Podcast
Questions and Answers
What is the target level for Serum Cystatin-C?
What is the target level for Serum Cystatin-C?
What is the most common cause of liver enzyme elevation in diabetic patients?
What is the most common cause of liver enzyme elevation in diabetic patients?
How often should patients with Type 1 Diabetes Mellitus (T1DM) have their Serum Cystatin-C measured?
How often should patients with Type 1 Diabetes Mellitus (T1DM) have their Serum Cystatin-C measured?
What fasting target level is recommended for LDL cholesterol?
What fasting target level is recommended for LDL cholesterol?
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What is the role of HbA1c in diabetic patients?
What is the role of HbA1c in diabetic patients?
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Why is routine monitoring of liver enzymes necessary in diabetes management?
Why is routine monitoring of liver enzymes necessary in diabetes management?
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What is dyslipidemia a strong predisposition for in diabetic patients?
What is dyslipidemia a strong predisposition for in diabetic patients?
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When should the screening for liver enzymes begin in diabetes management?
When should the screening for liver enzymes begin in diabetes management?
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Which of the following statements is true regarding hsCRP?
Which of the following statements is true regarding hsCRP?
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What is a significant flaw in microalbuminuria detection in patients taking ACE inhibitors?
What is a significant flaw in microalbuminuria detection in patients taking ACE inhibitors?
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Study Notes
Limitations of 1,5-AG
- Low levels of 1,5-AG indicate hyperglycemia in the preceding 24 hours.
- It is not reliable in patients with renal disease and gestational diabetes mellitus (GDM).
Monitoring of Glycemic Control
- Long-term monitoring methods include:
- HbA1c
- Glycated Albumin
- Fructosamine
- Advanced Glycation End-products (AGE)
- C-peptide
- Insulin
Glycated Haemoglobin (HbA1c)
- Non-enzymatic glucose attachment to hemoglobin signifies average glycemic control over 90-120 days.
- Gold standard for monitoring diabetes mellitus (DM), sensitive to changes in the last month.
- No fasting required for testing.
- Decreasing HbA1c levels correlates with reduced risk for microvascular disease (37%), myocardial infarction (14%), and death (21%).
- Should be measured 2-4 times per year in DM patients.
Limitations of HbA1c
- Results may be skewed by erythrocyte turnover, hemoglobinopathies, chronic kidney disease (CKD), or alcoholism.
- It does not measure glycemic variability or hypoglycemia.
- Levels increase with age, and there are racial disparities in results.
- Less reliable in rapidly evolving Type 1 diabetes mellitus (T1DM).
HbA1c and Plasma Glucose Relationship
- Strong relationship exists between HbA1c and plasma glucose:
- Average Plasma Glucose (mg/dL) = (HbA1c x 35.6) - 77.3
- Average Plasma Glucose (mmol/L) = (HbA1c x 1.98) - 4.29
Glycated Albumin and Fructosamine
- Glycated Albumin and fructosamine measure glycemic state over 2-3 weeks, useful when HbA1c is unreliable.
- Fructosamine indicates recent glycemic control changes.
- Glycated albumin is advantageous for DM patients with CKD.
Clinical Utility and Limitations of Glycated Albumin and Fructosamine
- Useful in monitoring poorly controlled DM and predicting complications.
- Limitations include underestimation in obesity and effects of systemic illness on serum proteins.
C-peptide
- C-peptide indicates insulin production, reflecting residual beta-cell function.
- Helps assess insulin replacement adequacy and dosage adjustments.
- Higher C-peptide levels correlate with lower complication rates in T1DM and better control in T2DM.
- Distinguishes DM types: low in T1DM, high or normal in early T2DM.
Detection and Management of Diabetic Complications
-
Acute Complications:
- Diabetic Ketoacidosis (DKA)
- Hyperglycemic Hyperosmolar State (HHS)
- Hypoglycemia
- Lactic acidosis
-
Chronic Complications:
- Microvascular: nephropathy, neuropathy, retinopathy
- Macrovascular: coronary heart disease, peripheral vascular disease, cerebrovascular disease
Monitoring Acute Complications
- Key tests for diagnosis include glucose, lactate, creatine kinase, electrolytes, and ketone levels.
- Blood urea nitrogen (BUN) and creatinine levels monitor risk for acute kidney injury during DKA and HHS.
- Liver enzymes (AST, ALT) track potential liver dysfunction associated with DKA and HHS.
Monitoring Chronic Complications
- Urine Albumin and ACR should target <30 mg/g for early nephropathy detection.
- Serum creatinine and estimated glomerular filtration rate (eGFR) help assess kidney function.
- Serum cystatin-C is more sensitive for renal impairment assessment in diabetics.
- Monitor lipid profiles annually due to cardiovascular risk association.
- Regular HbA1c testing helps identify risk for chronic complications related to DM.
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