31 May 2014

Target comprehensive metabolic control and monitoring in diabetes

Diabetes mellitus (DM) is a common metabolic disorders where hyperglycemia is the predominant manifestation. It is a multi system disease because of the  associated metabolic dysregulation. In United states DM is the leading cause of end-stage renal disease (ESRD), adult blindness and non-traumatic lower extremity amputations.It also increases the risk  for cardiovascular disorders. Diabetes is a lifelong disease. Comprehensive diabetes care involves not only  plasma glucose control, but also detect and manage DM-specific complications and modify its risk factors .

Treatment of diabetes:
Old concept
Involves only glucose control
Which prevent only  microangiopathic complication.
Recent treatment
Comprehensive metabolic control, which control blood glucose and other metabolic disturbances

FPG - Fasting plasma glucose
PPG - Postprandial plasma glucose
HbA1C - hemoglobin A1C
LDL-C - Law density cholesterol
Tg - Tryglyceride
BP - Blood pressure

Following things needed to be monitored in diabetic patients
  1. Urine glucose has no value.
  2. Plasma glucose - Fasting or postprandial weekly.
  3. Glycated Hb - 8 to 12 weeks (RBC life–12wks), marker for long term control.
  4. HbA1C better co-relates with PPG than FPG.
  5. Monitor all 3 parameters (FPG, PPG, HbA1C).
  6. BP -  In all sittings, every 3 months.
  7. Urine Albumin - Once in year.
  8. Lipid profile - Once in 6 months.
  9. Fundus/Foot exam - Once in a year.
                      Some blood glucose meters

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