ada2 Flashcards
What is the primary end point of the Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial?
The primary end point was reduced cardiovascular outcome.
What is the recommended use of SGLT2 inhibitors in individuals with type 2 diabetes and diabetic kidney disease?
Use of an SGLT2 inhibitor is recommended to reduce CKD progression and cardiovascular events.
Describe the two different classes of MRAs.
There are two different classes of MRAs, steroidal and nonsteroidal.
What is the risk associated with MRAs in diabetic kidney disease?
The risk of hyperkalemia is associated with MRAs in diabetic kidney disease.
What is the mean albuminuria in people with an eGFR of 20 mL/min/1.73 m²?
The mean albuminuria was 852 mg/g (interquartile range 446-1,634 mg/g).
How did finerenone compare with placebo in reducing cardiovascular outcome?
Finerenone had a lower hazard ratio (HR 0.82) compared to placebo in reducing cardiovascular outcome.
What percentage of the study group experienced hyperkalemia-related discontinuation?
2.3% of the study group experienced hyperkalemia-related discontinuation.
What are ongoing clinical trials focusing on?
Ongoing clinical trials are focusing on CKD and cardiovascular outcomes in people with diabetes.
What is the purpose of the FIDELITY analysis?
To evaluate the efficacy and safety of finerenone in individuals with chronic kidney disease.
Describe the findings of the FIDELITY analysis.
The analysis showed a 14% reduction in composite cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for individuals with chronic kidney disease.
How does finerenone compare to the placebo group in terms of hyperkalemia incidence?
There was a higher incidence of hyperkalemia in the finerenone group compared to the placebo group.
Define chronic kidney disease (CKD).
A condition characterized by the gradual loss of kidney function over time.
What should healthcare professionals educate their patients about regarding CKD?
They should educate their patients about the progressive nature of CKD, the kidney preservation benefits of proactive treatment of blood pressure and blood glucose, and the potential need for renal replacement therapy.
Describe the relationship between diabetes and nephropathy.
Diabetes is a risk factor for the development of nephropathy, a condition characterized by kidney damage and impaired kidney function.
What is the purpose of the randomized clinical trial mentioned in the content?
The purpose of the randomized clinical trial was to evaluate the effects of blood-pressure lowering and glucose control in patients with type 2 diabetes.
Define acute kidney injury.
Acute kidney injury refers to a sudden and temporary loss of kidney function, often caused by a decrease in blood flow to the kidneys or direct damage to the kidneys.
How do SGLT2 inhibitors impact the risk of acute kidney injury in patients?
A propensity-matched analysis showed that SGLT2 inhibitors may increase the risk of acute kidney injury in patients with diabetes.
Describe the findings of the EMPA-REG OUTCOME study.
The EMPA-REG OUTCOME study found that empagliflozin, an SGLT2 inhibitor, reduced the risk of cardiovascular events and progression of kidney disease in patients with type 2 diabetes.
Describe the CREDENCE study.
The CREDENCE study investigated the effects of Canagliflozin on cardiovascular and renal outcomes in type 2 diabetes mellitus and chronic kidney disease stages 3A, 3B, or 4.
What are the potential benefits of SGLT2 inhibitors in diabetic kidney disease?
SGLT2 inhibitors, such as Canagliflozin, may reduce inflammation, fibrosis biomarkers, and hypertension, leading to improved kidney function in diabetic kidney disease.
Define chronic kidney disease.
Chronic kidney disease refers to the gradual loss of kidney function over time, often caused by conditions like diabetes or high blood pressure.
How do SGLT2 inhibitors work in diabetes?
SGLT2 inhibitors, like Canagliflozin, work by blocking the reabsorption of glucose in the kidneys, leading to increased glucose excretion in the urine and lower blood sugar levels.
Describe the effects of Canagliflozin on intrarenal angiotensinogen augmentation.
Canagliflozin prevents intrarenal angiotensinogen augmentation, which can help reduce kidney injury and hypertension in a mouse model of type 2 diabetes mellitus.
Describe the effects of Canagliflozin on intrarenal angiotensinogen augmentation.
Canagliflozin prevents intrarenal angiotensinogen augmentation, which can help reduce kidney injury and hypertension in a mouse model of type 2 diabetes mellitus.
Describe chronic kidney disease.
Chronic kidney disease refers to the gradual loss of kidney function over time, leading to the accumulation of waste and fluid in the body. It is typically caused by conditions like diabetes or high blood pressure and can progress to end-stage renal disease, requiring dialysis or kidney transplantation.
