Diabetes Flashcards by Anita Ogbonnaya

What is the definition of Diabetes Mellitus?

A metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both

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What percentage of diabetes cases are Type 1?

5-10% of cases

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What percentage of diabetes cases are Type 2?

90-95% of cases

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What are the main types of diabetes mellitus?

i. type 1 diabetes, ii. type 2 diabetes, iii. gestational diabetes, iv. other types (cystic fibrosis-related DM, hemochromatosis, thyroid dx, drugs, chronic pancreatitis, tumors of the pancreas, or pancreatic surgery)

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What is the main characteristic of Type 1 diabetes?

Absolute deficiency of insulin secretion

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What are the two main characteristics of Type 2 diabetes?

Insulin resistance and β-cell dysfunction

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In Nigeria, how many people are estimated to have DM?

About 16 million Nigerians

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What is the rank of diabetes as a cause of death in adult Nigerians?

4th leading cause of death

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What percentage of Nigerians with DM also have hypertension?

2 out of every 5 (40%)

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What are the main challenges in diabetes care mentioned in the document?

Cost of healthcare, shortage of qualified HCPs, limited government support/poor infrastructure, sporadic HbA1c monitoring & complications screening, insulin availability

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What is the relationship between obesity and Type 2 diabetes?

Obesity leads to insulin resistance, which can progress to hyperinsulinemia, impaired glucose tolerance, early diabetes, and eventually late diabetes with decreased insulin secretion and β-cell failure

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What is the diagnostic criterion for diabetes using fasting plasma glucose (FPG)?

FPG ≥126 mg per dL (7.0 mmol per L)

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What is the diagnostic criterion for diabetes using 2-hour postprandial glucose (2hrPPG)?

2hrPPG ≥200 mg per dL (11.1 mmol per L) after a 75-g glucose load

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What is the diagnostic criterion for diabetes using HbA1c?

HbA1c ≥6.5%

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What is the diagnostic criterion for diabetes using casual plasma glucose?

Symptoms of DM plus casual plasma glucose concentration ≥200 mg per dL (11.1 mmol per L)

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What is the range for Impaired Fasting Glucose (IFG)?

FPG from 110 to <126 mg/dL (6.1 to 7.0 mmol per L)

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What is the range for Impaired Glucose Tolerance (IGT)?

2hrPPG from 140 to <200 mg/dL (7.75 to <11.1 mmol per L)

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What are the values for normal fasting plasma glucose (FPG)?

FPG <110 mg per dL (6.1 mmol per L)

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What are the values for normal 2-hour postprandial glucose (2hrPPG)?

2hrPPG <140 mg per dL (7.75 mmol per L)

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What should be done if diabetes test results are normal?

Repeat testing at least every 3 years, consider increased testing frequency based on initial results and risk status

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Name at least 5 risk factors that warrant diabetes testing in asymptomatic overweight/obese adults.

First-degree relative with diabetes, high-risk race/ethnicity, history of CVD, hypertension, low HDL cholesterol/high triglycerides, women with polycystic ovary syndrome, physical inactivity

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What are the main principles in diabetes management?

Control symptoms of high blood glucose, diabetes and foot care education, screening for complications & early treatment, set blood glucose targets, maintain optimal BMI <25kg/m2, control BP & cholesterol, discourage smoking, moderate or no alcohol consumption, exercise at least 20mins thrice a week

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What is the primary lifestyle approach to diabetes management?

Weight optimization, healthy diet, increased activity level

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What are the insulin sensitizers for diabetes treatment?

Biguanides (e.g., metformin), 2. Thiazolidinediones (e.g., rosiglitazone, pioglitazone), 3. Double PPAR agonists (e.g., saroglitazar)

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What are insulin secretagogues used in diabetes treatment?

Sulphonylureas (e.g., glimepiride, glibenclamide) and Non-sulphonylurea secretagogues - Meglitinides (e.g., repaglinide, nateglinide)

Name the categories of insulin based on action time.

Fast acting (lispro, aspart, glulisine), short acting (Regular insulin), long acting (glargine, detemir, NPH insulin), ultralong acting (insulin degludec)

What is the mechanism of action of Metformin?

Activates AMP-kinase, reduces hepatic glucose production

What are the advantages of Metformin?

Extensive experience, no hypoglycemia, weight neutral, potentially reduces cardiovascular disease events

What are the disadvantages of Metformin?

