1. Shadi Al-Ahmadi

2. The Presentation will include: Hypertension Dyslipidemia CVD Type 2 Diabetes-Associated Retinopathy Diabetic Periphral Neuropathy Diabetic Nephropathy

3. Hypertension Facts: Seventy-three percent of adults with diabetes have a blood pressure level of 130/80 mm Hg or higher, or take prescription drugs to manage hypertension. Concomitant hypertension augments the effects of hyperglycemia in microvascular complications.

4. Hypertension The target blood pressure level goal for individuals with type 2 diabetes should be less than 130/80 mm Hg. Pharmacologic treatment: - ACE inhibitor. - When second drug is needed: - GFR > 50 Ml/min  thiazide diuretic - GFR < 50 Ml/min  loop diuretic

5. Dyslipidemia We should attempt to lower the LDL cholestrol level to less than 100 mg/dL. For patients with overt CVD and diabetes, an LDL cholesterol level of less than 70 mg/dL is recommended.

6. Dyslipidemia The triglyceride level goal should be less than 150 mg/dL. The HDL cholesterol level goal should be: - > 40 mg/dL for men. - > 50 mg/dL for women. The statins are the drug class of choice for Lowering lipid levels in the management of type 2 diabetes.

7. Cardiovascular Disease 55% of adult patients with diabetes have CVD Annual assessment of Cardiovascular risk factors is recommended. In asymptomatic patients older than 40 years type 2 diabetes and another risk factor for coronary heart disease, treatment using a statin and aspirin is recommended.

8. Cardiovascular Disease Secondary prevention of CVD in patients with type 2 diabetes include: - optimizing control of diabetes, hypertension, body weight, and lipid levels. - ACE inhibitor - aspirin - statin - Beta blockers

9. Type 2 Diabetes-Associate Retinopathy Diabetic retinopathy (DR) is a leading cause of vision loss in adults ages 20 to 74 years. The prevalence is directly related to the length of lime a patient has diabetes. The majority of patients with type 2 diabetes exhibit some degree of DR within 20 years of diagnosis.

10. Type 2 Diabetes-Associate Retinopathy Although retinopathy typically develops approximately 5 years after hyperglycemia begins, many patients with type 2 diabetes with DR are undiagnosed for long periods. The initial examination should be performed at the time of diabetes diagnosis. with subsequent examinations annually.

11. Type 2 Diabetes-Associate Retinopathy Laser Phototherapy is a widely used therapy to manage DR. It was found to decrease the risk of proliferative DR-induced vision loss from 15.9% to 6.4% in patients with diabetes.

12. Diabetic Periphral Neuropathy Neuropathies are some of the most common long- term diabetic complications, with up to 47% of patients developing peripheral neuropathy (DPN). Screening for peripheral neuropathy should be performed when the diagnosis of type 2 diabetes is made. Patients should be screened annually thereafter.

13. Diabetic Periphral Neuropathy Current guidelines recommend an annual comprehensive foot screening that should include: - inspection and assessment of pulses. - assessment of protective sensation using monofilament + one of the following: * 128-Hz tuning fork * ankle reflex testing. * pinprick sensation rest.

14. Diabetic Periphral Neuropathy Management: Patients with DPN should receive enhanced education regarding root care and special footwear. Two drugs are FDA-approved to manage chronic pain associated with DPN.

15. Diabetic Periphral Neuropathy Duloxetine (Cymbalta) is a ser0tonin norepinephrine reuptake inhibitor. 60 to 120 mg PO OD Pregabalin (Lyrica) is an anti­convulsant. 100 mg PO TID

16. Diabetic Nephropathy Diabetes is a leading cause of ESRD. Albuminuria is the earliest indicator of diabetic nephropathy. Microalbuminuria is diagnosed when levels of urinary albumin exceed 30 mg/day or 20 mcg/min.

17. Diabetic Nephropathy 20% to 40%0 of those with type 2 diabetes and microaIbuminuria develop nephropathy. But only 20% progress to ESRD within 20 years. The urinary albumin level should be measured starting at diagnosis and then annually in patients with newly diagnosed type 2 diabetes.

18. Diabetic Nephropathy Medical treatment include: - ACE Inhibitor - thiazide or loop diuretic. Annual measurement of serum creatinine level to assess renal function and stage of chronic kidney disease is recommended.

19. THANK YOU