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T2DM > Diabetes Mellitus Type 2 in Adults > Flashcards

Diabetes Mellitus Type 2 in Adults Flashcards

1
Q

What is the accuracy of fasting capillary blood glucose and fasting venous plasma glucose for screening diabetes?

A

Fasting capillary blood glucose and fasting venous plasma glucose have similar accuracy for screening diabetes.

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2
Q

What are the results of random capillary blood glucose for screening diabetes?

A

Random capillary blood glucose has inconsistent results for screening diabetes.

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3
Q

What are the generally accepted screening tests for diagnosing prediabetes and type 2 diabetes in adults?

A

The generally accepted screening tests for diagnosing prediabetes and type 2 diabetes in adults are HbA1c, fasting plasma glucose, 2-hour 75-g oral glucose tolerance test (OGTT), fasting venous plasma glucose, and 2-hour postload glucose levels.

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4
Q

What is the preferred test for diagnosing diabetes in Canada?

A

The preferred test for diagnosing diabetes in Canada is HbA1c.

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5
Q

What HbA1c value is considered diagnostic for diabetes?

A

An HbA1c value of ≥ 6.5% is considered diagnostic for diabetes.

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6
Q

According to the ADA, when should patients who are prescribed an atypical antipsychotic be screened for prediabetes and diabetes after beginning the medication?

A

Patients who are prescribed an atypical antipsychotic should be screened for prediabetes and diabetes 4 months after beginning the medication, or sooner if clinically relevant, and at least annually thereafter.

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7
Q

What is the recommended test to diagnose posttransplantation diabetes mellitus?

A

The oral glucose tolerance test is the recommended test to diagnose posttransplantation diabetes mellitus.

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8
Q

What is the recommended approach for screening hyperglycemia in patients after organ transplantation?

A

Perform screening for hyperglycemia in patients after organ transplantation

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9
Q

What is the recommended screening test for cystic fibrosis-related diabetes?

A

The recommended screening test for cystic fibrosis-related diabetes is an oral glucose tolerance test.

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10
Q

How often should annual monitoring for complications of diabetes be performed after the diagnosis of cystic fibrosis-related diabetes?

A

Annual monitoring for complications of diabetes should be performed beginning 5 years after the diagnosis of cystic fibrosis-related diabetes.

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11
Q

How should patients with cystic fibrosis-related diabetes be treated?

A

Patients with cystic fibrosis-related diabetes should be treated with insulin to individualized glycemic goals.

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12
Q

According to ADA recommendations, when should fasting glucose be assessed for patients with HIV infection?

A

Fasting glucose should be assessed before starting antiretroviral therapy, at the time of changing antiretroviral therapy, and 3-6 months after initiating/changing antiretroviral therapy then annually .

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13
Q

Why is the HbA1c test not recommended for diagnosing diabetes in patients with HIV infection?

A

The HbA1c test is not recommended as it underestimates glycemia in this population and may present monitoring challenges.

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14
Q

How often should fasting glucose be retested in patients with fasting glucose test results near the diagnostic threshold HIV PT?

A

Fasting glucose should be retested every 3-6 months to monitor for progression to diabetes.

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15
Q

When should screening tests for diabetes be repeated?

A

Screening tests for diabetes should be repeated at least **every 3 years **or sooner with symptoms or change in risk, or

annually if the patient is diagnosed with prediabetes.

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16
Q

What is the recommended frequency for repeat screening tests for diabetes in adults with normal results?

A

Repeat screening tests for diabetes in adults with normal results should be done at least every 3 years or sooner with symptoms or change in risk, according to ADA recommendations.

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17
Q

What are the risk factors that should be considered when screening asymptomatic adults for type 2 diabetes?

A

The risk factors that should be considered when screening asymptomatic adults for type 2 diabetes include overweight or obesity, having a first-degree relative with diabetes, previous diagnosis of prediabetes, low levels of high-density lipoprotein cholesterol, high triglyceride levels, hypertension, physical inactivity, race or ethnicity at increased risk, history of cardiovascular disease, polycystic ovary syndrome, and other conditions associated with insulin resistance.

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18
Q

What are the recommended criteria for testing to detect type 2 diabetes or prediabetes in asymptomatic adults?

A

The recommended criteria for testing to detect type 2 diabetes or prediabetes in asymptomatic adults include adults ≥ 35 years old or adults of any age with overweight or obesity (BMI ≥ 25 kg/m2) with ≥ 1 additional risk factor such as a first-degree relative with diabetes, previous diagnosis of prediabetes, low levels of high-density lipoprotein cholesterol, high triglyceride levels, hypertension, physical inactivity, race or ethnicity at increased risk, history of cardiovascular disease, polycystic ovary syndrome, or other conditions associated with insulin resistance.

