1 / 16

Diabetes Update 2010

Diabetes Update 2010. Adam Rush, MD, MHA Chief Resident Riverside Methodist Hospital Columbus, OH October 1, 2010. Objectives. Review the following topics in diabetes management: Diagnostic criteria for diabetes Blood pressure control in the diabetic patient

jaden
Download Presentation

Diabetes Update 2010

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. Diabetes Update 2010 Adam Rush, MD, MHA Chief Resident Riverside Methodist Hospital Columbus, OH October 1, 2010

  2. Objectives • Review the following topics in diabetes management: • Diagnostic criteria for diabetes • Blood pressure control in the diabetic patient • Antiplatelet therapy for primary prevention of cardiovascular disease • Inpatient glycemic targets • Intensive versus standard glycemic control in type 2 diabetics

  3. Case 1 • A 45 year old white male (Bob) • Past History: Hypertension on hydrochlorothiazide, BMI 27 • Screened for diabetes mellitus by PCP with fasting glucose and HbA1C • Fasting glucose 115, HbA1C 6.6 Should Bob be considered a diabetic?

  4. Criteria for the Diagnosis of Diabetes American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61

  5. Case 1, Part 2 • Follow-up visit to PCP • Blood pressure (BP) recorded as 135/89 • Only other previous BP reading recorded in office 138/86 What should Bob’s target BP be?

  6. Blood Pressure Goals in Diabetes • “Patients with diabetes should be treated to a systolic blood pressure < 130 mm Hg.” • “Patients with diabetes should be treated to a diastolic blood pressure < 80 mm Hg.” American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61

  7. Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus The ACCORD Study Group: Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. N Engl J Med 2010;362:1575-1585 *Composite of nonfatal MI, nonfatal stroke, or death from cardiovascular causes.

  8. Case 1, Part 3 • Bob works out at the local gym. • He embraced therapeutic lifestyle changes. • His brother Jim (age 50) had a massive MI two weeks ago. • He is a voracious reader of online medical information. Is daily aspirin therapy indicated for Bob?

  9. Recommendations for Aspirin: Primary Prevention • “Consider aspirin therapy as a primary prevention strategy in those with type 1 or type 2 diabetes at increased cardiovascular risk (10 year risk > 10 %).” • “There is not sufficient evidence to recommend aspirin for primary prevention in lower risk individuals, such as men < 50 years of age or women < 60 years of age without other major risk factors.” American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61

  10. Case 2 • Bob’s brother Jim recently hospitalized for acute MI • Diagnosed with type 2 diabetes with HbA1C of 8.2 • Required steroids and mechanical ventilation for COPD exacerbation during admission, blood glucose readings in the 300’s What should be Jim’s goal blood glucose as an inpatient?

  11. Critically ill patient Threshold for treatment of hyperglycemia with insulin is 180 mg/dL Goal glucose range of 140-180 mg/dL Non-critically ill patient No clear evidence for specific blood glucose goals Blood glucose ranging from 140-180 mg/dL is recommended if this target can be safely achieved Consider more intensive control in patients with history of tight glucose control Goals for Blood Glucose Levels in Hospitalized Patient American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61

  12. Case 2, Part 2 • Jim discharged on metformin and glyburide • Attempting to adhere to therapeutic lifestyle changes • Now 3 months after hospitalization • HbA1C of 7.8 What should Jim’s goal HbA1C be?

  13. Goals for Glycemic Control in Adults • “Lowering A1C to below or around 7% has been shown to reduce microvascular and neuropathic complications of type 1 and type 2 diabetes. Therefore, for microvascular disease prevention, the A1C goal for nonpregnant adults in general is < 7%.” American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61

  14. Goals for Glycemic Control in Adults • Macrovascular disease???? • “Until more evidence becomes available, the general goal of < 7% appears reasonable for many adults for macrovascular risk reduction.” American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61

  15. References • American Diabetes Association: Standards of Medical Care in Diabetes-2010. Diabetes Care 2010;33 (Suppl. 1):S11-S61 • The ACCORD Study Group: Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. N Engl J Med 2010;362:1575-1585 • NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hebert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360:1283-1297

More Related