Supporting evidence is of class R Qll
C. Retinopathy - Prevalence of retinopathy is related to the duration of diabetes mellitus. After 20 years of diabetes mellitus more than 60 of patients with type 2 diabetes mellitus have some degree of retinopathy. Diabetic retinopathy is estimated to be the most frequent cause of new cases of blindness among adults ages 20 to 74 years. Up to 21 of patients with type 2 diabetes mellitus are found to have retinopathy at the time of diagnosis of diabetes mellitus. Generally retinopathy...
Is Diastolic Blood Pressure less than mm Hg
For patients with type 2 diabetes mellitus, the systolic blood pressure BP goal is less than 130 and the diastolic blood pressure BP goal is less than 80. For patients with type 2 diabetes mellitus, the systolic blood pressure BP goal is less than 130 and the diastolic blood pressure BP goal is less than 80. The HOT trial provides evidence that a target diastolic blood pressure less than 80 mm Hg has a cardioprotective effect in people with diabetes. This study reported that in the diabetic...
Optic fundi
Oral exam dental and gingival health Cardiovascular system heart, peripheral circulation including pulses and bruits abdominal, carotid, femoral Skin infections, xanthoma, insulin injection sites Feet nails, web spaces, ulcers, pulses, calluses, structural deformities, protective sensation and shoes Neurological system sensory state of hands and feet, muscle wasting, deep tendon reflexes Mental health assessment with consideration for depression anxiety screen Supporting evidence is of class R
Figure Using a SemmesWeinstein Monofilament to Screen the Diabetic Foot For
1 Show the monofilament to the patient and touch it to his her arm to demonstrate that it does not hurt. 2 Use the Semmes-Weinstein 5.07 10 gram monofilament to test sensation at the indicated sites on each foot . Avoid applying the monofilament to calluses, ulcers, or scars. 3 Hold the monofilament perpendicular to the skin and touch it to the skin using a smooth motion with sufficient force to cause the filament to bend. The test should take about 1-1 2 seconds at each site. 4 Ask the patient...
Glycemic Control Algorithm Annotations Glycemic Control Algorithm
Medical nutrition therapy may be all that is required to treat diabetes, especially for the patient with early mild symptomatic disease. Medical nutrition therapy should be maintained throughout the course of the disease, even as pharmacologic agents are used. Oral agent medications are generally used if medical nutrition therapy alone does not succeed in obtaining patients' goals within a reasonable time frame, usually no longer than 2-3 months. At the time of diagnosis, if patients have...
The results of the monofilament testing should be documented in the medical
Testing at the first and fifth metatarsal heads is sufficient. This combination of sites has been shown to detect the insensate foot with reasonable sensitivity 80 and specificity 86 . Testing the great toes may be of added benefit. Chart documentation is required for the American Diabetes Association - Provider Recognition Program. An annual diabetic foot examination is also one of the eight diabetes quality improvement project DQIP measures adopted by the National Committee for Quality...
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de Lemos JA, Blazing MA, Wiviott SD, et al. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes phase Z of the A to Z trial. JAMA 2004 292 1307-16. Class A Diabetes Control and Complications Trial Research Group, The. The absence of a glycemic threshold for the development of long-term complications the perspective of the diabetes control and complications trial. Diabetes 1996 45 1289-98. Class A Diabetic Retinopathy Study Research Group,...
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50 mg three times a day for patients weighing less than or equal to 60 kg 100 mg three times a day for patients weighing greater than 60 kg The A1C lowering commonly achieved with alpha glucosidase inhibitors is 0.5-1.0 . These agents are most appropriate in patients with glucose and glycosylated hemoglobin only moderately above goal. These agents delay carbohydrate absorption, which reduces postprandial blood glucose, and insulin levels. These agents must be taken at the beginning of a meal to...
B Start or Intensify Statin Dose
The LDL goal for people with diabetes mellitus without coronary artery disease CAD is less than 100 mg dL. The goal with CAD is less than 70 mg dL. Start a statin even if LDL is less than 100 mg dL. Intensify statin or lipid-lowering medications to LDL goal less than 100 mg dL with CAD or less than 70 mg dL with CAD. Recent evidence Colhoun, 2004 Heart Protection Study Group, 2002 and ATPIII consensus guidelines Grundy, 2004 suggest that statins are beneficial for high-risk patients with a...
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Pramlintide acetate injection Symlin Type 1 15 mcg SQ titrate at 15 mcg increments to maintenance dose of 30 mcg mcg SQ Given in divided doses three times per day Acting as an amylinomimetic agent has the following effects 1. modulation of gastric emptying 2. prevention of the postprandial rise in plasma glucagons 3. satiety leading to decreased caloric intake and potential weight loss. Indicated as an adjunct treatment in patients with Type 1 or Type 2 diabetes who use mealtime insulin therapy...