> Diabetes: exams and recommended

Disease diabetic

Nefropatia diabetica

diabetic Neuropathy

Piede diabetico

Retinopatia diabetic

What are the tests recommended for the person with diabetes and when to get them. The instructions for the use of the SID to not overdo it excess. But even in the defect

Esame Strumentale

Recommended Frequency

ECG a riposo

Echocardiography, color-doppler trans-thoracic resting

    the

  • Within 3 years from the diagnosis of type 2 diabetes
  • the

  • In the type 1 diabetics età >40 years

Screening nefropatiadiabetica:

    the

  • kidney Biopsy
    the

  • Ultrasound and color-doppler
    the

  • proteinuria in the range nefrosico or reduction of renal function in the absence of diabetic retinopathy
    the

  • proteinuria in the range nefrosico or reduction of renal function in subjects with duration of diabetes less than 5 years
    the

  • hematuria (microscopic), isolated or in the presence of urine sediment is active
    the

  • acute renal failure
    the

  • repeated Surveys for the morphological assessment of diabetic nephropathy

Screening of polyneuropathy sensorimotor
Screening of autonomic neuropathy cardiovascular CAN

    the

  • diagnosis of diabetes type 2
  • the

  • After 5 years from diagnosis of type 1 diabetes
  • the

  • Subsequently annual

Screening Disfunzione erettile

    the

  • diagnosis of type 2 diabetes and then annually
  • the

  • After 10 years from diagnosis of type 1 diabetes

Screening for diabetic retinopathy (1. Ophthalmoscopy, direct and/or indirect; 2. Biomicroscopia using a slit lamp with the lens is a contact who is not; 3. Retinografia)

    the

  • diagnosis of diabetes type 2
  • the

  • After 5 years from diagnosis of type 1 diabetes
  • the

  • Then, in the absence of retinopathy, every 2 years

Esami strumentali per lo screening della cardiopatia diabetica

ECG: this should be carried out once a year’s year, as screening of ischemic heart disease in persons with diabetes, regardless of the level of risk. And it’ s a examination simple and cheap, even if it has a low sensitivityà diagnostics. If positive, requires the passage of examinations of the second level.

exercise ECG: second level review, cheap and simple. Is made to search for a’ischemia under stress in a diabetic patient asymptomatic. In a patient on 3 not is possible to run it, for various contraindications or becauseé the patient is unable to make the effort.

HOLTER-ECG: it is not; recommended as a screening examination of ischemic heart disease in the person with diabetes.

ECHOCARDIOGRAM COLOR-flow DOPPLER: è a screening of ischemic heart disease silent in the diabetic patient, indicated in all patients with type 2 diabetes within three years from the time of diagnosis and in patients with type 1 diabetes with age above 40 years or with microvascular complications.

ECHOCARDIOGRAM COLOR-DOPPLERDA STRESS: method of screening of ischemic heart disease in the diabetic patient, is indicated only in the presence of high probability; and pre-testing of ischaemic heart disease. Può be made after physical exercise or with test drug (infusion of dobutamine, adenosine, dipyridamole). An eco-positive stress is an important predictor of mortality,à; a echo-stress, the negative has less prognostic value and should be repeated after 1 year.

SCINTIGRAPHY MYOCARDIAL (SPECT)  REST AND STRESS: method of screening of ischemic heart disease in the diabetic patient, to use if the patient is not able to perform an exercise ECG or, in the case of the exercise ECG are not diagnostic. The limits of this examination are l’exposure to ionizing radiation and the cost. In diabetic subjects, l’extension and the severityà of ischemic damage detected with SPECT predicts the risk of coronary events both short-term and long-term.

TAC CORONARY: it is a method of screening of ischemic heart disease in asymptomatic individuals with diabetes mellitus. Is used to assess the presence, localization, and l’extent of any calcifications of the coronary arteries (marker statements of atherosclerosis), which are more frequent and extensive in patients with diabetes compared to non-diabetics.

ANGIO-CT CORONARY. Not è given as a review of screening of ischemic heart disease in diabetic patients.

CARDIAC MAGNETIC RESONANCE imaging. MRI heart is a method of screening of ischemic heart disease silent in the diabetic patient.

CORONARY ANGIOGRAPHY. L’coronary angiography is not; as a method of screening of ischemic heart disease silent in the diabetic patient.

Instrumental examinations for the screening of diabetic nephropathy

The 40 percent of patients with diabetes develop a kidney damage (nephropathy). In type 2 diabetes, 30 percent of patients have albuminuria (protein in the urine), 20 percent of the reduced filtrate the glomerular (renal failure).

RENAL SONOGRAPHY and COLOR DOPPLER. Ultrasound and color-Doppler can be used at various stages of the evolution of the kidney damage from diabetes as widely available, easy to perform, is without side effects and economical.

RENAL BIOPSY. Allows you to classify the kidney damage in people with diabetes in three categories associated with different prognosis:

    the

  1. diabetic nephropathy
  2. the

  3. kidney disease non-diabetic
  4. the

  5. in a mixed condition between the first two.

L’usefulness; and the renal biopsy in individuals with diabetes is still the subject of debate. There is consensus on the indications and when to do it.