What is the role of angiotensin receptor blockers in chronic kidney disease?
Angiotensin receptor blockers (ARBs) are medications that help to lower blood pressure and reduce proteinuria in patients with chronic kidney disease. They work by blocking the action of angiotensin II, a hormone that constricts blood vessels and increases blood pressure.
How does diabetes contribute to chronic kidney disease?
Diabetes is a leading cause of chronic kidney disease. High blood sugar levels over time can damage the blood vessels in the kidneys, impairing their ability to filter waste and fluid from the body. This can eventually lead to kidney failure if not properly managed.
Define proteinuria.
Proteinuria is a condition characterized by the presence of excess protein in the urine. It is often a sign of kidney damage or dysfunction, as the kidneys normally filter out waste products while retaining essential proteins in the bloodstream. Proteinuria can be an indicator of chronic kidney disease.
What is the purpose of the ADA Standards of Care in Diabetes?
To provide clinical practice recommendations and tools for evaluating quality of care in diabetes.
Describe diabetic retinopathy.
Diabetic retinopathy is a vascular complication of diabetes that can lead to blindness.
What are the recommendations for optimizing glycemic control in diabetic retinopathy?
Optimize glycemic control to reduce the risk or slow the progression of diabetic retinopathy.
How does the prevalence of diabetic retinopathy relate to diabetes duration and glycemic control?
The prevalence of diabetic retinopathy is strongly related to both the duration of diabetes and the level of glycemic control.
What are the recommended intervals for monitoring retinopathy status in pregnant women with diabetes?
Retinopathy status should be monitored every trimester and for 1 year postpartum.
What can retinal photography enhance in terms of efficiency and cost reduction?
Retinal photography may enhance efficiency and reduce costs when the expertise of ophthalmologists can be used for complex examinations and therapy.
Describe the association between rapid reductions in A1C and retinopathy worsening.
Rapid reductions in A1C, such as those using GLP-1 RAs, can be associated with initial worsening of retinopathy.
What is the recommended screening approach for diabetic retinopathy?
Diabetic retinopathy screening should be performed using validated approaches and methodologies.
When should adults with type 1 diabetes have their initial dilated and comprehensive eye examination?
Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination within 5 years after the onset of diabetes.
What is the alternative to traditional screening approaches for diabetic retinopathy?
Artificial intelligence systems authorized for use by the U.S. FDA represent an alternative to traditional screening approaches.
How can prompt diagnosis of diabetic retinopathy benefit patients?
Prompt diagnosis allows triage of patients and timely intervention that may prevent vision loss.
Describe the screening recommendation for people with type 2 diabetes.
People with type 2 diabetes should have an initial dilated and comprehensive eye examination at the time of the diabetes diagnosis.
What is the importance of screening youth with type 1 or type 2 diabetes for diabetic retinopathy?
Youth with type 1 or type 2 diabetes are also at risk for complications and need to be screened for diabetic retinopathy.
What are the common complications of diabetes?
Retinopathy, neuropathy, and foot care.
Describe the prevalence of any diabetic retinopathy and PDR in early pregnancy.
The prevalence of any diabetic retinopathy and PDR in early pregnancy was 52.3% and 6.1%, respectively.
What is the alternative treatment to traditional panretinal laser photocoagulation for diabetic retinopathy?
Intravitreous injections of anti-vascular endothelial growth factor (anti-VEGF) are a reasonable alternative.
How can macular focal/grid laser photocoagulation be effective in treating diabetic macular edema?
Macular focal/grid laser photocoagulation has been shown to be effective in treating eyes with clinically significant macular edema from diabetes.
What is the association between intensive glycemic management and retinopathy?
Rapid implementation of intensive glycemic management in the setting of retinopathy is associated with early worsening of retinopathy.
Describe the purpose of intravitreal anti-VEGF agents in the treatment of diabetic macular edema.
Intravitreal anti-VEGF agents are used to provide an effective treatment plan for central-involved diabetic macular edema, reducing symptoms and improving quality of life.
What is the recommended frequency of intravitreal therapy with anti-VEGF agents for the treatment of diabetic macular edema?
Patients typically require near-monthly administration of intravitreal therapy with anti-VEGF agents during the first 12 months of treatment, with fewer injections needed in subsequent years to maintain remission.
How can glycemic control impact the progression of diabetic peripheral neuropathy (DPN) and cardiac autonomic neuropathy (CAN)?
Glycemic control can effectively prevent DPN and CAN in type 1 diabetes and may modestly slow their progression in type 2 diabetes.
