Diabetes Lecture 2

Course Overview

• Course No: 2

• Course Title: Management of Diabetes

• Duration: Almost 1811 Period

• Symptoms of Diabetes:

  • Excessive eating and drinking due to increased blood glucose levels

• Understanding Diabetes:

  • Type and age-related factors contribute to risk.

  • Overview of prevention strategies

Management of Patient with Diabetes

• Establish Individualized Glycemic Targets:

  • Personalized goals based on patient needs and conditions

• Management of Hyperglycemia:

  • Monitoring and medications tailored to individual requirements

• Managing CVD Risk Factors:

  • Address smoking, dyslipidemia, obesity, and hypertension

• Preventing and Treating Complications:

  • Screen for acute and chronic complications diligently

• Increase Quality of Life:

  • Focus on holistic care and regular health assessments

Weight Management in Diabetes

• Weight Loss Goals:

  • For those with BMI ≥ 25 kg/m² or waist circumference ≥ 94/80 cm (men/women).

  • Aim for 5-15% body weight reduction or a steady weight loss of 0.5-1 kg/week

• Assessing Underlying Causes and Comorbidities:

  • Evaluate previous weight loss attempts and associated health issues

• Management Strategies:

  • Nutrition, physical activity, behavioral therapy, and pharmacotherapy to support weight loss efforts

• Following Weight Loss:

  • Assess the impacts on comorbidities and develop maintenance strategies

Hypertension and Diabetes

• BP Goals for Diabetics with Hypertension:

  • Target BP:<140/90 mmHg

  • Consider lower targets (<130/80 mmHg) for younger patients, those with albuminuria, or multiple atherosclerotic risks

Lipid Management in Diabetes

• Non-HDL Cholesterol:

  • Represents atherogenic lipid components such as LDL

  • Calculated as total cholesterol minus HDL cholesterol, with higher levels indicating increased atherosclerosis risk

Management of Hyperglycemia

• Monitoring and Evaluation:

  • HbA1c test every 6 months for stable patients or every 3 months for patients not meeting targets

• Glycemic Self-Monitoring:

  • Glucose monitoring helps adjust medications, especially essential in insulin therapy

• Continuous Glycemic Monitoring:

  • Evaluates interstitial glucose levels and assists in managing insulin treatment along with hypoglycemia awareness

Glycemic Targets for Nonpregnant Adults

• Targets:

  • A1c: <7.0% (<53 mmol/mol)

  • Preprandial capillary plasma glucose: 80–130 mg/dL (4.4–7.2 mmol/L)

  • Peak postprandial capillary plasma glucose: <180 mg/dL (<10.0 mmol/L)

Individualization of Glycemic Targets

• Factors Influencing Target Setting:

  • Patient motivation, disease duration, life expectancy, and comorbidities

Pharmacological Management

• Hyperglycemia Management Approaches:

  • Lifestyle optimization and medical nutrition therapy

  • Considerations on pharmacotherapy include oral agents, non-insulin injectables, and insulin therapy

• Medication Aspects:

  • Antidiabetic agents need to be discussed in terms of efficacy, weight effects, and side effects for personalized treatment

Lifestyle Optimization

• Dietary Recommendations:

  • Healthy diet focusing on balanced meals and adequate nutrition

  • Avoiding excessive food that leads to weight gain or high glycemic control risks

• Activity Level:

  • Encourage regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week

Risks of Alcohol Consumption

• Potential Dangers:

  • Alcohol may increase the risk of hypoglycemia and other complications particular to diabetic patients

Dietary Guidelines

• Carbohydrate Intake:

  • Focus on healthful carbohydrates and understanding portion sizes

• Fat and Protein Considerations:

  • Recommendations on the quality and quantity of fat and protein intake

• Micronutrient Needs:

  • Adequate nutrition generally fulfills micronutrient requirements without the need for supplementation

Insulin Therapy for Type 1 and Type 2 Diabetes

• Insulin Types:

  • Separate fast-acting and long-acting insulin for personalized regimens

• Pharmacokinetics:

  • Understanding various insulins' onset, peak, and duration is key to effective management

Insulin Pump Therapy

• Basics:

  • Continuous infusion of insulin for basal requirements and prandial doses as necessary

• Benefits and Drawbacks:

  • Discuss advantages in lifestyle flexibility versus complications from pump malfunction

SGLT-2 Inhibitors

• Mechanisms and Effects:

  • Promote glucose excretion through urine, contributing to weight management and blood pressure control

GLP-1 Receptor Agonists and DPP-4 Inhibitors

• Role in Treatment:

  • Enhancing glycemic control and metabolic effects through distinct mechanisms of action

Final Notes

• Patient Compliance:

  • Critical factor in the success of glycemic control measures and treatment protocols

• Take Home Message:

  • Knowledge is valuable only if effectively communicated to and utilized by patients.