UW Diabetes

Location:
Diabetes Care Center
Roosevelt North Building
3rd floor
Attending:
Subbu Trikudanathan
Tracy Tylee
Dace Trence,
Lorena Wright

Absences:
For planned absences (vacation, conference leave, etc.):

Dace Trence, MD,

For emergency absences (sick leave, family emergency, etc.):

Dace Trence, MD,

Sessions:
Monday mornings
Wednesday mornings
Thursday afternoons
Friday mornings

Morning clinic start varies among providers; first day arrival should be 8:00 am. Afternoon clinics start at 1:00pm.

Description

Evaluate patients with diabetes comprehensively including assessments of:

  1. glycemic control (long-term with HbA IC, short-term with the history and the SMBG log including identification of both hyper- and hypoglycemia. Also basic understanding of meter glucose downloading skills);
  2. blood pressure contol;
  3. lipid control (fasting lipid profile);
  4. the status of microvascular complications (history, dilated eye examination, detailed foot examination including monofilament testing, urine albumin;
  5. macrovascular complications (history, cardiovascular examination, appropriate strategies for screening for coronary atery disease, cerebral vascular disease, and renal artery stenosis);
  6. the need for additional self management education, medical nutrition therapy, or both; and
  7. smoking status

There will be exposure to many different types of diabetes beyond Type 1 and Type 2, specifically including, but not limited to cystic fibrosis associated diabetes , post-transplant diabetes, pancreatic diabetes, tropical diabetes.

Additionally there will be exposure to many treatment modalities including insulin pumps, continuous glucose sensors, GLP-1 receptor agonists. Included will be the ability to learn the limitations of currently used metrics with added information from laboratory such as fructosamine, 1,5 anhydriglucitol, even patient self-obtained data from glucose meter downloads.

Goals

Clinical experience in a multidisciplinary diabetes education and care program. To gain expertise in the evalution and managment Type 1 and 2 diabetes mellitus and less common forms of diabetes (pancreatic diabetes, steroid-induced diabetes, monogenic forms of diabetes) including:

  1. Patient monitoring and treatment objectives in adolescents and adults
  2. Hypoglycemia and chronic complications, including
    1. Hypoglycemia diagnosis and prevention
    2. Microvascular and macrovascular disease, including
      1. Diabetic retinopathy
      2. Diabetic nephropathy
      3. Diabetic neuropathy
      4. Dermatologic aspects of diabetes
      5. Coronary heart disease
      6. Peripheral vascular disease
      7. Cerebrovascular disease
    3. Infections in the diabetic patient
  3. Patient education
  4. Psychological issues
  5. Dietary principles

Benchmarks of Practice-Based Learning

Management of adolescent and adult patients of all patients of all ages with diabetes mellitus including, but not limited to, the following aspects of disease:

  • The utilization and interpretation of autoimmune markers of type 1 diabetes in patient management and counseling
  • Prescription of exercise program
  • Rationale for and calculation of diabetic diets
  • Oral antidiabetic therapy
  • Chronic insulin administration, including used of all varieties of insulin delivery systems. Residents should understand the basic principles for insulin initiation and chronic use in both type 1 and type 2 diabetes, with comprehension of the 3 components of insulin therapy (basal, prandial, and correction dose) and the use of SMBG for patient self-managment.
  • Glucose monitoring devises
  • Role of continuous glucose monitoring (retrospecive and real-time)
  • Funduscopic examination, recognitin, and appropriate referral of patients with diabetic retinopathy
  • Foot care
  • Psychological effects of diabetes mellitus on patients and their families, community resource availability

Educational Goals and Objectives

Develop skill in the management of adolescent and adult patients of all ages with diabetes mellitus, including the utilization and interpretation of autoimmune markers of type 1 diabetes in patient managment and counseling, prescription of exercise programs, the rationale for and calculation of diabetic diets, oral antidiabetic therapy, the use of intravenous insulin administration in acute decompensated diabetes, the use of all varieties of insuling delivery systems, glucose monitoring devices, fundoscopic examination and recognition and appropriate referral of patients with diabetic retinopathy, foot care, psychosocial effects of diabetes on patients and their families, and patient and community relations.

Resources

American Diabetes Association Standards of Medical Care in Diabetes, 2015. Diabetes Care. January 2015; 38 (Supplement 1). Entire issue available online.

American Association of Clinical Endocrinologists Diabetes algorithm and Consensus statement: www.aace.com/publications/algorithm