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Treatment -diabetes
treatment differs based on the cause of diabetes.
Lack of insulin such as with type 1 requires insulin therapy. If insulin resistance is the main problem, exercise, weight
loss, dietary strategies along with medications may be useful.
These measures are also helpful for type 1 patients as well.
-the goals of
therapy are to reduce the complications seen with diabetes including
retinopathy, neuropathy, cardiovascular events, and nephropathy. -Diabetes
Control and Complications Trial (DCCT) is a recent study that demonstrates
improved outcomes with strict diabetes control.
This type of therapy is most useful in motivated patients.
It requires more frequent glucose monitoring and more frequent insulin
injections as well. -Diet and
exercise are also cornerstones in diabetes treatment.
It reduces insulin resistance and delays onset of adverse complications.
-Smoking
cessation has one of the highest benefits of all interventions.
Daily aspirin therapy (unless contraindicated) is useful especially in
patients who have other cardiac risk factors.
-Treatment of
hypertension is also very important with a goal blood pressure of less than
130/80. Angiotensin receptor
blockers and angiotensin-converting enzyme inhibitors can be useful in patients
with proteinuria (see Diabetic Nephropathy Pearl).
-Dyslipidemia
should be treated aggressively usually with a statin with goal LDL less than
100mg/dl. -An eye exam by
a trained professional should be performed at least on a yearly basis -Monitoring
Hemoglobin A1c (hgbA1c) is helpful to see glycemic control on a longitudinal
basis. Goal HgbA1c is below 7.0.
In older patients or those with a limited life expectancy hgbA1c can be
controlled less rigorously. -Foot exams are
also important for both the patient to check periodically at home and for the
health care professional to perform on an annual basis including sensation with
a monofilament, pulses, hair distribution looking for early signs of neuropathy
and/or peripheral vascular disease |