Diabetes Mellitus Concept Map

Diabetes Mellitus Concept Map Order the full map

Definition

The map starts with Diabetes Mellitus (DM) definition which is a syndrome that is caused by absolute or relative lack of insulin, resistance to the action of insulin, or both.  It is characterized by hyperglycemia and alteration in lipid and protein metabolism. This definition is linked with the normal physiology of insulin and glucagon secretion in response to blood glucose level (BGL).  From DM definition, there are also links to symptoms of hyperglycemia and DM complications (including micro- and macrovascular complications).

Diagnosis

Diabetes Mellitus – Criteria for diagnosis and diagnostic tests

Symptoms of hyperglycemia are written under (DIAGNOSIS), where DM diagnostic criteria. DM is diagnosed by demonstrating any one of the following along with symptoms of hyperglycemai:

• Symptoms of hyperglycemia or hyperglycemic crisis plus casual plasma glucose ≥ 200 mg/dL (11.1 mmol/L)
• Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L)
• 2-hour postload glucose ≥ 200mg/dL (11.1 mmol/L) during OGTT
• HbA ≥ 6.5%.

From these criteria, there are links to DM diagnostic tests including: Random Blood Glucose Test, Fasting Blood Glucose Test, Oral Glucose Tolerance Test (OGTT)/2-Hour Postprandial Test, and Glycosylated Hemoglobin (HbA1C), with a comparison of their relevant values of blood glucose level in cases of normal BGL, Impaired glucose tolerance (IGT), Impaired fasting glucose (IFG), Increased risk of diabetes mellitus, and values in case of DM.

Monitoring

Although (MONITORING) part is usually mentioned in any reference at the end of the topic, it is mentioned in this map close to (Diagnosis) part to show differences between all tests used in diabetes and to clarify which ones that are used for diagnosis and/or monitoring. Tests that are used in DM monitoring are: Self / Home Monitoring of Blood Glucose (SMBG /HMBG), Glycosylated Hemoglobin (HbA1C), and Serum Fructosamine.  Each one is explained and followed by normal values of BGL and values that indicate DM or inadequate glucose control.  (Monitoring) part is also followed by explanations of screening tests that are usually used by diabetic patients.  The first one is screening for glucose in urine, a condition that is called (Glucosuria) and the second is to screen for ketones in urine, a conditions that is called (Ketonuria). The other part of (Monitoring) is related to DM complications, when to start monitor for these complications and what monitoring tests are used.

Types of Diabetes mellitus

A comparison between diabetes mellitus type 1 and type 2 is included within the map.  This comparison covers the following points:

Age of onset – Onset – Risk Factors -Pancreatic Function – Pathophysiology – Clinical Presentation – Obesity – Complications – Treatment.

Treatment of DM type 1 includes : insulin, diet, and exercise, while treatment of type 2 includes: diet, exercise, oral antidiabetics (OAD), insulin.

Type 1 Diabetes Mellitus vs Type 2

Treatment

A mind map of diabetes mellitus treatment is included under (TREATMENT). The main function of this map is to differentiate between the sites of action of medications used in the management of DM, i.e. to show whether this medicine acts to stimulate pancreatic insulin secretion (Insulin secretagogues), decrease  peripheral insulin resistance (Thiazolidinediones), decrease hepatic glucose production (Biguanides), or slow digestion and absorption of carbohydrates (α-Glucosidase inhibitors (AGIs)) …etc.  Medications used in the management of diabetes mellitus are discussed in comparisons that involve their mechanisms of action, adverse effects, drug interactions, precautions, and contraindications if any.

Diabetes Mellitus – Pathophysiology and treatment map (abbreviations are mentioned in the map)

The pharmacological treatment of diabetes mellitus includes:

• Insulin
• Glucagon-Like Peptide 1 (GLP-1 ) Agonists (Incretin mimetics )
• Oral Antidiabetics (OAD)

• Insulin secretagogues:

1) Sulfonylureas (SU’ s) / Long-acting insulin secretagogues 2) Meglitinides / Short-acting insulin secretagogues

• Insulin sensitizers

1) Biguanides 2) Thiazolidinediones (TZDs) / Glitazones / PPARγ Agonists

• Intestinal enzyme inhibitors

α-Glucosidase inhibitors (AGIs)

• Dipeptidyl peptidase – 4 inhibi tors

• New therapies:

–          Amylin analogue –          Dopamine Agonists –          Bile Acid Sequestrants

 Diabetes Complications

Diabetes Mellitus Complications – Diabetic ketoacidosis (DKA)

Lifelong insulin is required in all type 1 DM patients and it should be started immediately after diagnosis, unless patient probably will experience an acute complication of diabetes which is called “Diabetic Ketoacidosis” – DKA.  It is a diabetic emergency that is caused by absolute or relative insulin deficiency.  A separate concept map for diabetic ketoacidosis is included to give an overview of DKA definition, pathophysiology, diagnosis, and management.  Next to DKA map, there is an overview of another diabetic complication called “Hyperosmolar Hyperglycemic State” – HHS which mainly occurs in type 2 DM patients. Differences between DKA and HHS are highlighted with dotted boxes.

