Major_Disease_States_and_Preventive_Care_fall_2012 (3)

Risk factor assessment age men 45 women 55 family

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Risk Factor Assessment Age Men ≥ 45 Women ≥ 55 Family history of premature CHD Men ≤ 55 Women ≤ 65 Cigarette smoking Hypertension BP ≥ 140/90 mm Hg or on medication Low HDL-C (< 40 mg/dL) High HDL-C is a NEGATIVE risk factor (≥ 60 mg/dL) National Cholesterol Education Program’s Expert Panel on Detection, Evaluation, and Treatment of High  Blood Cholesterol in Adults, Adult Treatment Panel III. NCEP ATP III Update. Circulation. 2004.
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Determining LDL Goal: Risk Factor Assessment HIGH risk CHD CHD risk equivalent Peripheral arterial disease Abdominal aortic aneurysm Carotid artery disease Diabetes LOW risk 0-1 NCEP risk factors
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Dyslipidemia: Goals Risk Category LDL-C Goal  (mg/dL) Initiate TLC  (mg/dL) High risk <100 (optional <70) ≥ 100 Moderately high risk < 130 (optional < 100) ≥ 130 Moderate risk < 130 ≥ 130 Lower risk < 160 ≥ 160 National Cholesterol Education Program’s Expert Panel on Detection, Evaluation, and Treatment of High  Blood Cholesterol in Adults, Adult Treatment Panel III. NCEP ATP III Update. Circulation. 2004.
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Risk Assessment: Risk Calculator
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DIABETES MELLITUS (DM)
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Diabetes: Epidemiology 25.8 million (8.3%) people in the United States have diabetes 1/4 of these patients are undiagnosed 79 million have pre-diabetes 90-95% of patients with diabetes have type 2 diabetes In 2010, it was the 7th leading cause of death in the United States  Accessed Sept. 18, 2012
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Diabetes: Risk Factors Age ≥ 45 BMI ≥ 25 kg/m 2 Physical inactivity First-degree relative with diabetes Race Delivered a baby > 9 lb. or h/o GDM Hypertension HDL cholesterol < 35 mg/dL and/or triglycerides > 250 mg/dL Had IFG or IGT Have PCOS Have a history of CVD
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Diabetes FPG (mg/dL) RPG (mg/dL) 2-Hour Post OGTT (mg/dL) Hemoglobin A1c Normal 70-100 < 140 < 140 < 6% IFG 100-125 < 140 < 140 6-6.4% IGT 70-100 140-199 140-199 Diabetes ≥ 126 ≥ 200* ≥ 200 > 6.5% Standards of Medical Care in Diabetes – 2012. American Diabetes Association (ADA). Diabetes Care. 2012
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DIABETES INCREASES THE RISK OF…
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Diabetes Complications 1. CVD (heart disease, stroke) 2. Blindness (retinopathy) 3. Kidney disease (nephropathy) 4. Neuropathy 5. Dental caries 6. Complications with pregnancy
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Nutrition and Diabetes Carbohydrates 45-65% of calories should come from carbohydrate Should include fruits, vegetables, whole grains, legumes, low-fat milk Education on carbohydrates and how to monitor the total amounts of carbohydrates (in grams) Sucrose-containing food may be substituted for other carbohydrates in the meal plan
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Nutrition and Diabetes Nutritive Sorbitol Mannitol Xylitol Non-nutritive Saccharin Aspartame Sucralose Acesulfame potassium Alternative  Sweeteners Standards of Medical Care in Diabetes – 2010. American Diabetes Association (ADA).
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