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19
Q

What is the recommended screening approach for type 2 diabetes in asymptomatic adults?

A

The recommended screening approach for type 2 diabetes in asymptomatic adults is to perform informal assessment of risk factors or use a validated risk calculator such as the ADA risk test to determine the need for diagnostic testing.

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20
Q

What are some pharmacologic therapies that may reduce progression to diabetes in patients with prediabetes?

A

Some pharmacologic therapies that may reduce progression to diabetes in patients with prediabetes are alpha-glucosidase inhibitors (acarbose, voglibose), orlistat, liraglutide, and glitazones (pioglitazone, rosiglitazone).

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21
Q

What is the risk associated with glitazones in the treatment of prediabetes?

A

The use of glitazones (pioglitazone, rosiglitazone) for the treatment of prediabetes is associated with a boxed warning regarding the risk of heart failure.

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22
Q

What is the recommended pharmacologic therapy for adults at high risk of type 2 diabetes?

A

Metformin therapy is recommended for adults at high risk of type 2 diabetes, particularly for patients who are aged 25-59 years with a body mass index (BMI) of ≥ 35 kg/m2, higher fasting plasma glucose (≥110 mg/dL), and higher HbA1C (≥ 6%), or those with a history of gestational diabetes mellitus.

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23
Q

What is the potential benefit of metformin therapy for preventing type 2 diabetes in adults?

A

Metformin therapy may reduce the incidence of diabetes in adults at high risk of type 2 diabetes, when used alone or in combination with lifestyle modifications.

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24
Q

What level of evidence supports the use of metformin for the prevention of type 2 diabetes in adults?

A

The use of metformin for the prevention of type 2 diabetes in adults is supported by DynaMed Level 3 evidence.

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25
Q

What is the first-line treatment for patients with prediabetes?

A

The first-line treatment for patients with prediabetes is lifestyle interventions, including diet, activity, weight loss, and smoking cessation.

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26
Q

What are the recommended dietary interventions for patients at high risk for type 2 diabetes?

A

Patients at high risk for type 2 diabetes are recommended to follow a significantly reduced-calorie diet and engage in ≥ 150 minutes/week of moderate-intensity physical activity.

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27
Q

What types of foods should be emphasized in the diet to prevent or manage type 2 diabetes?

A

The diet should emphasize nutrient-dense foods high in fiber, such as nonstarchy vegetables, fruits, legumes, and whole grains. Dairy products with minimally added sugar are also recommended.

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28
Q

What type of diet is recommended to improve glucose metabolism and reduce cardiovascular disease risk in patients with type 2 diabetes?

A

A Mediterranean-style diet rich in monounsaturated and polyunsaturated fats is recommended to improve glucose metabolism and reduce cardiovascular disease risk in patients with type 2 diabetes.

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29
Q

What is the recommended action for patients in terms of tobacco use?

A

Patients are advised to avoid using cigarettes, e-cigarettes, or other tobacco products.

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30
Q

What are some examples of foods rich in omega-3 fatty acids that can help prevent or treat cardiovascular disease?

A

Examples of foods rich in omega-3 fatty acids include fatty fish, nuts, and seeds.

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31
Q

According to the information provided, does prevention of diabetes delay or prevent complications compared to treatment after diagnosis?

A

It has not been established that prevention of diabetes delays or prevents complications compared with treatment once diabetes is diagnosed.

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32
Q

What is the evidence for the relation between BMI and mortality in patients with diabetes mellitus type 2?

A

The evidence is inconsistent for the relation between BMI and mortality in patients with diabetes mellitus type 2.

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33
Q

Does type 2 diabetes increase the likelihood of cognitive impairment in adults?

A

Yes, type 2 diabetes may increase the likelihood of cognitive impairment in adults.

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34
Q

What are factors contributing to bone abnormalities in patients with type 2 diabetes?

A

Factors contributing to bone abnormalities in patients with type 2 diabetes include cellular and molecular mechanisms such as low bone turnover, altered calcium and parathyroid hormone metabolism, proinflammatory state, oxidative stress, advanced glycation end products, loss of incretin effect, increased bone marrow adiposity, dysregulation of adipokines, altered insulin-like growth factor-1 signaling, and certain medications like thiazolidinediones and sodium-glucose cotransporter-2 inhibitors.

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35
Q

Which medication used in the treatment of type 2 diabetes may cause bone loss at the hip?

A

Canagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, may cause bone loss at the hip in patients with type 2 diabetes.

