2,46 Mb - GuÃaSalud
2,46 Mb - GuÃaSalud
2,46 Mb - GuÃaSalud
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Appendix 6. Assessment of macro- and microangiopathy<br />
in the diagnose and follow-up of DM 2<br />
Diagnosis<br />
CV Risk:<br />
BP, CT, TG, HDL,<br />
HbA 1 c, Tobacco<br />
Initial assessment of macro/microangiopathy<br />
Nephropathy:<br />
Albumin / creatinine<br />
ratio (mg/g)<br />
Diabetic foot:<br />
Monofi lament, AA Index a ,<br />
Foot and footwear inspection,<br />
symptoms<br />
Ocular:<br />
OF b<br />
CVR c ≥10%<br />
after 3-6 months<br />
with modification<br />
of lifestyle<br />
PAS ≥140<br />
PAD ≥80<br />
30-299<br />
Education and assessment<br />
of ulcer risk<br />
General care<br />
Statins<br />
Assess<br />
aspirin<br />
ACE<br />
inhibitors<br />
or<br />
Diuretic<br />
Energy<br />
multifactorial<br />
intervention d<br />
Risk<br />
Low<br />
Increases<br />
High e<br />
Ulcerate e<br />
Control<br />
Annual<br />
3-6 months<br />
1-3 months<br />
Individual<br />
CVR c ≥10% SBP ≥140<br />
30-299<br />
Diabetes evolution DBP ≥80<br />
>15 years Education and assessment<br />
of ulcer risk<br />
General care<br />
Retinopathy<br />
No<br />
Non-proliferative<br />
Proliferative<br />
Control<br />
3 years<br />
2 years<br />
Individual<br />
Follow-up<br />
CV Risk:<br />
BP, CT, TG, HDL,<br />
HbA 1<br />
c, Tobacco<br />
Nephropathy:<br />
Albumin / creatinine<br />
ratio (mg/g)<br />
Diabetic foot:<br />
Monofi lament, AA Index a ,<br />
Foot and footwear inspection,<br />
symptoms<br />
Annual assessment of macro/microangiopathy<br />
Ocular:<br />
OF b<br />
a<br />
AA Index (ankle-arm): in case of abnormal physical examination or another macro/microangiopathic disorder.<br />
b<br />
OF (ocular fundus): non-mydriatic camera or ophthalmologic consultation if there is no camera available.<br />
c<br />
CVR (cardiovascular risk): estimate according to the REGICOR table.<br />
d<br />
Diet, exercise, anti-tobacco therapy, ACE-inhibitors, aspirin, therapeutic target: SBP £130 mmHg, intensive HbA 1<br />
c and<br />
cholesterol control.<br />
e<br />
Requires assessment by specialized staff or, if available, foot unit staff or chiropodist.<br />
BP, SBP, DBP: blood pressure, systolic blood pressure, diastolic blood pressure; ; OF: ocular fundus; CT: cholesterol; TG:<br />
triglycerides.<br />
CLINICAL PRACTICE GUIDELINE ON TYPE 2 DIABETES 145
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