What are the three commonly used anti-VEGF agents for the treatment of central-involved diabetic macular edema?
The three commonly used anti-VEGF agents are bevacizumab, ranibizumab, and aflibercept.
What is the purpose of assessing symptoms and signs of autonomic neuropathy in people with diabetes?
Assessing symptoms and signs of autonomic neuropathy can help identify potential complications and aid in the relief of pain and improvement of quality of life.
What are the clinical features of atypical neuropathy in people with type 2 diabetes?
The clinical features of atypical neuropathy in people with type 2 diabetes include a pressure increase by >20 mmHg or >10 mmHg upon standing without an appropriate increase in heart rate.
How should treatment for diabetic neuropathy be focused?
Treatment for diabetic neuropathy is generally focused on alleviating symptoms and optimizing blood pressure and serum lipid control to reduce the risk or slow the progression of diabetic neuropathy.
Describe the manifestations of gastrointestinal neuropathies in individuals with diabetes.
Gastrointestinal neuropathies in individuals with diabetes may involve any portion of the gastrointestinal tract and can manifest as esophageal dysmotility, gastroparesis, constipation, diarrhea, and fecal incontinence.
What initial pharmacologic treatments are recommended for neuropathic pain in diabetes?
Gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers are recommended as initial pharmacologic treatments for neuropathic pain in diabetes.
When should individuals with type 1 diabetes or type 2 diabetes be assessed for autonomic neuropathy?
Individuals who have had type 1 diabetes for 5 years and all individuals with type 2 diabetes should be assessed annually for autonomic neuropathy.
When should individuals with type 1 diabetes or type 2 diabetes be assessed for autonomic neuropathy?
Individuals who have had type 1 diabetes for 5 years and all individuals with type 2 diabetes should be assessed annually for autonomic neuropathy.
Describe the relationship between retinopathy, neuropathy, and foot care in diabetes.
Retinopathy, neuropathy, and foot care are interconnected aspects of diabetes care, with retinopathy affecting the eyes, neuropathy affecting the nerves, and foot care being crucial to prevent complications like ulcers and amputations.
What are some areas of disagreement in the treatment of pain in diabetic peripheral neuropathy (DPN)?
There are disagreements around the use of SNRI/opioid dual-mechanism agents and the role of sodium channel blockers in treating pain in DPN.
How is capsaicin used in the treatment of pain in DPN?
Capsaicin has received FDA approval for treating pain in DPN using an 8% patch, and topical capsaicin cream can also be considered for patients who prefer topical treatments.
Define gabapentinoids and their role in the treatment of pain in DPN.
Gabapentinoids are a class of drugs that include several calcium channel a2-8 subunit ligands. They have been shown to be effective in treating pain in DPN, with pregabalin and gabapentin being commonly used.
Define gabapentinoids and their role in the treatment of pain in DPN.
Gabapentinoids are a class of drugs that include several calcium channel a2-8 subunit ligands. They have been shown to be effective in treating pain in DPN, with pregabalin and gabapentin being commonly used.
Define gabapentinoids and their role in the treatment of pain in DPN.
Gabapentinoids are a class of drugs that include several calcium channel a2-8 subunit ligands. They have been shown to be effective in treating pain in DPN, with pregabalin and gabapentin being commonly used.
Define gabapentinoids and their role in the treatment of pain in DPN.
Gabapentinoids are a class of drugs that include several calcium channel a2-8 subunit ligands. They have been shown to be effective in treating pain in DPN, with pregabalin and gabapentin being commonly used.
Define gabapentinoids and their role in the treatment of pain in DPN.
Gabapentinoids are a class of drugs that include several calcium channel a2-8 subunit ligands. They have been shown to be effective in treating pain in DPN, with pregabalin and gabapentin being commonly used.
Define gabapentinoids and their role in the treatment of pain in DPN.
Gabapentinoids are a class of drugs that include several calcium channel a2-8 subunit ligands. They have been shown to be effective in treating pain in DPN, with pregabalin and gabapentin being commonly used.
What is the therapeutic goal in treating orthostatic hypotension?
The therapeutic goal in treating orthostatic hypotension is to minimize postural symptoms rather than to completely eliminate them.
What is the therapeutic goal in treating orthostatic hypotension?
The therapeutic goal in treating orthostatic hypotension is to minimize postural symptoms rather than to completely eliminate them.
Describe the importance of specialized therapeutic footwear for people with diabetes.