Patient education icon is scattered at different sites within the map to indicate the importance of patient education in those particular areas for example:

• Risk factors of diabetes mellitus 2 including “insulin resistance syndrome” or “metabolic syndrome”
• Self / Home Monitoring of Blood Glucose (SMBG /HMBG)
• Monitoring using (SMBG) and (HbA1c) for insulin dosage adjustment
• Importance of insulin therapy in order to avoid DKA

 Diabetes mellitus concept map also includes:

Non pharmacological treatment of DM:

Modifications in diet and exercise should be adjusted individually, with different diet requirements for both types of DM.

Adjunctive treatment

Treatment and prevention of complications and recommendations of using ACEIs, ARBs, aspirin, and/or lipid-lowering agents according to patient’s case.

Diabetes Mellitus Folded Map

This map is available in two forms: printable version and folded poster. We hope you find Diabetes Mellitus Concept Map helpful and we are looking forward to hearing your opinion.

Diabetes Mellitus Concept Map, version no. 2.0, by Maha Atef, B Pharm

Last updated on: 31 October 2012  

References

“American Diabetes Association Treatment Algorithm for Type 2 Diabetes.” Pharmacist’s Letter. November 2006. 11 May 2009.

“Diabetic Ketoacidosis (DKA).” The Merck Manuals for Healthcare Professionals. May 2007. Merck Medicus. 29 April 2009 DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach. 8th. The McGraw-Hill Companies , 2011. Fauci, Anthony S., et al. Harrison’s Online. 17th Edition ed. The McGraw-Hill Companies, 2008. Merck Medicus. 2008. 17 Feb. 2009 <http://www.merckmedicus.com/pp/us/hcp/frame_textbooks.jsp?pg=http://www.accessmedicine.com/resourceTOC.aspx? resourceID=4>  // //

Obesity Concept Map

Obesity Concept Map

Obesity Concept Map: An Overview

The aim of this concept map is to clarify the approach for evaluating and managing overweight/obesity patients.

Definition

The map starts with the definition of Obesity “obesity is excess body fat.  It is defined as a body mass index (BMI) ≥ 30 kg/m².” and the epidemiology.  On the left side of the map, you’ll find obesity etiology and risk factors stated and represented using a funny image that will help you memorize this part easily.

Etiology and Risk Factors

Factors that contribute to obesity include:

• Genetic factors; cause primary obesity
• Environmental factors
• Secondary causes; medications and medical conditions that may cause secondary obesity
• Psychiatric disorders
• Physiological factors
• Other risk factors

Obesity Etiology and Risk Factors – part of the map

Classification

According to the etiology:

• Primary obesity
• Secondary obesity

According to body mass index (BMI)

Classification of obesity according to BMI

According to waist-to-hip ratio

(fat distribution):

• Apple obesity
• Pear obesity

Diagnosis and Clinical Presentation

Diagnosis of obesity is based on

1-     History; it is important to assess patient’s dietary habit, physical
activity level, whether obesity is due to one of the secondary causes or not,
and if the patient have any of obesity comorbid conditions that should be
managed besides to obesity.

2-     Physical Examination, includes:

– Body mass index (BMI) = weight / height² (kg/m²); it is used to assess the severity of obesity; see previous table

– Body composition analysis; assesses percentage of body fat and muscle.

– Waist circumference; estimates visceral fat

– Waist-to-hip ratio; measures fat distribution; accordingly obesity is classified into: Pear obesity (gynoid obesity) and Apple obesity (Android obesity)

3-     Laboratory Test that assess secondary causes and/or comorbid condition,
examples:

– Fasting lipid profile

– Fasting plasma glucose, hemoglobin A1c, and electrolyte measurements

– Serum thyroid stimulation hormone and free T4 measurement

Complications and Comorbidities

They are stated in the map using a simple figure showing sites of organs exposed to obesity complications.  Overall they can be: psychosocial, neurological, cardiovascular, endocrinal, musculoskeletal, renal, gastrointestinal, and/ or pulmonary.

Using the previously mentioned aspects of obesity – risk factors, secondary causes and information got from
diagnosis and clinical presentation – individualized treatment goals and plan are to be set.

Treatment of Obesity

The map includes treatment goals and approach.

First line therapy for obesity is Non-Pharmacological Treatment including: Low-calorie diet (LCD), Exercise, and Behavioral Modification – benefits of each and more details are stated in the map.

Pharmacotherapy – presented in the form of comparison; comparing:

–         Centrally acting anorexiant medications (impair dietary intake)

First, Agents Approved for Long-Term Use (Lorcaserin – Phentermine/Topiramate ER)

Second, Agents Approved for Short-Term Use (Phentermine – Diethylpropion)

–         Peripherally acting medications (impair dietary absorption): Orlistat

Bariatric Surgery – the map explains its indications, benefits, most common procedures (Adjustable gastric banding –
Roux-en-Y gastric bypass (RYGB)), and post-operative maintenance and supplementation.

This map will help you link between obesity etiology and/or risk factors and diagnosis for the aim of individualizing therapy.

Obesity Folded Map

This map is available in two forms: printable version and folded poster. We hope you find Obesity concept map helpful and we are looking forward t hearing your opinion.

Obesity concept map is written by:
Hagar M. Abdel AA’l, B Pharm.

Reviewed and edited by Maha Atef, B Pharm.

Last updated on: 7 February 2013