Summary Diabetes and Complications: Clinical Presentation, Investigations, Management in a GP Setting
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Course
MEDI3101
Institution
University Of Newcastle (UON
)
Structured summary of T1/T2 diabetes and the complications, management in a GP setting
Includes:
- T1DM
- T2DM
- Peripheral nephropathy
- Diabetic retinopathy
T2DM
● Risk factors: genetic, HTN, overweight/obese, sedentary, poor diet, increased weight
around waist, PCOS, antipsychotic meds, ATSI, Hx of CV events
● Hx: usually asymptomatic; lethargy, polyuria, polydipsia, frequent infections, blurred
vision, numbness, poor wound healing, weight loss
● Insulin resistance signs: acanthosis nigricans, skin tags, central obesity, hirsutism
● Dx:
○ Asymptomatic patients: 2nd lab results required to confirm diagnosis on
separate occasion
■ Fasting blood glucose (FBG) >/= 7mmol/L or RBG >/= 11.1mmol/L
■ Oral glucose tolerance test (OGTT) - FBG >/= 7mmol/L or 2hr blood
glucose >11.1mmol/L
■ HbA1c >/= 48mmol/mol (6.5%)
■ Check pts for risk every 3yrs when 40yrs > using AUSDRISK tool
■ High risk: AUDSRISK score >/= 12, Hx of CV event, Hx GDM/PCOS,
antidepressants, >40yrs + overweight/obese, 1st degree relative w
diabetes, high-risk ethnic groups
○ High risk screened with FBG or HbA1c every 3 years/yearly i impaired results
■ Screen all ATSI 18yrs + with fasting glucose, random glucose, HbA1c
yearly - much higher risk
○ Symptomatic: symptoms suggestive of hyperglycaemia or clear clinical
diagnosis
, ● Aims of Mx:
○ 5-10% weight loss, 30min exercise/day, <2 standards/day, FBG 6-9mmol, 8-
10mmol/L postprandial
○ HbA1c <7%, total cholesterol <4mmol/L, HDL-C >1mmol/L, LDL <2, TGs <2
○ BP < 140/90mmHg
● Mx:
○ Check secondary causes for diabetes and Mx if present, eg,drugs
(antipsychotics, steroids), hemochromatosis, endocrine disorders
(acromegaly, cushing’s), pancreatitis, CF
○ Other investigations:
■ Check pt baseline: renal function (GFR, ACR), lipids, HbA1c
■ Urinalysis: albumin, ketones, nitrates/leucocytes
■ ECG if >50yrs + other CVD risk, TSH if Fx/thyroid disease suspicion
○ CVD risk assessment
○ Assess diabetes impact on pt: BMI
■ CVS: BP, peripheral/neck vessels
■ eyes: visual acuity, cataracts, retinopathy
■ Feet: sensation, circulation, skin condition, pressure areas, abnormal
bone
■ Peripheral nerves: tendon reflex, vibration, fine touch
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