Specialized therapeutic footwear is recommended for people with diabetes at high risk for ulceration, including those with loss of protective sensation, foot deformities, ulcers, callous formation, poor peripheral circulation, or a history of amputation.
What is the FDA-approved treatment for gastroparesis?
Metoclopramide is the only FDA-approved treatment for gastroparesis.
Define peripheral arterial disease.
Peripheral arterial disease refers to the narrowing or blockage of the arteries that supply blood to the limbs, typically the legs.
How can peripheral arterial disease be screened?
Initial screening for peripheral arterial disease should include assessment of lower-extremity pulses, capillary refill time, rubor on dependency, pallor on elevation, and venous filling time.
What are some adjunctive treatments for chronic diabetic foot ulcers that have failed to heal with standard care alone?
Considerations might include negative-pressure wound therapy, placental membranes, bioengineered skin substitutes, several acellular matrices, autologous fibrin and leukocyte platelet patches.
What is one of the most useful tests to determine loss of protective sensation (LOPS) in the foot?
The 10-g monofilament test.
Describe the assessment that should be performed annually in all people with diabetes.
A thorough examination of the feet, including assessment of skin integrity, assessment for LOPS using the 10-g monofilament test, assessment of neurological function, and assessment for foot deformities.
What are toe systolic blood pressures <30 mmHg suggestive of?
Peripheral arterial disease (PAD) and an inability to heal foot ulcerations.
How often should individuals with diabetes >50 years of age undergo screening via noninvasive arterial studies?
Every 5 years.
Define loss of protective sensation (LOPS).
The absence of monofilament sensation and one other abnormal test, confirming the presence of neuropathy in the foot.
Describe the five basic principles of ulcer treatment for individuals at risk of foot deformities, LOPS, and PAD.
Offloading of plantar ulcerations, Debridement of necrotic, nonviable tissue, Revascularization of ischemic wounds when necessary, Management of infection: soft tissue or bone, Use of physiologic, topical dressings or multidisciplinary team.
What are the initial treatment recommendations for individuals with foot problems related to diabetes?
Daily foot inspection, use of moisturizers for dry, scaly skin, avoidance of self-care of ingrown nails and calluses, well-fitted athletic or walking shoes with customized pressure-relieving orthoses.
How should individuals with LOPS examine their feet for daily surveillance of early foot problems?
They should palpate or visually inspect their feet using an unbreakable mirror.
How should individuals with LOPS examine their feet for daily surveillance of early foot problems?
They should palpate or visually inspect their feet using an unbreakable mirror.
Define advanced wound therapy and when it should be employed.
Advanced wound therapy refers to specialized treatments for chronic ulcers that fail to heal using basic principles. It should be employed when a wound fails to show a reduction of 50% or more after 4 weeks of appropriate wound management.
Describe the importance of referrals to foot care specialists for individuals with diabetes and foot disease.
Referrals to foot care specialists are important for further evaluation and regular surveillance of foot problems. They are especially crucial for individuals with LOPS, PAD, or structural foot deformities, as well as those with open ulceration or unexplained swelling, erythema, or increased skin temperature.
Describe the importance of referrals to foot care specialists for individuals with diabetes and foot disease.
Referrals to foot care specialists are important for further evaluation and regular surveillance of foot problems. They are especially crucial for individuals with LOPS, PAD, or structural foot deformities, as well as those with open ulceration or unexplained swelling, erythema, or increased skin temperature.
Describe the importance of referrals to foot care specialists for individuals with diabetes and foot disease.
Referrals to foot care specialists are important for further evaluation and regular surveillance of foot problems. They are especially crucial for individuals with LOPS, PAD, or structural foot deformities, as well as those with open ulceration or unexplained swelling, erythema, or increased skin temperature.
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy is the delivery of oxygen through a chamber, either individual or multiperson, with the intention of increasing tissue oxygenation to increase tissue perfusion and neovascularization, combat resistant bacteria, and stimulate wound healing.
Describe negative-pressure wound therapy.
Negative-pressure wound therapy is a category of advanced wound therapy that involves the use of either standard electrically powered or mechanically powered devices to create a vacuum environment around the wound, promoting healing and preventing infection.
What are the categories of advanced wound therapies?
The categories of advanced wound therapies include negative-pressure wound therapy, oxygen therapies, biophysical therapies, growth factors, autologous blood products, acellular matrix tissues, xenograft dermis, and topical oxygen therapy.
How effective is hyperbaric oxygen therapy in managing nonhealing diabetic foot ulcers (DFUs)?
