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Published byChester Parsons Modified over 9 years ago
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Epidemiology and Diagnosis A Practical Guide to Therapy Monotherapy Combination Therapy Add ons
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Impaired Glucose Tolerance - IGT Impaired Fasting Glucose - IFG
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Evaluation of Major Risk Factors in Diabetics Cigarette Smoking Blood Pressure Serum Lipids & Lipoproteins Albuminuria Glycemic Status Body Weight BMI (Kgs/M2& W/H Ratio Physical activity Family History
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Detection of Clinical & Subclinical Cardiovascular Disease in the Diabetics Stress testing (BP & HR response blunted) Painless ST depression, lowered specificity Echo : diastolic dysfunction Tc 99 perfusion Scintigraphy Autonomic dysfunction (50% mort. In 5yrs) LVH in ECG is strong predictor of CHD Coronary calcium scoring - CT based
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Predictors of Worsening of GT Insulin resistance Insulin Secretory dysfunction These can be assessed by –Insulin stimulated glucose disposal (M) –Acute insulin Secretory response (AIR) –Hydrodensitometry (body composition)
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Beta cell mechanism Insulin secretion and Glucose regulation Effects of hyper glycemia Biphasic Insulin response Insulin secretagogues Glycaemic goals & Pregnancy Diabetic retinopathy Glitazones Hyperglycemia
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Etiologic classification of diabetes mellitus Glucose tolerance categories Diagnosis of Diabetes Diagnosis of Diabetes II
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Management Goals Metabolic Targets Deterioration in Median Antihyperglycemic Agents Antihyperglycemic Agents(Sites) Antihyperglycemic Agents(Mechanism) The -Glucosidase inhibitors The -Glucosidase inhibitors(Effect) Acarbose Effect on HbA1c The Biguanides(Characteristics) Metformin (Mechanism)
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Metformin Effect(Glucose) Metformin Effect(HbA1c) Dose Response(Metformin) Insulin Secretagogues Repaglinide Effect(HbA1c) Repaglinide after Sulfonylurea Sulfonylurea Effect(Glucose) Dose Response(Sulfonylurea) Once vs Twice daily(Sulfonylurea) Placebo subtracted dose Selected insulin secretagogues -Glucosidase Dosing Hypoglycemic episodes Sulfonylureas Insulin Secretagogues Initial treatment Secondary Failures Metformin -Glucosidase Inhibitors
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Glycemic Improvements Sulfonylurea+Metformin Sulfonylurea+Acarbose Combinations of Oral agents Secondary Failure Metformin+Repaglinide Metformin+Acarbose Glimepride+Insulin(FPG) Glimepride+Insulin(HbA1c) Oral Agents+Insulin Sulfonyurea+Insulin Insulin+Metformin(HbA1c) Insulin+Metformin(Effect)
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