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36
Q

What are some cellular and molecular mechanisms contributing to bone abnormalities in patients with type 2 diabetes?

A

Some cellular and molecular mechanisms contributing to bone abnormalities in patients with type 2 diabetes include low bone turnover, altered calcium and parathyroid hormone metabolism, proinflammatory state, oxidative stress, accumulation of advanced glycation end products, loss of incretin effect, increased bone marrow adiposity, dysregulation of adipokines, and altered insulin-like growth factor-1 (IGF-1) signaling.

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37
Q

Do patients with type 2 diabetes have an increased risk of fractures?

A

Yes, patients with type 2 diabetes have an increased risk of fractures.

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38
Q

What type of fractures are patients with type 2 diabetes at an increased risk for?

A

Patients with type 2 diabetes are at an increased risk for hip fractures, particularly.

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39
Q

What is limited joint mobility syndrome?

A

Limited joint mobility syndrome is a condition characterized by stiffness, contractures, and impairment of joint function.

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40
Q

What are some clinical presentations of limited joint mobility syndrome?

A

Clinical presentations of limited joint mobility syndrome include pain, paresthesia, waxy and thick skin around the fingers, fixed flexion contractures of hand joints, and impaired fine motor and grip strength in the hands.

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41
Q

What are some examination findings associated with limited joint mobility syndrome?

A

Examination findings may include a positive ‘prayer sign’ (inability to press opposed palms together) or positive ‘tabletop sign’ (inability to make contact with the table at 1 spot when hands are flat on the table and forearm is at a 90-degree angle).

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42
Q

What are the potential long-term effects of limited joint mobility syndrome?

A

Long-term progression of limited joint mobility syndrome may result in impairment of other joints such as the ankle, spine, shoulder, and hip.

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43
Q

What types of cancer are associated with type 2 diabetes?

A

Liver, pancreas, endometrium, colon/rectum, breast, and bladder.

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44
Q

What are some risk factors for hypoglycemia in patients with type 2 diabetes?

A

Risk factors for hypoglycemia in patients with type 2 diabetes include treatment with insulin or insulin secretagogues, problems with kidney or hepatic function, increased duration of diabetes, older age and frailty, cognitive impairment, hypoglycemia unawareness/impaired counterregulatory response, impaired behavioral response to hypoglycemia due to physical or intellectual disability, use of alcohol, polypharmacy, including ACE inhibitors, ARBs, and nonselective beta-blockers, and history of a severe hypoglycemic event.

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45
Q

What is the association between severe hypoglycemia and cognitive function in patients with type 2 diabetes?

A

Severe hypoglycemia is associated with impaired cognitive function in patients with type 2 diabetes.

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46
Q

What are some factors that contribute to the severity of hypoglycemia in patients with type 2 diabetes?

A

Factors that contribute to the severity of hypoglycemia in patients with type 2 diabetes include increasing cognitive decline, treatment with insulin or insulin secretagogues, problems with kidney or hepatic function, increased duration of diabetes, older age and frailty, cognitive impairment, hypoglycemia unawareness/impaired counterregulatory response, impaired behavioral response to hypoglycemia due to physical or intellectual disability, use of alcohol, polypharmacy, including ACE inhibitors, ARBs, and nonselective beta-blockers, and a history of a severe hypoglycemic event.

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47
Q

What are some microvascular complications of diabetes?

A

Some microvascular complications of diabetes are retinopathy, nephropathy, and neuropathy (which may contribute to diabetic foot ulcer).

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48
Q

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

A

Retinopathy is the leading cause of preventable blindness in adults with diabetes.

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49
Q

What factors are associated with an increased risk of macrovascular events in patients with type 2 diabetes?

A

Older age, older age at diagnosis, and longer diabetes duration are associated with an increased risk of macrovascular events in patients with type 2 diabetes.

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50
Q

What are the macrovascular complications of type 2 diabetes?

A

The macrovascular complications of type 2 diabetes include cardiovascular disease, stroke, and peripheral arterial disease (PAD) of lower extremities.

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51
Q

What is the recommended consideration for patients above 75 years old who are not on statin therapy?

A

Consider initiating moderate-intensity statin therapy after discussing potential risks and benefits (ADA Grade C).

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52
Q

What should be done in patients who do not tolerate the intended dose of statin?

A

Adjust to the maximally tolerated dose (ADA Grade E).

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53
Q

What is the recommended lipid-lowering drug therapy for primary prevention of major coronary events in patients with diabetes?

A

The ADA recommends using moderate-intensity statins in combination with lifestyle therapy in adults aged 40-75 years without cardiovascular risk factors.