Recent studies with significant design deficiencies and participant dropouts have failed to provide corroborating evidence that hyperbaric oxygen therapy should be widely used for managing nonhealing DFUs.
Describe the efficacy of topical oxygen therapy in healing chronic DFUs.
Several high-quality randomized controlled trials and systematic reviews have supported the efficacy of topical oxygen therapy in healing chronic DFUs at 12 weeks.
Describe the Diabetes Control and Complications Trial.
A clinical trial that evaluated the effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
What is the purpose of the Protocol W randomized clinical trial?
To evaluate the effect of intensive treatment of diabetes on the development and progression of diabetic retinopathy.
Define retinopathy.
A condition characterized by damage to the blood vessels in the retina, often caused by diabetes.
How is diabetic retinopathy screened for?
Through teleretinal screening programs that use automated diagnostic systems to detect signs of retinopathy.
Describe the evolution of teleophthalmology programs in the United Kingdom.
They have expanded beyond diabetic retinopathy screening to include other eye diseases and conditions.
Describe the differential diagnosis of diabetic neuropathy.
Not all neuropathy in diabetes is of diabetic etiology
What is the prevalence and risk factors for diabetic peripheral neuropathy in type 2 diabetic patients?
Prevalence and risk factors for diabetic peripheral neuropathy in type 2 diabetic patients from 14 countries: estimates of the INTERPRET-DD study
Define cardiovascular autonomic neuropathy.
Association between cardiovascular autonomic neuropathy and left ventricular dysfunction
How does gastric electrical stimulation with Enterra therapy improve symptoms from diabetic gastroparesis?
Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study
Describe the impact of foot care education on self efficacy and self care in patients with diabetes.
Foot care education has been shown to improve self efficacy and self care in patients with diabetes, according to a systematic review published in the European Journal of Vascular and Endovascular Surgery in 2020.
What is a robust predictor of complete healing in diabetic foot ulcers over a 12-week period?
The percent change in wound area of diabetic foot ulcers over a 4-week period has been identified as a robust predictor of complete healing in a 12-week prospective trial published in Diabetes Care in 2003.
Define continuous diffusion of oxygen in the context of diabetic foot ulcer healing.
Continuous diffusion of oxygen refers to a therapeutic approach that improves diabetic foot ulcer healing by delivering oxygen to the wound site. This method has been found to be more effective than a placebo control in a randomized, double-blind, multicenter study published in J Wound Care in 2018.
Describe the efficacy of topical oxygen therapy in the treatment of diabetic foot ulcers.
Topical oxygen therapy has shown efficacy in the treatment of diabetic foot ulcers, as demonstrated in a multicenter, open, randomized controlled clinical trial published in the Journal of Wound Care in 2021.
What is the purpose of the American Diabetes Association (ADA) Standards of Care in Diabetes?
To provide clinical practice recommendations and tools for evaluating quality of care in diabetes management.
Who is responsible for updating the ADA Standards of Care annually?
The ADA Professional Practice Committee, a multidisciplinary expert committee.
What should be considered when assessing older adults with diabetes?
Medical, psychological, functional (self-management abilities), and social domains.
Why is it important to screen for geriatric syndromes in older adults with diabetes?
Geriatric syndromes can affect diabetes self-management and diminish quality of life.
What percentage of people over the age of 65 years have diabetes?
Over one-quarter (25%) of people over the age of 65 years have diabetes.
What are some examples of geriatric syndromes that should be screened for in older adults with diabetes?
Polypharmacy, cognitive impairment, depression, urinary incontinence, falls, persistent pain, and frailty.
Describe the prevalence of diabetes in older adults.
Over one-quarter of people over the age of 65 years have diabetes, and one-half of older adults have prediabetes.
What is the expected trend in the number of older adults with diabetes in the coming decades?
The number of older adults living with diabetes is expected to increase rapidly.
Describe the association between diabetes and cognitive function in older adults.
Older adults with diabetes are at a greater risk for decline in cognitive function.
What are some common geriatric syndromes that may impact older adults with diabetes?
Polypharmacy, cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, and frailty.
What is the recommended action for individuals who screen positive for cognitive impairment?
They should receive diagnostic assessment, including referral to a behavioral health professional for formal cognitive/neuropsychological evaluation.
Define hypoglycemia.
Hypoglycemia refers to low blood sugar levels.
How have clinical trials of specific interventions for cognitive decline in older adults with diabetes shown positive therapeutic benefit?
Clinical trials have not shown positive therapeutic benefit in maintaining or significantly improving cognitive function or preventing cognitive decline.
