Escolar Documentos
Profissional Documentos
Cultura Documentos
DISEASE MANAGEMENT
ILLUSTRATED WITH
DIABETES
INTERDISCIPLINARY APPROACH
TRANSDISCIPLINARY TEAM
APPROACHES
TRANSDISCIPLINARY TEAM
MULTIDISCIPLINARY TEAM
APPROACH
diabetes
Improved diabetes management
Lowered risk for complications
Lfficient patient education
Allowed each professional to
share different areas of
expertise while standardizing
systems
Clinical staff can become more
specialized in effective DM
management.
Enhanced opportunities for
higher level training
Improved
glycemic
control
Increased patient
follow-up
Higher patient
satisfaction
Improved quality of
life
Reduced
hospitalizations
Decreased health
care costs
FPG, mg/dL
(measured after 8-hour fast)
PPG, mg/dL
(measured with an OGTT
performed 2 hours after 75g oral glucose load taken
after 8-hour fast)
Random plasma glucose,
mg/dL
With polyurea, polydipsia,
or polyphagia
Hemoglobin A1C, %
(screening only)
Result
Diagnosis
99
Normal
100-125
126
Diabetes
Confirmed by repeat testing
on a different day
139
Normal
140-199
200
Diabetes
Confirmed by repeat testing
on a different day
200
Diabetes
5.4
Normal
5.5-6.4
High risk/prediabetes
6.5
Diabetes
Confirmed by repeat testing
of FPG or PPG on a
different day
Result
Diagnosis
5.6
Normal
5.7-6.4
High risk/prediabetes
6.5
Diabetes
Confirmed by repeat testing
in absence of unequivocal
hyperglycemia
99
Normal
100-125
126
Diabetes
Confirmed by repeat testing
in absence of unequivocal
hyperglycemia
139
Normal
140-199
200
Diabetes
Confirmed by repeat testing
in absence of unequivocal
hyperglycemia
200
Diabetes
Hemoglobin A1C, %
FPG, mg/dL
PPG, mg/dL
(measured with an OGTT
performed 2 hours after 75g oral glucose load)
GDM
mg/dL
one hour post-challenge 180 mg/dL; or two
hours 153 mg/dL)
deficiency
Hemolytic anemias
Thalassemias
Spherocytosis
Severe hepatic or renal disease
GLYCAEMIC MANAGEMENT IN
TYPE 2 DIABETES
Treatment Goal
Lipids (mg/dL)
LDL-C
non-HDL-C
apolipoprotein B levels
HDL-C
Triglycerides
< 150
130
Diastolic
80
Treatment Goal
Weight
Weight loss
Anticoagulant Therapy
Aspirin
IMPLEMENTATION OF A DIABETES
COMPREHENSIVE CARE PLAN REQUIRES A
MULTIDISCIPLINARY TEAM APPROACH
DIABETES COMPREHENSIVE
CARE PLAN
GLYCAEMIC MANAGEMENT IN
TYPE 2 DIABETES
Therapeutic
Lifestyle Change
COMPONENTS OF THERAPEUTIC
LIFESTYLE CHANGE
Healthful eating
Sufficient physical activity
Sufficient amounts of sleep
Avoidance of tobacco products
Limited alcohol consumption
Stress reduction
Recommendation
AACE HEALTHFUL
EATING RECOMMENDATIONS
Regular meals and snacks; avoid fasting to lose weight
Topic
General eating
habits
Carbohydrate
Fat
Protein
Micronutrients
MEDICAL NUTRITIONAL
THERAPY RECOMMENDATIONS
PHYSICAL ACTIVITY
RECOMMENDATIONS
Evaluate for
contraindications
and/or limitations to
increased physical
activity before
patient begins or
intensifies exercise
program
Develop exercise
recommendations
according to
individual goals and
limitations
GLYCEMIC MANAGEMENT IN
TYPE 2 DIABETES
Antihyperglycemic
Therapy
PATHOPHYSIOLOGY OF T2DM
Organ System
Major Role
Pancreatic beta
cells
Muscle
Liver
Contributing Role
Adipose tissue
Digestive tract
Pancreatic alpha
cells
Kidney
Nervous system
Defect
Decreased insulin secretion
Inefficient glucose uptake
Increased endogenous glucose
secretion
Increased FFA production
Decreased incretin effect
Increased glucagon secretion
Increased glucose reabsorption
Neurotransmitter dysfunction
Biguanide
Bile acid
sequestrant
DPP-4
inhibitors
Dopamine-2
agonist
Agent
Acarbose
Miglitol
Available as
Precose or generic
Glyset
Pramlintide
Symlin
Metformin
Glucophage or
generic
Colesevelam
WelChol
Linagliptin
Saxagliptin
Sitagliptin
Tradjenta
Onglyza
Januvia
Bromocriptine Cycloset
Glinides
GLP-1 receptor
agonists
Agent
Nateglinide
Repaglinide
Available as
Starlix or generic
Prandin
Exenatide
Byetta
Exenatide XR
Bydureon
Liraglutide
Victoza
Glimepiride
Amaryl or generic
Glucotrol or
generic
Diaeta, Glynase,
Micronase, or
generic
Actos
Glipizide
Sulfonylureas
Thiazolidinediones
Pioglitazone
Rosiglitazone* Avandia
Available as
Levemir
Lantus
Generic
NovoLog
Apidra
Humalog
Humulin
NovoLog Mix
Humalog Mix
Added Agent
Linagliptin
Saxagliptin
Sitagliptin
Repaglinide
Available as
Jentadueto
Metformin + DPP-4 inhibitor
Kombiglyze XR
Janumet
Metformin + glinide
Prandimet
Metaglip and
Glipizide
generic
Metformin + sulfonylurea
Glucovance and
Glyburide
generic
Pioglitazone
ACTOplus Met
Metformin + thiazolidinedione
Rosiglitazone* Avandamet
Pioglitazone
Duetact
Thiazolidinedione +
sulfonylurea
Rosiglitazone* Avandaryl
*Use restricted due to increased risk of myocardial infarction (MI)
Stratify treatment
based on initial A1C
level
Initial monotherapy
for A1C 6.5% - 7.5%
Initial dual therapy
for A1C 7.6% - 9.0%
Initial triple therapy
or insulin for A1C
>9.0%
CONCLUSION
CONCLUSION