Algorithm for management of the patient with pain because of DSPN

Slides:



Advertisements
Similar presentations
Date of download: 7/6/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Effect of Duloxetine on Pain, Function, and Quality.
Advertisements

Mechanisms of diabetic neuropathy.
Duloxetine Flavio Guzman, MD.
Current Therapy for Type II Diabetes
A: Percentage of type 1 diabetic and type 2 diabetic patients with asymptomatic hypoglycemias detected by the CGMS. B: Daily distribution of asymptomatic.
The means and SDs of the data from all Glucommander runs from 1984 to 1998 are graphed. The means and SDs of the data from all Glucommander runs from 1984.
Gender differences in diabetes prevalence in 2009 in the general Portuguese population patients and in patients with CAP. Diabetes prevalence is higher.
Mean daily glucose concentration and frequency of hypoglycemia in long-term care residents with type 2 diabetes. Mean daily glucose concentration and frequency.
Scatterplot showing the association between baseline weight and weight change at 1 year, relative to baseline for each treatment group. Scatterplot showing.
Patient disposition. Patient disposition. AE, adverse event. *One patient died during the follow-up period. ^Four of the 12 discontinuations of treatment.
Incidence rates and HRs for total cardiovascular events and stroke stratified by the TCF7L2-rs polymorphism and the dietary intervention group after.
The rates of occurrences of cardiovascular, cerebrovascular, and all events expressed in cases per 1, 000 patient-years in diabetic subgroups divided by.
Trends in prevalence of diabetes in middle-aged women grouped according to BMI at the first survey of the ALSWH. ▪, healthy (n = 5,252); ♦, overweight.
Age-adjusted OR (A) and multivariate-adjusted OR (B) and 95% CI for the presence of retinopathy and albuminuria by quintiles of WBC count in 3,776 patients.
An algorithm depicting the basic approach to the Charcot foot
Mean mesangial area (micron2) across normal controls (normal C), patients with type 2 diabetes and normoalbuminuria (normo), patients with type 2 diabetes.
The incidence of insulin-treated type 1 diabetes in the first 35 years of life. The incidence of insulin-treated type 1 diabetes in the first 35 years.
—ROC curves for each simple test compared with NCS (gold standard) plotting the sensitivity versus 1-specificity (the false-positive rate) for different.
Shown are cumulative incidence curves of TNNHS and DPT-1 participants who either had DPTRS values >7.00 (A) or dysglycemia (B). Shown are cumulative incidence.
The concept of immortal time bias is depicted schematically using the cohort study from the Taiwanese National Health Insurance data during 2000–2007:
FMD and PWV of patients with diabetes with (T2DM-SCT) or without (T2DM) SCT and of healthy individuals with (SCT) or without (CONT) SCT. FMD measured at.
Forefoot peak plantar pressure in diabetic patients without and with mild, moderate, and severe peripheral neuropathy. *Severe and moderate neuropathy.
Pooled risk with 95% CI of ACM (A) and CVD risk (B) for the highest vs
The effect of PAD and infection on outcome of cast treatment
Kaplan-Meier estimation of diabetes-related survival curves in patients grouped according to increased 24-h proteinuria (A), the presence of preexisting.
Mean fasting C-peptide levels (for all subjects [A]) and mean peak C-peptide levels (all subjects [B], adolescents [C], and adults [D])after mixed-meal.
Two-year changes in albumin-to-creatinine ratio across microalbuminuria at baseline. Two-year changes in albumin-to-creatinine ratio across microalbuminuria.
Selection of DFU patients and non-DFU controls
Glucose control performance (by CGM) characterized by median and interquartile range cumulative % time in glucose range (A), overall glucose (B), and insulin.
Patient flowchart of recruitment and treatment failure and success with glyburide vs. metformin. Patient flowchart of recruitment and treatment failure.
Treatment response patterns and effect size over time in exclusively placebo-controlled trials. Treatment response patterns and effect size over time in.
Forest plot and pooled estimates of the effect of NAFLD on the risk of incident diabetes in 16 eligible studies, stratified by length of follow-up (FU)
Relationship between week 24 A1C and week 24 BeAM in the exploratory analysis (A), the main analysis (only patients with A1C >7.0% at week 24 were included.
Metabolic parameters in the three groups of patients during l-arginine infusion. Metabolic parameters in the three groups of patients during l-arginine.
Waveform analysis at the popliteal artery in 176 diabetic patients with normal ABI (non-PAD). Waveform analysis at the popliteal artery in 176 diabetic.
A total of 173 individuals were positive for GADA, and 16 of these were positive for a second antibody (11 were IA-2A positive, and 6 were ZnT8A positive).
Kaplan-Meier survival curve for CVD mortality among physically active and inactive type 2 diabetic patients stratified by baseline hs-CRP levels. Kaplan-Meier.
