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Diabetes
| Term | Definition |
|---|---|
| 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
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