Case 6: 57-
year-old
woman
diabetes
care visit
What are the ADA's phsycian tasks for diabetes care
(5)? - ANSWER-1. work to detect diabetes
complications and potential comorbidities
2. review previous treatment and risk factor control
3. begin patient engagement in the formulation of a
care management paln
4. review and discuss prevention of complications
5. develop a plan for continuing care
Relevant medical history for a patient with
diabetes? - ANSWERAdvantages/Disadvantages of EMR - ANSWER-1.
offers template that increases likelihood that pt
receive recommended care
2. provides tools to evaluate pt care across an entire
population
3. allows documentation of improved physician
performance, which may increase reimbursements
by some insurers
-------------------------
4. Has been shown to interrupt the physician-pt
relationship (screen gaze)
Pathophysiology of T1DM v. T2DM - ANSWERT1DM: pancreas is damaged, beta cells don't
produce enough insulin (immunologic etiology)
T2DM: body is unable to recognize he insulin
produced by the pancreas and use it properly
(insulin resistance). Increased beta cell secretion
may initially compensate, but over time, beta cells
fail
Do types 1 and 2 diabetes cause the same
complications? - ANSWER-Yes. Both types cause the
same end-damage.
High blood glucose eventually affects blood vessels
and therefore organs throughout the entire body.
Heart, brain, kidneys, and eyes and the nerves that
control sensation and autonomic function are
affected.
Hyperglycemia (which many patients with diabetes
have) makes the vascular disease much worse
What is the leading cause of death in patients with
diabetes? - ANSWER-Cardiovascular disease,
including coronary heart disease and
cerebrovascular disease.
People with diabetes are 2-4x more likely to have
heart
disease or stroke than people without.
Patients with DM who have an MI have
worse outcomes than patients without, and a dx of
DM is considered equivalent in risk to
having had a previous
MI.
Management of cardiovascular risk factors so
commonly found in
diabetes is therefore essential in preventing
morbidity and mortality in these patients
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