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Glucagon Stimulate glycolysis; Stimulate hepatic gluconeogenesis and ketogenesis
Insulin Stimulate Glu uptake by muscles and adipose tissue; Suppress glucagon secretion; Stimulate glycogen, protein, and fat synthesis; Stimulate Glu use as energy
Amylin Suppress glucagon secretion; Slow gastric emptying; Reduce food intake and body weight
GLP-1 Stimulate Glu-dependent insulin release; Suppress glucagon secretion; Slow gastric emptying; Reduce food intake and body weight; Promote beta-cell health
ADA American Diabetes Association
AACE/ACE American Association of Clinical Endocrinologists/American College of Endocrinology
Diagnostic criteria for Pre-DM Fasting: 100-125 Postprandial: 140-199 A1C: 5.7-6.4% (ADA) or 5.5-6.4% (AACE)
ADA Targets Fasting: 80-130 Postprandial: <180 A1C: 7%
AACE/ACE Targets Fasting: <110 Postprandial: <140 A1C: <6.5%
DCCT T1DM: Aggressive Glu control (>3 shots/day or pump) decreases microvascular complications
UKPDS T2DM: Each 1% decrease in A1C = 35% reduction in microvascular complications; No impact on macrovascular; Metformin decreased macrovascular risk in obese populations
ACCORD T2DM: Ended early due to increased rate of mortality in intensive glycemic control group (A1C <6%)
ADVANCE T2DM: Intensive control (A1C <6.5%) decreased risk of renal events, but no difference in major macrovascular events
VADT T2DM: No difference in macrovascular events or mortality
Macrovascular Brain (stroke) Heart (CAD) Extremities (PVD)
Microvascular Eyes (retinopathy) Kidney (nephropathy) Nerves (neuropathy)
HTN Management Screening: annually Goal: <140/90 Treatment: lifestyle modifications and ACEI/ARB
Lipid Management Screening: at diagnosis and every 5 years Treatment: <40 and no risk factors = none; >40 and no risk factors = moderate; risk factors or ASCVD = high
High intensity statins Atorvastatin 40-80 mg Rosuvastatin 20-40 mg
Antiplatelet Therapy Primary Px: ASA if >50 + risk factor(s) Secondary Px: ASA 75-162 mg/day
Nephropathy Screening: annually Goal: urine albumin/Cr <30 Treatment: ACEI/ARB; protein restriction (0.8 g/kg/day)
Peripheral Neuropathy Screening: annual w/monofilament Treatment: TCAs, gabapentin, pregabalin, duloxetine, tapentadol
Retinopathy Screening: annual w/dilation Treatment: refer to ophthalmologist
Immunizations Annual flu vaccine Pneumococcal vaccine Hepatitis B vaccine
NICE-SUGAR Inpatient DM: Less stringent Glu control (<180) had decreased mortality and decreased hypogylcemia
Created by: kcapizzi