Diabetes Guidelines An Approach to Diagnosis and Treatment ：糖尿病的诊断和治疗指南.ppt

Macrovascular Cardiovascular disease-coronary, peripheral, carotid, cerebrovascular Microvascular Nephropathy Retinopathy Neuropathy Depression Sleep Apnea Screening for coronary artery disease in asymptomatic patients does not improve outcomes or mortality VADT (Vet. Affairs Diab. Trial) –improvement of 90% of future cardiovascular events with intensive glycemic control those with coronary calcium scores100 at initiation of intensive control-level A Use of aspirin (men 65 yo) reduction in all cause and CV mortality-level B (effects of ASA are reduced in environment of elevated glucose) Aggressive BP control improves rate CV events in diabetics (ALLHAT/HOPE) Microalbuminuria 30-299 mg/gm albumin to creatinine ratio Random urine Measured annually Abnormal should be confirmed by second test GFR should also be used in screening (NKF-Classifications)-calculated annually Prevention Treatment includes intensive glycemic control (A1C7), use of ACE/ARB, BP control (130/80) and control of other risk factors (lipids/tobacco) level A Limitation of protein intake to 10% of daily caloric intake for persistent decline in renal function Aliskerin (direct renin inhibitor) for persistent albuminuria as an additional agent-Level A Dilated retinal examination recommended annually for those without retinal disease Initially at the time of diagnosis for all with Type 2 DM (after 5 years for type 1 DM) More frequent examinations during and after pregnancy Diagnosis is clinical Strict glycemic control Lipid lowering agents Control of BP-level A Tricyclics, anticonvulsants, serotonin/ norepinephrine reuptake inhibitors-level A Large fiber-strength/balance and gait training-level A Small fiber-foot protection/supportive shoes/diabetic socks/regular foot inspection/protection from heat injury/ emollient creams/ medications for pain-level A Influenza annually Pneumococcal at diagnosis and one additional dose at the appropriate time according to ACIP recommendations Diabetes educati