Kaplan-Meier survival analysis for all-cause and CVD mortality in 2,823 type 2 diabetic patients stratified by CKD according to each creatinine-based equation.
Associations between biomarkers of subclinical inflammation and progression of DSPN assessed by changes in MNSI in individuals with DSPN in KORA F4/FF4.
Changes in glycated hemoglobin (HbA1c) levels after 12 weeks’ treatment with lixisenatide (according to dose increase regimen) or placebo. Changes in glycated.
Study design (A) and patient disposition (B).
Enrollment, outcomes, and pharmacokinetics.
Effects of vinegar (□) and placebo (⧫) on plasma glucose (A–C) and insulin (D–F) responses after a standard meal in control subjects, insulin-resistant.
Number of antihypertensive agents prescribed for known nephropaths in phases I and II (▪), with blood pressure recordings falling outside guidelines, compared.
HRs for type 2 diabetes by category of age at menarche in the EPIC-InterAct study. HRs for type 2 diabetes by category of age at menarche in the EPIC-InterAct.
Pooled analysis of association between (nonexclusive) breast-feeding and childhood-onset type 1 diabetes in studies investigating ∼2 weeks (nonexclusive)
Percent binding of cross-reactive antibodies from cross-over studies in insulin-treated patients with type 1 or type 2 diabetes. Percent binding of cross-reactive.
RBP4 and glucose metabolism.
Percent binding of cross-reactive antibodies from parallel studies in insulin-treated patients with type 1 or type 2 diabetes. Percent binding of cross-reactive.
Visualization of prescriptive algorithm: provider dashboard prototype.
Periods of activation for the knee extensor (VL) and ankle extensor (GN) muscles with respect to foot-step contact (occurring at time zero) during stair.
One-year cumulative incidence rates of adverse clinical outcomes in 9,428 outpatients with CHF stratified by diabetes status at baseline. One-year cumulative.
A: Typical course of a normal sympathetic vasomotor response as recorded by continuous wave Doppler sonography. A: Typical course of a normal sympathetic.
Plots of average estimated and measured GFR vs
A: Probability of retinopathy-free survival.
Algorithm for management of patients with pain due to DSPN
Mean HbA1c (%) and estimated marginal mean SH rate (per 100 patient-years) adjusted for sex, age-group at diagnosis, and diabetes duration, by time period,
Pooled estimate of relative risk and 95% CIs of colorectal cancer associated with metformin therapy based on four studies comprising 107,961 diabetic patients.
Correlation between urinary albumin excretion rate and expression of platelet surface markers, active GPIIb/IIIa, and P-selectin. Correlation between urinary.
A1C at baseline, 16 weeks, and 32 weeks according to study group in all participants (A), adult participants (B), and adolescent participants (C) who returned.
Predicted, unadjusted prevalence of aggregate MVD (retinopathy, nephropathy, and/or neuropathy) (A), nephropathy (B), retinopathy (C), and neuropathy (D)
Glycemic profile at time of recruitment of women with ICP (n = 19) and uncomplicated pregnancy (n = 23) using a CGMS (Medtronic iPro2) over 3 days. Glycemic.
Recommendations for the treatment of confirmed hypertension in people with diabetes. *An ACE inhibitor (ACEi) or ARB is suggested to treat hypertension.
Upper panel: For performance of the 10-g monofilament test, the device is placed perpendicular to the skin, with pressure applied until the monofilament.
Risk of mortality in patients with diabetes and ESRD
WM volume did not show the expected increase in volume with age in children with type 1 diabetes (●), in contrast with HC subjects (▲) who showed the (expected)
The ADA research program supports research across the broad spectrum of diabetes types and research topic areas (proportions of 2011 allocations in dollars).
Four–time point diurnal profiles of plasma glucose concentrations (A) and AUCs (B) over quintiles of HbA1c. ○, AUC1; •, AUC2; ▴, AUC2 − AUC1 (differences.
Cumulative mean numbers of confirmed (plasma glucose ≤3
Few patients with youth-onset type 2 diabetes are available to participate in clinical trials. Few patients with youth-onset type 2 diabetes are available.
Presentation transcript:

Algorithm for management of the patient with pain because of DSPN Algorithm for management of the patient with pain because of DSPN. AE, adverse events.*Pregabalin is FDA approved for painful DSPN, whereas gabapentin is not. Algorithm for management of the patient with pain because of DSPN. AE, adverse events.*Pregabalin is FDA approved for painful DSPN, whereas gabapentin is not. Pharmacokinetic profile, spectrum of AEs, drug interactions, comorbidities, and costs to be considered in selecting the agent of choice. **Duloxetine is FDA approved for painful DSPN, whereas venlafaxine is not. Pharmacokinetic profile, spectrum of AEs, drug interactions, comorbidities, and costs to be considered in selecting the agent of choice. #None is FDA approved for painful DSPN. Spectrum of AEs, drug interactions, and comorbidities need be considered if selecting these agents. Rodica Pop-Busui et al. Dia Care 2017;40:136-154 ©2017 by American Diabetes Association