Shadi Al-Ahmadi

The Presentation will include:HypertensionDyslipidemiaCVDType 2 Diabetes-Associated RetinopathyDiabetic Periphral NeuropathyDiabetic Nephropathy

HypertensionFacts: Seventy-three percent of adults with

diabetes have a blood pressure level of 130/80 mm Hg or

higher, or take prescription drugs to manage hypertension.

Concomitant hypertension augments the effects of hyperglycemia in microvascular complications.

HypertensionThe target blood pressure level goal for

individuals with type 2 diabetes should be less than 130/80 mm Hg .

Pharmacologic treatment: - ACE inhibitor. - When second drug is needed: - GFR > 50 Ml/min thiazide diuretic - GFR < 50 Ml/min loop diuretic

Dyslipidemia

We should attempt to lower the LDL cholestrol level to less than 100 mg/dL.

For patients with overt CVD and diabetes, an LDL cholesterol level of less than 70 mg/dL is recommended.

DyslipidemiaThe triglyceride level goal should be less than

150 mg/dL.

The HDL cholesterol level goal should be: - > 40 mg/dL for men. - > 50 mg/dL for women.

The statins are the drug class of choice for Lowering lipid levels in the management of type 2 diabetes.

Cardiovascular Disease55% of adult patients with diabetes have CVDAnnual assessment of Cardiovascular risk

factors is recommended.

In asymptomatic patients older than 40 years type 2 diabetes and another risk factor for coronary heart disease, treatment using a statin and aspirin is recommended.

Cardiovascular DiseaseSecondary prevention of CVD in patients with

type 2 diabetes include: - optimizing control of diabetes,

hypertension, body weight, and lipid levels. - ACE inhibitor - aspirin - statin - Beta blockers

Type 2 Diabetes-Associate Retinopathy

Diabetic retinopathy (DR) is a leading cause of vision loss in adults ages 20 to 74 years.

The prevalence is directly related to the length of lime a patient has diabetes.

The majority of patients with type 2 diabetes exhibit some degree of DR within 20 years of diagnosis.

Type 2 Diabetes-Associate Retinopathy

Although retinopathy typically develops approximately 5 years after hyperglycemia begins, many patients with type 2 diabetes with DR are undiagnosed for long periods.

The initial examination should be performed at the time of diabetes diagnosis. with subsequent examinations annually.

Type 2 Diabetes-Associate Retinopathy

Laser Phototherapy is a widely used therapy to manage DR.

It was found to decrease the risk of proliferative DR-induced vision loss from 15.9% to 6.4% in patients with diabetes.

Diabetic Periphral NeuropathyNeuropathies are some of the most common

long-term diabetic complications, with up to 47% of patients developing peripheral neuropathy (DPN).

Screening for peripheral neuropathy should be performed when the diagnosis of type 2 diabetes is made.

Patients should be screened annually thereafter.

Diabetic Periphral NeuropathyCurrent guidelines recommend an annual

comprehensive foot screening that should include:

- inspection and assessment of pulses. - assessment of protective sensation using

monofilament + one of the following: * 128-Hz tuning fork * ankle reflex testing. * pinprick sensation rest.

Diabetic Periphral NeuropathyManagement: Patients with DPN should receive enhanced

education regarding root care and special footwear.

Two drugs are FDA-approved to manage chronic pain associated with DPN .

Diabetic Periphral Neuropathy

Duloxetine (Cymbalta) is a ser0tonin norepinephrine reuptake inhibitor.

60 to 120 mg PO OD

Pregabalin (Lyrica) is an anti convulsant. 100 mg PO TID

Diabetic NephropathyDiabetes is a leading cause of ESRD.

Albuminuria is the earliest indicator of diabetic nephropathy.

Microalbuminuria is diagnosed when levels of urinary albumin exceed 30 mg/day or 20 mcg/min.

Diabetic Nephropathy20% to 40%0 of those with type 2 diabetes

and microaIbuminuria develop nephropathy.

But only 20% progress to ESRD within 20 years.

The urinary albumin level should be measured starting at diagnosis and then annually in patients with newly diagnosed type 2 diabetes.

Diabetic NephropathyMedical treatment include: - ACE Inhibitor - thiazide or loop diuretic.

Annual measurement of serum creatinine level to assess renal function and stage of chronic kidney disease is recommended.

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