Concomitant Diseases Related to Diabetes Mellitus!

TREATMENT OF CONCOMINANT CONDITIONS RELATED TO DIABETES MELLITUS

Coronary Heart Disease
Dyslipidemia
Hypertension
HIV and AIDS
Antipsychotic Therapy
Hypoglycemia
Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycemic state
Retinopathy
Neuropathy
Foot Ulcers

1.CORONARY HEART DISEASE

"Cardiovascular disease is the major cause of morbidity and mortality for patients with DM".

Interventions:

The interventions to manage CVS disease:

Smoking cessation
BP Control
Lipid management
Antiplatelet therapy
Lifestyle modification

Medications:

All DM patients with a history of cardiovascular disease should be prescribed;

Aspirin 75-125mg/day as a secondary prevention strategy
or Clopidogrel 75mg/day.

The ADA recommends that antiplatelet therapy should be considered for any patient with DM as a primary prevention strategy, if that patient is at risk of cardiovascular disease greater than 10% for over 10 years. This includes most men older than 50 years of age and most women older than 60 years of age who have at least one additional cardiovascular risk factor.

2.DYSLIPIDEMIA

The National Cholesterol Education Program for Adult Treatment Panel III Guidelines classify the presence of DM to be of the same risk equivalence as coronary heart disease (CHD).

The primary target for lipid lowering treatment in most patients with DM is LDL Cholesterol with a goal of less than 100mg/dL.
For patients at high cardiovascular risks, including those with a history of cardiovascular disease, the LDL target may be set more stringently at 70mg/dL.
Only when triglycerides level exceed 500mg/dL should they replace LDL as the patient's primary therapeutic goal.

Statins Therapy (First Line Therapy):

Because of the potent LDL cholesterol lowering ability and the known benefit in terms of improved cardiovascular morbidity and mortality, statins are considered First line therapy for Hyperlipidemia.
Because statin therapy has been shown to benefit even patients with relatively low-baseline LDL cholesterol levels, it is also important to note that the ADA guidelines currently call for all patients with DM to be prescribed a statin who fall into either of the following two categories: those who have overt cardiovascular disease, and those who do not have overt cardiovascular disease but are older than age 40 years and have one or more other cardiovascular disease risk factors.

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