • Protein to provide 10-20% of kcal/day • Saturated fat to provide < 10% of kcal/day (< 7 % for those with elevated LDL). • Polyunsaturated fat to provide < 10 % of kcal. • Remaining calories to be divided between carbohydrate & monounsaturated fat, based on medical needs & personal tolerance. • Use of caloric sweeteners is acceptable.

  24. Considerations in Pharmacologic Treatment of Diabetes • Complications/tolerability • Frequency of hypoglycemia • Compliance/complexity of regimen • Cost

  25. Sulfonylureas

  26. THANK YOU

More Related