Gastrointestinal side effects, risk of lactic acidosis, B-12 deficiency, contraindications in certain conditions

What is the mechanism of action of Sulfonylureas?

Closes KATP channels, increases insulin secretion

What are the disadvantages of Sulfonylureas?

Hypoglycemia, weight gain, low durability, potential impact on ischemic preconditioning

What is the mechanism of action of DPP-4 inhibitors?

Inhibits DPP-4, increases GLP-1 and GIP

What are the advantages of DPP-4 inhibitors?

No hypoglycemia, well tolerated

What is the mechanism of action of GLP-1 receptor agonists?

Activates GLP-1 receptor, increases insulin, decreases glucagon, slows gastric emptying, increases satiety

What are the advantages of GLP-1 receptor agonists?

Weight loss, no hypoglycemia, potentially increases beta cell mass, possible cardiovascular protection

What is the recommended first-line pharmacologic agent for Type 2 diabetes?

Metformin, if not contraindicated and if tolerated

When should insulin therapy be considered at diagnosis of Type 2 diabetes?

In patients who are symptomatic and/or have A1C ≥10% and/or blood glucose levels ≥300 mg/dL

When should dual therapy be considered at diagnosis?

In patients with newly diagnosed T2DM who have A1C ≥9%

What should be considered when choosing pharmacologic agents for diabetes?

Efficacy, hypoglycemia risk, history of ASCVD, impact on weight, potential side effects, renal effects, delivery method, cost, and patient preferences

For patients with T2DM and established ASCVD, what should therapy include?

Lifestyle management, metformin, and an agent proven to reduce major adverse CV events and CV mortality (empagliflozin and liraglutide)

What are the typical HbA1c reductions with Metformin?

1-2%

What are the typical HbA1c reductions with Sulfonylureas?

1-2%

What are the typical HbA1c reductions with DPP-IV inhibitors?

0.5-0.8%

What are the typical HbA1c reductions with GLP-1 agonists?

0.5-1.0%

What are the typical HbA1c reductions with Insulin?

1.5-3.5%

What are the indications for insulin therapy in Type 2 diabetes?

Symptoms of hyperglycemia, presence of complications, scheduled for surgery, high values at diagnosis (FPG >250 mg/dL, PPG >300 mg/dL, HbA1c >9%), unsatisfactory glycemic control on optimal dose of 2-3 OADs

What are the types of insulin based on onset of action?

Rapid-acting, short-acting, intermediate-acting, long-acting, pre-mixed

Name examples of rapid-acting insulin.

Aspart, lispro, glulisine

Name examples of short-acting insulin.

Insuman R, Actrapid, Humulin R

Name examples of intermediate-acting insulin.

Insuman N, Insulatard

Name an example of long-acting insulin.

Lantus

Name examples of pre-mixed insulin.

Insuman combo, mixtard

What are potential complications of insulin therapy?

Hypoglycemia, lipodystrophy, allergy, insulin edema

What comorbidities should be screened for in diabetes patients?

Obesity, hypertension, dyslipidemia, eye complications, nephropathy, neuropathy, foot problems

What are the target blood pressure values for diabetes patients?

<130/80 mmHg

What are the target fasting blood sugar values for diabetes patients?

70-120 mg/dL

What are the target 2-hour postprandial glucose values for diabetes patients?

100-180 mg/dL

What is the target HbA1c value for diabetes patients?

<7%

What are the target lipid values for diabetes patients?

T-C <200 mg/dl; HDL-C >40 mg/dl (>50 female); LDL-C <100 mg/dl; TG <150 mg/dl

What are the acute complications of diabetes due to hyperglycemia?

Diabetic ketoacidosis, hyperosmolar hyperglycemic state (HHS), hypoglycemia

What are the microvascular complications of diabetes?

Neuropathy, nephropathy, retinopathy

What are the macrovascular complications of diabetes?

Coronary artery disease, peripheral vascular disease, stroke

What is the leading cause of blindness in adults with diabetes?

Diabetic retinopathy

What is the leading cause of end-stage renal disease in diabetes?

Diabetic nephropathy

What is the leading cause of non-traumatic lower extremity amputations in diabetes?

Diabetic neuropathy

What percentage of individuals with diabetes die from cardiovascular events?

8 out of 10 (80%)

What basic foot care should diabetic patients follow?

Check feet daily, wash feet daily, keep toenails short, protect feet, always wear shoes, look inside shoes before putting them on, always wear socks, break in new shoes gradually

Diabetes Flashcards

(67 cards)