Instrumental examinations for the screening of diabetic neuropathy 

The polyneuropathy diabetic is the form more common of diabetic neuropathy: 1 person on 3 has the polyneuropathy sensorimotor. Screening for this complication is necessary becauseé in 50 percent of the cases is asymptomatic; the presence of a deficit of feel or engines is predictive of ulcers, ‘feet’ of Charcot, fractures or falls.

POLYNEUROPATHY DIABETIC sensorimotor. screening of polyneuropathy sensorimotor è indicated in all subjects with type 1 diabetes after 5 years from diagnosis and in those with type 2 diabetes at diagnosis. Subsequent assessments should be an annual event.

The screening of polyneuropathy sensorimotor involves the collection of patient history, and l’use of clinical tests simple: the evaluation of the sensitivityà the puncture needle (small fibers) and sensitivityà pressor to the monofilament 10 g and vibration by a tuning fork or biotesiometro (large fibers).

AUTONOMIC NEUROPATHY of the CARDIOVASCULAR system. screening è indicated in all asymptomatic subjects with type 1 diabetes after 5 years from diagnosis and in all subjects with type 2 diabetes, regardless of the diagnosis. Evaluations subsequent to the first must have annual. The CAN (especially the presence of high resting heart rate, reduced variabilityà of the frequency, elongation dell’s QT interval to’ECG, orthostatic hypotension), is predictive of mortality,à cardiovascular and associated with arrhythmias, silent heart attack, and heart failure.

AUTONOMIC NEUROPATHY GASTROINTESTINAL tract. The neuropathy dell’s digestive tract is frequent in people with diabetes and can; cause symptoms such as nausea, abdominal swelling, loss of the’appetite, sazietà early, the sense of gut fill and enhance gastric, abdominal pain, vomiting, post-prandial, burning retro-sternal, dysphagia, constipation or diarrhea, and fecal incontinence. In the presence of symptoms suggestive of diabetic gastroparesis (nausea, vomiting, gut fill and enhance gastric, sazietà early, abdominal bloating) you can use to gastric scintigraphy, or to the breath test all’octanoic acid with 13C.

NEUROPATHY URO-GENITAL. The neuropathy genito-urinary cause disorders of urination, erectile dysfunction and retrograde ejaculation in the’man and sexual dysfunction in women. The dysfunction of the bladder increases the usedà to infections of the urinary tract. Erectile dysfunction is associated with a’and increased incidence of cardiovascular diseases.

In all subjects with diabetes and with other complications neuropathic must be sought in signs and symptoms of bladder dysfunction (dysuria, urinary frequency, nocturia, incontinence and recurrent cystitis). A validated (LUTS: Lower UrinaryTractSymptoms) può be used for the screening home.

The presence of erectile dysfunction (ed) in subjects with Type 2 diabetes must be sought già at diagnosis and then re-evaluated once l’year. In subjects with Type 1 diabetes the DE is to be sought in the presence of a long disease duration (>10 years) or chronic complications, such as neuropathy and vasculopathy.

Instrumental examinations for the screening of the diabetic foot 

The diabetic foot (presence of ulceration or destruction of deep tissues associated with neurological abnormalities and various degrees of vasculopathy device) represents the first cause of amputation, non-traumatic limb and is a frequent reason for hospital admission for diabetic patient.

ARTERIOPATHY OBLITERANS, CHRONIC the LOWER LIMBS. In all subjects with diabetes with an ulcer on the foot should be carried out and the research of vasculopathy device, through the assessment of the peripheral pulses and the determination of the’Ankle-brachial Index.

Among the instrumental examinations: doppler of the arteries of the lower limbs, l’angio Tc, l’angio Rm, and l’arteriography.

THE INFECTED DIABETIC FOOT. L’infection is a frequent and dangerous complication of a’s ulcer, and is often the cause that leads to the’major amputation. And it’ s useful to conduct a microbiological examination to set a specific antibiotic therapy.

OSTEOMYELITIS (infection of the’s bone). Può to complicate up to 20% of infections in minor or moderate and 50-60 percent of the injuries severely infected in subjects with diabetic foot.

The x-ray of the foot è often l’only test necessary in suspected osteomyelitis. L’execution of a series of x-rays, at a distance of 2-4 weeks, gives all’examination for greater sensitivityà and specificà.

The nuclear magnetic resonance (Nmr) is a esamenon always necessary for the diagnosis and management dell’osteomyelitis (survey expensive, often of limited availability; and may be difficult to interpret by a non-expert).

An examination alternative to the Mri è l’s use of scintigraphy with leukocytes marked, preferably with the technique of double-tracer.

The bone biopsy l’isolation of germs from a sample of bone, together with the presence of inflammatory cells and osteonecrosis allow a certain diagnosis of osteomyelitis.

Instrumental examinations for the screening of diabetic retinopathy 

The screening può be executed through l’ophthalmoscopy, the biomicroscopio with slit lamp, photographs of the back of the eye.

Source: the Position Statement on the’s appropriateness in the prescription of instrumental examinations in diabetes. Panorama diabetes 2017 – Companyà of the Italian Diabetology (Sid)

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12 march 2017

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