Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Treatment (6)

• Treatment (6)

• If patients have eGFR <30, refer for evaluation for renal replacement treatment. A

• Promptly refer to a physician experienced in the care of DKD for: B

• Uncertainty about the etiology of disease
• Difficult management issues
• Rapidly progressing kidney disease

To reduce the risk or slow the progression of retinopathy

• To reduce the risk or slow the progression of retinopathy

• Optimize glycemic control A
• Optimize blood pressure control A

Screening:

• Screening:

• Initial dilated and comprehensive eye examination by an ophthalmologist or optometrist:

• Adults with type 1 diabetes, within 5 years of diabetes onset. B
• Patients with type 2 diabetes at the time of diabetes diagnosis. B

Screening (2):

• Screening (2):

• If no evidence of retinopathy for one or more eye exam, exams every 2 years may be considered. B

• If diabetic retinopathy is present, subsequent examinations should be repeated at least annually by an ophthalmologist or optometrist. B

• If retinopathy is progressing or sight-threatening, more frequent exams required. B

Screening (3):

• Screening (3):

• Retinal photography may serve as a screening tool for retinopathy, but is not a substitute for a comprehensive eye exam. E

Screening (4):

• Screening (4):

• Women with preexisting diabetes who are planning pregnancy or who have become pregnant: B

• Counseled on risk of development and/or progression of diabetic retinopathy
• Eye examination should occur before pregnancy or in 1st trimester and then monitored every trimester and for 1 year postpartum as indicated by degree of retinopathy

Treatment:

• Treatment:

• Promptly refer patients with macular edema, severe NPDR, or any PDR to an ophthalmologist knowledgeable & experienced in management, treatment of diabetic retinopathy. A

• Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk PDR and, in some cases, severe NPDR. A

Treatment (2):

• Treatment (2):

• Intravitreal injections of VEGF are indicated for center-involved diabetic macular edema, which occurs beneath the foveal center and which may threaten reading vision. A

• Retinopathy is not a contraindication to aspirin therapy for cardioprotection, as it does not increase the risk of retinal hemorrhage. A

Early recognition & management is important because:

• Early recognition & management is important because:

• DN is a diagnosis of exclusion.

• Numerous treatment options exist.

• Up to 50% of DPN may be asymptomatic.

• Recognition & treatment may improve symptoms, reduce sequelae, and improve quality-of-life.

Screening:

• Screening:

• Assess all patients for DPN at dx for T2DM, 5 years after dx for T1DM, and at least annually thereafter. B

• Assessment should include history & 10g monofilament testing, vibration sensation (large-fiber function), and temperature or pinprick (small-fiber function) B

• Symptoms of autonomic neuropathy should be assessed in patients with microvascular & neuropathic complications. E

Treatment:

• Treatment:

• Optimize glucose control to prevent or delay the development of neuropathy in patients with T1DM A & to slow progression in patients with T2DM. B

• Assess & treat patients to reduce pain related to DPN B and symptoms of autonomic neuropathy and to improve quality of life. E

Treatment:

• Treatment:

• Either pregabalin or duloxetine are recommended as initial pharmacologic treatments for neuropathic pain in diabetes. A

Perform a comprehensive foot evaluation annually to identify risk factors for ulcers & amputations. B

• Perform a comprehensive foot evaluation annually to identify risk factors for ulcers & amputations. B

• All patients with diabetes should have their feet inspected at every visit. C

• History should contain prior hx of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy & renal disease; and should assess current symptoms of neuropathy and vascular disease. B

Exam should include inspection of the skin, assessment of foot deformities, neurologic assessment & vascular assessment including pulses in the legs and feet. B

• Exam should include inspection of the skin, assessment of foot deformities, neurologic assessment & vascular assessment including pulses in the legs and feet. B