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Common Complications in Diabetes

Common Complications in Diabetes. March 9, 2011 Kevin Wang. Let’s Make a List!. DynaMed & UpToDate Have …. Macrovascular Coronary Artery Disease Cerebrovascular Disease Peripheral Arterial Disease Infection Depression Dysautonomia Erectile Dysfunction Microvascular Neuropathy

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Common Complications in Diabetes

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  1. Common Complications in Diabetes March 9, 2011 Kevin Wang

  2. Let’s Make a List!

  3. DynaMed & UpToDate Have … • Macrovascular • Coronary Artery Disease • Cerebrovascular Disease • Peripheral Arterial Disease • Infection • Depression • Dysautonomia • Erectile Dysfunction • Microvascular • Neuropathy • Nephropathy • Retinopathy • Hypoglycemia • DKA/HNK • Impaired Wound Healing • Periodontitis

  4. Objectives • Discuss the common complications associated with diabetes • Discuss preventative measures to decrease the risk of developing these complications

  5. Macrovascular Complications • Coronary Artery Disease • DM as a CAD Equivalent

  6. Macrovascular Complications (Cont.) • Cerebrovascular Disease

  7. Macrovascular Complications (Cont.) • Peripheral Vascular Disease

  8. Risk Reduction • Diet • Smoking • HTN • Dyslipidemia • Physical Inactivity

  9. Risk Reduction (Cont.) • Aspirin • Primary Prevention (Grade C) • Secondary Prevention (Grade A)

  10. Glycemic Control in CAD/CVA • Intensive Therapy • ACCORD: Action to Control Cardiovascular Risk in DM • ADVANCE: Action in DM and Vascular Disease • VACSDM/VADT: Veterans Affairs Cooperative Study of DM • UKPDS: UK Prospective DM Study

  11. Screening for CAD in DM Patients • 2006 ADA Recommendations • 2002 ACC/AHA Recommendations

  12. Screening for PAD • Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease • ACC/AHA • American College of Physicians • USPSTF

  13. Overview of Prevention for Macrovascular Complications in DM It’s Multifactorial!

  14. Microvascular Complications • Diabetic Retinopathy

  15. Measures to Reduce Risk and Progression of DR • ACCORD Eye Trial • Glycemic Control • Antihypertensive Therapy • Lipid Lowering Therapy • Antiplatelet Agents

  16. Screening for DR

  17. Microvascular Complications (Cont.) • Diabetic Nephropathy

  18. Treatment of Diabetic Nephropathy • Glycemic Control • BP Control • ACEI/ARB • CCB • Protein Restriction

  19. Screening for Diabetic Nephropathy • Urine Albumin Concentration • Urine Albumin-to-Creatinine Ratio • Timing

  20. Microvascular Complications (Cont.) • Diabetic Neuropathy

  21. Prevention of Diabetic Neuropathy • Glycemic Control

  22. Treatment of Diabetic Neuropathy • First Line Treatment • Second Line Treatment • Third Line Treatment • Adjunct Treatment • Complementary Treatment

  23. Screening for Neuropathy

  24. Diabetic Foot Ulcers

  25. Foot Care

  26. Foot Ulcer Management

  27. Dental Screening

  28. Depression • Just a reminder … • www.meetup.com/seattle-social-diabetics • www.defeatdiabetes.org

  29. Prevention of DM • Moderate Weight Loss of At Least 7% • Regular Physical Activity – 150 min/week (Level B) • Medical Nutrition Therapy (Level B) • Increase Fiber Intake (14 gm/day) • Decrease Saturated Fat Intake < 7% of Total Calories (Level B) • Reduction in Trans Fat Intake (Level B)

  30. Thank You!

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