SPPS249Diabetes050211bw

SPPS249Diabetes050211bw - Management of Diabetes...

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Unformatted text preview: Management of Diabetes Mellitus (SPPS 249) Steven Chessler, MD PhD Department of Medicine Division of Endocrinology [email protected] 5/2011 Glucose measurements Benefits of treatment Modalities of treatment Glycation of circulating proteins: a measurement of average blood sugars Hemoglobin A1C (Hgb A 1 C) glycation of the N-terminus of Hgb β chain life span of red cells: 4 months A1C: average BG in the preceding 1.5-2 mos. assess and adjust therapy for diagnosis (A1C ≥ 6.5) From UCSF DTC Rate of formation of HbA1c is directly related to the ambient glucose concentration Erythrocytes are freely permeable to glucose HbA1c provides a glycemic history of the previous 90 days, the average erythrocyte lifespan Current recommendations (ADA): 2-4 HbA1c measurements each year Protein Glycation: HbA1c HbA1C versus mean blood glucose Monitoring of blood glucose • Glycosuria: honey-sweet (mellitus) o Taste o Self-monitoring of urine glucose • Glucose (venous blood) first patent: 1971 • SMBG (self-monitoring of BG)-Finger sticks, capillary blood, glucometer • CGMS (continuous glucose monitor)-interstitial fluid Monitoring of blood glucose SMBG (self-monitoring of BG) Bayer Glucometer, 1981: f rst home glucometer Monitoring of blood glucose SMBG (self-monitoring of BG) glucose oxidase reacts with glucose in the blood producing a small electrical current. As little as 0.6 microliters 5 sec Monitoring of blood glucose CGMS (continuous glucose monitor)-subQ catheter-interstitial fluid Glucose measurements Benefits of treatment Modalities of treatment Symptoms of hyperglycemia: Polyuria, Polydipsia, Polyphagia • Osmotic diuresis : Excessive urine output due to increased load of glucose or other osmotically active molecules • when BG >180 mg/dl : tubular reabsorption saturated--> glucose remains in the lumen--> fluid trapped in the lumen (osmosis)--> diuresis and glycosuria. •dehydration major component of acute, life-threatening conditions associated with diabetes Acute, life-threatening complications: Hyperosmolar coma Ketoacidosis Long-term complications of diabetes: Macrovascular (atherosclerosis) heart attack, stroke, limbs, impotence Microvascular retina, kidney, nerves Non-vascular: lens, joint, infection DCCT Relationship of HbA 1c to Risk of Microvascular Complications Skyler. Endocrinol Metab Clin. 1996;25:243-254 Relative Risk Retinopathy Nephropathy Neuropathy Microalbuminuria HbA 1c (%) 15 13 11 9 7 5 3 1 6 7 8 9 10 11 12 ACCORD TRIAL Median Glycated Hemoglobin Levels at Each Study Visit The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med 2008;358:2545-2559 ACCORD TRIAL Kaplan-Meier Curves for the Primary Outcome and Death from Any Cause The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med 2008;358:2545-2559 Conclusion • As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortalityhemoglobin levels for 3....
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This note was uploaded on 09/14/2011 for the course PHARM pp taught by Professor Staff during the Spring '11 term at UCSD.

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SPPS249Diabetes050211bw - Management of Diabetes...

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