Saturday, January 03, 2015

Management of Type 2 Diabetes Mellitus

Farah and I went through CPG Management of T2DM this morning.

You can have the softcopy of the CPG (4th Edition, 2009) here. If you want to get more CPGs, go to this website.

Come, let's revise a bit about T2DM.

1. SCREENING

Done annually, measure Random Blood Glucose by using glucometer and strips

1.1 Who should be screened?

a. Symptomatic individuals suggestive of DM - tiredness, lethargy, polyuria, polydipsia, polyphagia, weight loss, pruritis vulvae, balanitis

b. For asymptomatic adult individuals, all adults who are overweight BMI > 23 or WC ≥ 80 cm for women and ≥ 90 cm for men and have additional risk factors:

  • Dyslipidaemia either HDL < 0.9 mmol/L or TG > 1.7 mmol/L
  • History of cardiovascular disease (CVD)
  • Hypertension (≥140/90 mmHg or on therapy for hypertension)
  • Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IFG) on previous testing
  • First-degree relative with diabetes
  • Other clinical conditions associated with insulin resistance (e.g. severe obesity and acanthosis nigricans)
  • Physical inactivity
  • Women with polycystic ovarian syndrome (PCOS)

c. Pregnant women with risk factors:
  • BMI > 27
  • Previous macrosomic baby weighing 4kg or above
  • Previous gestational diabetes mellitus (GDM)
  • First-degree relative with diabetes
  • Bad obstetric history
  • Glycosuria at the first prenatal visit
  • Current obstetric problems (essential hypertension, PIH, hypertension, polyhydramnios and current use of steroids)
  • Age above 25

d. Women with history of gestational diabetes should be screened for diabetes annually.

e. In the absence of the above criteria, testing should begin at age ≥ 30 years.

f. Children and adolescents who are overweight (BMI > 85th percentile for age and sex, or weight > 120% of ideal) and have any two of the following risk factors:

  • Family history of T2DM in first- or second- degree relative
  • Maternal history of GDM
  • Ethnicity (those of Indian ethnic background are at higher risks of developing T2DM)
  • Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidaemia, PCOS)


2. DIAGNOSIS

Can be confirmed by measuring Venous Plasma Glucose

For symptomatic patients, FPG ≥ 7 or RPG ≥ 11.1


For asymptomatic patients with risk factors,
CPG 
≥ 5.6, FPG ≥ 7 twice or RPG ≥ 11.1 twice 


3. COMPLICATIONS

3.1 Acute
a) Hypoglycaemia
b) Hyperglycaemia

3.2 Chronic
a) Macrovascular (Cardiovascular, Cerebrovascular, Peripheral vascular systems)
b) Microvascular (Nephropathy, Neuropathy, Retinopathy)
c) Mixed (Diabetic Foot, Erectile Dysfunction)

4. MANAGEMENT 

Here I made a note on OHA to remember the drugs easily:

Can you read the writing? Hehehe ;)

Ok ok here I made a better one. The simplified version:

We have Biguanide, SU, non-SU, AGI, TZD, DPP-4 inhibitor and GLP-1 analogue

How about insulin? Here is from CPG:

Four types of insulin : Fast, Intermediate, Long and Premixed

To conclude it all - remember this diagram ok!


Have fun revising! :)

1 comment:

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