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criteria for a diagnosis of diabetes
- A1C > 6.5%
- FBG > 126 mg/dl
- symptoms of DM + random glucose > 200 mg/dL
- 2 hour plasma glucose > 200 during OGTT
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criteria for pre-diabetes
- A1C 5.7-6.4%
- FPG 100-125 mg/dL
- OGTT 140-199 mg/dL
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12 risk factors for DM
- obesity/overweight BMI >25 kg/m2physical inactivity
- 1st degree relative with DM
- high risk ethnicity
- women w/history of GDM or baby > 9 lbs
- PCOS
- history of CVD
- HDL < 35 mg/dL
- triglycerides > 250 mg/dL
- HTN: BP > 140/90 mmHg or on treatment
- Resistance conditions
- BMI > 40 kg/m2
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Acanthosis Nigrans
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High risk ethnicity/race groups for DM
- African american
- latino
- native american
- Asian american
- pacific islander
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microvascular complication from DM
- nephropathy
- retinopathy
- neuropathy
- foot ulcers/lesions
- numbness, pain
- sexual dysfunction
- gastroparesis
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macrovascular complications of DM
- cardiovascular disease - CVD
- coronary artery disease - CAD
- myocardial infarction - MI
- stroke or transient ischemic attack - TIA
- peripheral artery disease - PAD
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3 adult groups that should receive screenings for DM
- all adults (>18 yo) with BMI > 25 kg/m2 and 1 or more risk factors
- adults w/o risk factors - start at age 45
- pt w/pre-diabetes values - yearly
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ADA goals for DM
- A1C < 7%
- 6.5% if short duration of DM, long life
- expectancy and significant CVD
- <8% for hypoglycemia, elderly & pregnancy
- pre-prandial 70-130
- postprandial <180
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LDL goals for DM
- < 100 mg/dL w/o CVD
- < 70 mg/dL w/ CVD
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triglyceride goal for DM
< 150 mg/dL
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HDL goal for men and women with DM
- men - > 40 mg/dL
- women - > 50 mg/dL
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4 broad Tx goals of DM
- relieve symptoms
- prevent or slow progression of complications
- minimize cardiovascular risks
- improve quality of life
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