8 Diabetes
Diabetes Mellitus
Examples
Antonio Santiago is a 55 year old man who was diagnosed a decade ago with type 2 diabetes. His wife Marta loves to cook, especially rice dishes and delicious baked goods. Antonio’s BMI is 38 and his last A1c was 7.9.
Family History: His father Carlos died of stroke at age 84. His mother Margarita is alive at age 81; she also has type 2 diabetes. He has two older brothers: Diego, 61, has hypertension, and Juan, 57, has no diagnoses.
Questions to Consider
- What tests would you order (if any)?
- What are the most important interventions and treatments?
- What are the goals of care?
Learning Objectives
By the end of the session, the active participant will be able to:
- Use the Rule of 3’s framework for managing type 2 diabetes.
- Describe the macrovascular and microvascular complications of diabetes and name the interventions or tests appropriate for preventing or managing each.
- List the numeric benchmarks for type 2 diabetes care.
- Apply the most updated lipid guidelines.
Diabetes Mellitus: The Rule of Three’s
A model to Facilitate Comprehensive Care for Patients with Type 2 Diabetes Mellitus
| Micro-Vascular Complications | Blood Sugar Control | Macro-Vascular Complications |
| 1. EYES (Retinopathy)Annual visit with Ophthamologist | 1. HEMOGLOBIN A1CCheck every 3-6 months Goal is less than 8 |
1. HYPERTENSIONSystolic BP <140 Diastolic BP <90 |
| 2. KIDNEYS (Nephropathy)Annual screen for Microalbuminuria ACE-Inhibitor for HTN, Microalbuminuria Follow Renal Function (Creatinine) |
2. LIFESTYLENutrition Activity |
2. LIPIDSFollow 2013 AHA/ACC Guideline Emphasize level of risk instead of LDL |
| 3. FEET (Neuropathy)Patient Education: Foot Care Inspect Patient’s Feet Podiatry as needed |
3. MEDICATIONSMetformin First-Line OHA’s as endogenous insulin ↓ Insulin |
3. CAD/CVA PreventionSmoking Cessation, Nutrition, Activity Stress ↓: Yoga, Meditation, Therapy ASA: only if risk factors |
Created by Wayne Altman, MD (Tufts Family Medicine)
Required Reading: Type 2 Diabetes Therapies: A STEPS Approach
Required Reading: Oral Medications