E: Tissue Complications Of Dm

Front 1

• Name 3 organs or tissues characteristically affected by chronic microvascular disease in diabetes.

Back 1

diabetic "triopathy":
1) retinopathy
2) nephropathy
3) neuropathy

Front 2

cataracts, urinary tract infection, stroke, heart attack, hypertension, or gangrene due to vascular occlusions above the ankle are characterized as which type of DM complications?

Back 2

non-microvascular ones.

Front 3

• For type 1 and type 2 diabetes separately, name one randomized prospective clinical trial demonstrating the effectiveness of glycemic control in reducing the onset or progression of chronic microvascular disease.

Back 3

Type 1: DCCT

Type 2: UKPDS

Front 4

go through the stages of diabetic retinopathy.

Back 4

background retinopathy --> preproliferative retinopathy --> proliferative retinopathy

Front 5

Name the stage of diabetic retinopathy each of the following are associated with:
- microaneurysm, blot and punctate intraretinal hemorrhages, waxy hard exudates, macular edema, additional changes (often associated with HTN)
- neovascularization (hallmark), vitreous and preretinal hemorrhages, fibrovascular proliferation, retinal detachment.

Back 5

- backgroung and preproliferative
- proliferative

Front 6

• For nephropathy and retinopathy, summarize noninvestigational strategies other than glycemic control that have been proven to retard the progression of organ injury.

Back 6

retinopathy: VEGF antagonists, HTN and dyslipidemia

nephropathy: Smoking, heritable version of ACE, dyslipidemia, high protein diet, systemic HTN, glom hyperfiltration, ^intraglom capillary pressure
- ACE and ARB proven to be helpful.
- microalbuminuria is a known way to pick this up eariler.

Front 7

• For nephropathy and retinopathy, describe clinical methods of detecting the presence of the condition, and to state which of these methods are recommended by the American Diabetes Association (ADA) as part of a program of periodic monitoring.

Back 7

• BP check at each visit, target < 130/80
• Comprehensive foot exam annually and visual exam at each visit
• A1C quarterly if above target, otherwise semiannually
• Lipid panel annually
• Inquiry and counseling about smoking cessation
• Serum creatinine annually
• Microalbuminuria screening annually, normal < 30 (mcg albumin)/(mg creatinine)
• Dilated retinal exam annually

Front 8

• Name 4 complications of macrovascular disease that occur with greater frequency in the presence of type 2 diabetes

Back 8

MI, PVD, Stroke, angina pectoris

Front 9

• Name 4 factors that carry risk for cardiovascular disease in the presence of diabetes but are traditional risk factors for cardiovascular disease for nondiabetic people as well

Back 9

HTN, smoking, altered lipoprotein concentrations, inflammatory cytokine.

Front 10

• Name 4 nontraditional risk factors for cardiovascular disease that are traceable to diabetes or its complications

Back 10

glycated proteins, hyperG, albuminuria, endothelial dysfunction

Front 11

• Name two adverse outcomes among hospitalized patients reduced by intravenous insulin infusion, state the setting in which the risk reduction has been demonstrated, and state demonstrable effects of insulin that are likely to be important in the mechanism of protection.

Back 11

deep sternal wound infection is reduced in post-cardio surgx pts.

in ventilator dependent critically ill surgical pts IV glucose has been shown to reduce mortality, bactermia, unit neuropathy, transfusion requirement, and renal failure.

• fuel and energy metabolism
– glucose
– free fatty acids
– reactive oxygen species
– nutritional status
• coagulation pathway
• inflammatory pathway
• endothelium
– protection against vessel wall inflammatory processes
– vasodilatory action (nitric oxide synthase)
• heart (pump failure, arrhythmia)
• host defenses against infection

Front 12

What is the leading cause of viz loss in pts with t2dm?
- at what stage of retinopathy does this occur?

What is the other important cause of blindness?

Back 12

Clinically Significant Macular Edema (CSME):
- Definition: permeability, leakage, and accumulation of intraretinal fluid
- Lipid exudates from damaged retinal capillaries and microaneurysms

... this is a complication that results from retinopathy... can occur @ any stage.

ischemia --> neovascularizatoin --> proliferative DR.