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33761 - Public Health Approach Public Screening/Public...

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Public Health Approach Public Health Approach
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Screening/Public Health Approach Screening/Public Health Approach Public Education Screening for at risk individuals: Blood Sugar/ HbA1c Lipids Blood pressure Tobacco use Body habitus Family history
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Life-Style Modification: Is it Important? Life-Style Modification: Is it Important? Exercise Improves CV fitness, weight control, sensitivity to insulin, reduces incidence of diabetes Weight loss Improves lipids, insulin sensitivity, BP levels, reduces incidence of diabetes Goals: Goals: Brisk walking - 30 min./day Brisk walking - 30 min./day 10% reduction in body wt. 10% reduction in body wt.
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Smoking Cessation / Avoidance Smoking Cessation / Avoidance : : A risk factor for development in children and adults Both passive and active exposure harmful A major risk factor for: insulin resistance and metabolic syndrome macrovascular disease (PVD, MI, Stroke) microvascular complications of diabetes pulmonary disease, etc.
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Diabetes Control - How Important Diabetes Control - How Important ? ? Goals Goals : FBS - premeal <110, FBS - premeal <110, postmeal postmeal <180. <180. HbA1c <7% HbA1c <7% For every 1% rise in Hb A1c there is an 18% rise in risk of cardiovascular events & a 28% increase in peripheral arterial disease Evidence is accumulating to show that tight blood sugar control in both Type 1 and Type 2 diabetes reduces risk of CVD
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Lifestyle modification Diet Exercise Weight loss Smoking cessation If a 1% reduction in HbA 1c is achieved, you could expect a reduction in risk of: 21% for any diabetes- related endpoint 37% for microvascular complications 14% for myocardial infarction However, compliance is poor and most patients will require oral pharmacotherapy within a few years of diagnosis Stratton IM et al . BMJ 2000; 321: 405–412.
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Overcome Insulin Resistance/ Diabetes Overcome Insulin Resistance/ Diabetes : : Insulin Sensitizers: Biguanides – metformin Glitazones, Gltazars Can be used in combination Insulin Secretagogues: Sulfonylurea - glipizide, glyburide, glimeparide, glibenclamide Meglitinides - repaglanide, netiglamide
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Insulin Insulin Insulin Analogues: Lyspro /Aspart /glulysine used with meals Glargine & Livemer as basal insulin Continuous Subcutaneous Insulin Infusion (CSII) NPH/Regular, NPH/logs - Mixed or in fixed combinations (70/30, 75/25, 50/50) Insulin combined with oral agents
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BP Control - How Important BP Control - How Important ? ? Goal: BP. BP. <130/80 <130/80 MRFIT and Framingham Heart Studies: Conclusively proved the increased risk of CVD with long-term sustained hypertension Demonstrated a 10 year risk of cardiovascular disease in treated patients vs non-treated patients to be 0.40.
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