Diabetes Management in Primary Care Center.pptx

Diabetes Management in Primary Care Center.pptx

1. Patient-Centered Approaches for Newly Diagnosed Diabetes Dr. Jitendra Tekchandani

2. Management of DM2 The goals of treatment are to: Alleviate symptoms Minimize complications Improve quality of life Reduce mortality

3. Management of DM2 Treatment should focus on simultaneous control of: Blood Glucose Level Blood Pressure Blood Lipid Level Body Weight

4. Targets of Optimal DM2 Management

5. Stepwise Approach to Management of DM2

6. Step 1 Lifestyle Modification

7. Lifestyle Modification Start a trial of Lifestyle Modification measures alone for 2-4 months, and continue throughout management Weight loss Nutritional therapy Regular exercise program Stop smoking If not reaching target level after 2-4 months trial, then we go to step 2:

8. Weight Loss Weight loss is the cornerstone measure of lifestyle change 80-90% of DM patients are overweight Calories restricted to 1600-1800 calories/day Weight loss should be gradual, not more than 1 kg/week Weight loss should be prolonged until the target goal BMI and waist circumference reached

9. Nutritional Therapy DM diet must compose of 45-60% carbohydrates , < 35% fats, and 10-15% protein Encourage complex carbohydrates such as whole grains, fruits, and vegetables Avoid simple refined carbohydrates, which are processed, such as sugar, white bread, flour, and cookies, pastries High fiber diet of about 10-15gms/day Reduce sodium in diet (less than 6 gm/day)

10. Regular Exercise Regular exercise is important for controlling weight and also to improve insulin sensitivity Exercise improve quality of life Brisk walk 30-60 min/day, 5 days/week The patient and the people in his environment must know the signs and symptoms of hypoglycemia, and must know how to react to it Exercise schedule should be appropriate for the individual's physical strength

11. Stop Smoking Message to stop smoking must be clear and direct Assist patient to specify a “stop date” Offer advice on how to cope with anxiety and cravings Frequent small snacks Use of nicotine patches or chewing gum Withdrawal symptoms will subside with time

12. Step 2 Use of Oral Hypoglycemics

13. Mechanism of action of anti- hyperglycaemic drugs

14. Antidiabetic Therapy in Adults with T2DM

15. Use of Oral Hypoglycemics Initiate therapy with one oral hypoglycemic drug , choice depends on body composition and severity of hyperglycemia If single drug is not effective enough, so, combination therapy with two or more drugs that work by different mechanisms may reduce blood sugar to target level A Biguanide with a sulfonylurea is the most widely studied combination If not reaching target level, refer for specialized consultation and/or management

16. Step 3 Specialized Management (Insulin Therapy)

17. Insulin Therapy When a person with DM2 has done well on oral agents, and is not at target blood glucose levels, Then: Add or change to Insulin therapy program to reach glycemic target Strict control of co-existing hypertension and dyslipidemia Continue with lifestyle modification When target levels achieved, refer patient back to his primary care doctor for regular follow-up

18. Follow-up of DM2 Patient

19. Follow-up of DM2 Patient All DM patients should be evaluated on a regular basis The following parameters should be evaluated Annually: Physical examination : General Exam; such as, Blood pressure, Body Weight, Waist circumference... Systemic Exam; CVS (Peripheral pulses), Chest, Abdomen , Neurologic exam (especially lower extremities) Ophthalmic Examination; Visual Acuity, Fundus, Cataract… Foot exam; for sensation, infections , ulcers , callosity… Dental exam; to maintain proper oral hygiene Investigations; such as, FPG, RPG, HbA1C, Lipid profile, GUE, Urine ptn , S. Creatinin , ECG…

20. Referral to the Specialists Persistent hyperglycemia and/or other uncontrolled parameters (blood pressure, lipids) with above treatment Pregnancy and diabetes Diabetic ketoacidosis or hyperglycemic hyperosmolar coma Serious acute illness (chest pain, mental confusion) in addition to diabetes Switching from oral hypoglycemic medication to insulin Presence of microvascular changes (retinopathy, neuropathy, nephropathy)