Diabetes & Hypertension

Types of DiabetesType 1 Insulin Deficient. There is absolutely no insulin. -cell destruction.

Type 2 Autoimmune form. There is insulin but there is a lot of resistance to insulin. Progressive insulin secretory defect. It often occurs due to obesity.

Criteria for the Diagnosis of Diabetes

A1C 6.5%ORFasting plasma glucose (FPG) 126 mg/dL (7.0 mmol/L)OR2-h plasma glucose 200 mg/dL (11.1 mmol/L) during an OGTTORA random plasma glucose 200 mg/dL (11.1 mmol/L)

Criteria for the Diagnosis of DiabetesA1C 6.5%

The test should be performed in a laboratory using a method that isNGSP certified and standardizedto the DCCT assay*

Criteria for the Diagnosis of Diabetes

Fasting plasma glucose (FPG)126 mg/dL (7.0 mmol/L)

Fasting is defined as no caloric intakefor at least 8 h*

Criteria for the Diagnosis of Diabetes2-h plasma glucose 200 mg/dL(11.1 mmol/L) during an OGTT

The test should be performed as described by the WHO, using aglucose load containing the equivalentof 75 g anhydrous glucosedissolved in water*

Criteria for the Diagnosis of DiabetesIn a patient with classic symptoms of hyperglycemia or hyperglycemic crisis,a random plasma glucose 200 mg/dL (11.1 mmol/L)

Criteria for the Diagnosis of Pre -DiabetesFPG 100125 mg/dL (5.66.9 mmol/L): IFGOR2-h plasma glucose in the 75-g OGTT140199 mg/dL (7.811.0 mmol/L): IGTORA1C 5.76.4%

Recommendations: Testing for Diabetes in Asymptomatic PatientsConsider testing overweight/obese adults (BMI 25 kg/m2 or 23 kg/m2 in Asian Americans) with one or more additional risk factors for type 2 diabetes; for all patients, particularly those who are overweight, testing should begin at age 45 years BIf tests are normal, repeat testing at least at 3-year intervals is reasonable CTo test for diabetes/prediabetes, the A1C, FPG, or 2-h 75-g OGTT are appropriate BIn those with prediabetes, identify and, if appropriate, treat other CVD risk factors B

Criteria for the Diagnosis of Diabetes

2. In the absence of criteria (risk factors on previous slide), and particularly in those who are overweight or obese, testing for diabetes should begin at age 45 years

3. If results are normal, testing should be repeated at least at 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly), and risk status

Screening of Diabetes.Screening is with Fasting blood sugar fasting blood sugar greater than or equal to 126 mg% , on two separate occasions confirms DM ( Also, Random blood glucose > 200 with symptoms {Polyuria, Polydipsia, Polyphagia} indicate DM but it needs confirmation with a fasting blood sugar on another day)

Recommendations:Detection and Diagnosis of GDM (1)Screen for undiagnosed type 2 diabetesat the first prenatal visit in those withrisk factors, using standard diagnostic criteria BScreen for GDM at 2428 weeks of gestation in pregnant women not previously known to have diabetes AScreen women with GDM for persistent diabetes at 612 weeks postpartum, using OGTT, nonpregnancy diagnostic criteria E

Recommendations:Detection and Diagnosis of GDM (2)Women with a history of GDM shouldhave lifelong screening for the development of diabetes or prediabetesat least every 3 years BWomen with a history of GDM found to have prediabetes should receive lifestyle interventions or metformin to prevent diabetes A

Screening for and Diagnosis of GDMOne-step StrategyPerform a 75-g OGTT, with plasma glucose measurement fasting and at 1 and 2 h, at 2428 weeks of gestation in women not previously diagnosed with overt diabetesPerform OGTT in the morning after an overnight fast of at least 8 hGDM diagnosis: when any of the following plasma glucose values are exceededFasting: 92 mg/dL (5.1 mmol/L)1 h: 180 mg/dL (10.0 mmol/L)2 h: 153 mg/dL (8.5 mmol/L)

Screening for and Diagnosis of GDMTwo-step Strategy (1)

Step 1: Perform 50-g GLT (nonfasting) with plasma glucose measurement at 1 h at 2428 weeks of gestation in women not previously diagnosed with overt diabetes If plasma glucose level measured at 1 h after load is 140 mg/dL* (7.8 mmol/L), proceed to step 2, 100-g OGTT

Screening for and Diagnosis of GDMTwo-step Strategy (2)Step 2: 100-g OGTT is performed while patient is fasting. The diagnosis of GDM is made if 2 or more of the following plasma glucose levels are met or exceeded:

Carpenter/Coustan or NDDG______ Fasting 95 mg/dL (5.3 mmol/L) 105 mg/dL (5.8 mmol/L)1h 180 md/dL (10.0 mmol/L) 190 mg/dL (10.6 mmol/L)2h 155 mg/dL (8.6 mmol/L) 165 mg/dL (9.2 mmol/L)3h 140 mg/dL (7.8 mmol/L) 145 mg/dL (8.0 mmol/L)

Diabetes-related complicationsMicrovascular: retinopathy, nephropathy, neuropathySensory neuropathy, including history of foot lesionsAutonomic neuropathy, including sexual dysfunction and gastroparesisMacrovascular: CHD, cerebrovascular disease, PADOther: psychosocial problems,* dental disease*

Diet and Exercise2 hour ruleFrequent small meals45 minutes walk daily.Avoid cold drinks and junk food.Cooking oil Olive / MustardToned Milk Cows milk preferred.

Hypertension ClassificationBP Classification SBP DBPNormal 100

In adults (>18 years), note that classification is based on an average of 2 or more readings obtained at 2 or more separate visits. When white coat HTN is suspected or if the diagnosis of sustained HTN is not certain, consider ambulatory BP monitoring or self-recorded (home) BP measurements.

Facts about hypertension.SBP is more important Cardiovascular risk factor. Cardiovascular disease risk doubles with each 20/10mmHg increment over 115/75.Targets

140/90130/80 if diabetic or CKD125/75 if Diabetic Nephropathy ( microalbuminuria)Consider 2 agents if BP >20/10 above goal. One agent should usually be Thiazide diuretic. Second agent can be ACEI, ARB, Beta blocker or Calcium channel blockers. @ Thiazides reduce Angina, heart failure in a better way than CCBs and ACEIs in all races @ also reduces Stroke in Afracan Americans.Two or more agents usually required for effective control of blood pressure

Lifestyle ModificationApproximate SBP Reduction

Weight Reduction: 5 to 10 mm Hg for every 10kg weight reduction

DASH Diet: 8 to 14 mm Hg

Dietary Sodium Restriction: 2 to 8 mm Hg

Physical activity: 4 to 9 mm hg

Moderation of alcohol use: 2 to 4 mm hg

Any Questions ?