DiabeticComplications in afya

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Hypertension, hyperlipidaemia, hyperglycaemia
more impt to control BP than glc

''Hypertension''
BP targets - 130/80 with end organ damage else 140/80
if one reading raised - lifestyle advice and recheck 1/12 if >150/90 else in 2/12

if HT inc risk of CVD morbidity and mortality (macrovascular), diabetic renal and eye disease (microvascular) 
NNT 6 over 10years to prevent 1 event, 15 over 10years to prevent 1 death.
CVD - MI, heart failure, stroke, PVD (and amputation) - risk reduced esp if intensive BP control (death dec by 1/3)
Renal - reduce SBP by 20 and new disease and progression of existing disease dec by 1/3
Eye - tight BP control dec, retinopathy, exudates, need for Rx, risk of blindness

Mx - ACE inhibitor unless afrocaribbean or women of child bearing age then CCB

''Hyperglycaemia''
Aim for HbA1C <45mmol/l (6.5%) or agree higher target
High HbA1C is associated with macrovascular complications
Intensive Mx of HbA1C does NOT decrease macrovascular death (?? dec non-fatal MI) cf to good Mx but DOES decrease microvascular disease at inc risk of hypoglyc
Metformin decreases CVD
Mx - if HbA1C remains above target despite lifestyle, then Metformin
can use Sulphonylurea if not overweight, Metformin SE or CI, need for rapid Mx of hyperglycaemic Sx

''Hyperlipidaemia''
controlling lipids reduces macrovascular disease and reduces death (NNT is 27 to prevent 1 CVD event)

Statin - give (use Simvastatin nocte)
If <40 and high CVS risk
If >40 with no risk factors but CVS risk >20% or if risk factors
risk factors - weight, BP, smoke, microalbuminuria, lipids, FH or PH of CVD

Fibrate - if TG >4.5 or on statin and TG >2.3

''Smoking'' .....

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