Tiêu đề Metabolic and Endo SCA- IMA. Dr A.Ibrahim_watermark.pdf ✅

SCA- ENDOCRINE AND METABOLISM Dr.Amr Ibrahim MB ChB, MD, Alexandria University, Egypt MSc, University of Tsukuba, Japan
CLINICAL CASE ▪ 58 M, came for routine health check, bloods all NAD apart from HBA1c 47 asked by Nurse to see you. BMI 31 Another case 49 M, BG of allergic rhinitis on nasal steroids, routine bloods all NAD apart from HBA1c 44 , booked app to discuss. BMI 34 Prediabetes
QS TO ASK ▪ Remember – DM is multisystem ! ▪ Please ask about Meds ▪ Detailed and detailed Hx about lifestyle => Mr X , giving this is the first time I see you, I would like to know more about your lifestyle, could you please tell me more about your smoking, tell me about your diet , do you know your weight (have you put on weight). This will be the entrance to Start Mx after addressing ICE. ▪ Work and impact on work ▪ Please don’t forget FH ▪ ICE If pt came to discuss his results , how can you approach the case?
RF for T2DM ▪ Obesity and inactivity. ▪ Family history. ▪ Ethnicity. ▪ History of gestational diabetes. ▪ Diet. ▪ PCOS. ▪ Metabolic syndrome (HTN, fatty liver, dyslipidaemia, central obesity and tendency to DVT). ▪ Drug treatments: Statins, steroids, and combined Rx with a thiazide diuretic + BB. ▪ Low birth weight and premature (before 35 weeks) Pre-diabetes HBA1c FPG 42-47 mmol/mol 6 – 6.4 % 5.5- 6.9 How can you explain to pt? Invx Routine , lipids, HBA1c annual Intensive Lifestyle change program ↓ wt to BMI < 25 or < 23 ↓ wt by 5-10 % If BMI > 30 or >27.5 => offer structured wt loss program Diet: ↑ fibre, Use Skimmed or semi- skimmed , Fish ↓ saturated fat, fried food, fast food, sugary food. Ket diet or 5:2 diet NDPP Exercise , smoking, alcohol Meds Use only if: - not able to do the program. - Tried the program but still progressing to DM. Meds to use: Metformin Orlistat if BM > 28 RFs, Inx & Mx What about driving , annual eye and foot check?