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54
Q

When should high-intensity statin therapy be considered for lipid-lowering in patients with diabetes?

A

High-intensity statin therapy is suggested for patients aged 40-75 years at increased cardiovascular risk (especially patients with multiple cardiovascular risk factors and LDL cholesterol ≥ 70 mg/dL).

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55
Q

What is the recommended LDL goal for patients receiving high-intensity statin therapy for lipid-lowering in diabetes?

A

The target LDL goal is < 70 mg/dL for patients aged 40-75 years at increased cardiovascular risk (especially patients with multiple cardiovascular risk factors and LDL cholesterol ≥ 70 mg/dL).

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56
Q

What additional therapies can be considered for patients receiving maximally tolerated statin therapy and still have LDL cholesterol ≥ 70 mg/dL?

A

For patients aged 40-75 years at increased cardiovascular risk (especially patients with multiple cardiovascular risk factors and LDL cholesterol ≥ 70 mg/dL), adding ezetimibe or a pro-protein convertase subtilisin-kexin type 9 (PCSK9) inhibitor to maximally tolerated statin therapy can be considered.

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57
Q

What lifestyle modifications are recommended to improve the lipid profile in adults with diabetes and reduce the risk of atherosclerotic cardiovascular disease?

A

The recommended lifestyle modifications include losing weight if appropriate, using a Mediterranean-style or Dietary Approaches to Stop Hypertension (DASH) eating pattern, reducing intake of saturated fat, trans fat, and cholesterol, increasing intake of omega-3 fatty acids, fiber, and plant stanols/sterols, and increasing physical activity.

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58
Q

What are some recommended lifestyle modifications for managing dyslipidemia in adults with diabetes?

A

Some recommended lifestyle modifications include losing weight if appropriate, adopting a Mediterranean-style or Dietary Approaches to Stop Hypertension (DASH) eating pattern, reducing intake of saturated fat, trans fat, and cholesterol, increasing intake of omega-3 fatty acids, fiber, and plant stanols/sterols, and increasing physical activity.

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59
Q

What are some lifestyle modifications recommended to improve lipid profile in adults with diabetes?

A

Some lifestyle modifications recommended to improve lipid profile in adults with diabetes include losing weight if appropriate, using a Mediterranean-style or Dietary Approaches to Stop Hypertension (DASH) eating pattern, reducing intake of saturated fat, trans fat, and cholesterol, increasing intake of omega-3 fatty acids, fiber, and plant stanols/sterols, and increasing physical activity.

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60
Q

What does the ADA recommend for weight loss medications in patients with type 2 diabetes and a BMI ≥ 27 kg/m2?

A

The ADA recommends weight loss medications as effective adjuncts to diet, physical activity, and behavioral counseling for patients who respond sufficiently to the medication.

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61
Q

How is a sufficient response to weight loss medication defined by the ADA?

A

A sufficient response to weight loss medication is typically defined as > 5% weight loss after 3 months of use, according to the ADA.

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62
Q

What should be considered for patients with an insufficient response to weight loss medication or safety/tolerability issues?

A

For patients with an insufficient response to weight loss medication (< 5% weight loss after 3 months of use) or safety/tolerability issues, discontinuation of the medication and evaluation of alternative medications or treatment approaches should be considered, according to the ADA.

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63
Q

What is the potential benefit of using weight loss medications in patients with type 2 diabetes and a BMI ≥ 27 kg/m2?

A

The potential benefit of using weight loss medications in patients with type 2 diabetes and a BMI ≥ 27 kg/m2 is additional weight loss, which is likely with continued use, according to the ADA.

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64
Q

What are the lower glycemic goals for older adults who are otherwise healthy and have few coexisting chronic illnesses and intact cognitive and functional status?

A

HbA1c < 7%-7.5% (53-58 mmol/mol)

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65
Q

What are the less stringent glycemic goals for older adults with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence?

A

HbA1c < 8% (64 mmol/mol)

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66
Q

What should be avoided in older adults with relaxed glycemic goals as part of individualized care?

A

Hyperglycemia leading to symptoms and risk of acute hyperglycemia complications

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67
Q

What are the certain treatments common in older adults that may falsely increase or decrease HbA1c?

A

Hemodialysis, erythropoietin therapy, or transfusion

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68
Q

What are some clinical complications and comorbidities associated with type 2 diabetes in elderly patients?

A

Some clinical complications and comorbidities associated with type 2 diabetes in adults include impaired cognitive and renal function, slowed hormonal regulation and counterregulation, slowed intestinal absorption, suboptimal hydration, variable appetite and nutritional intake, and polypharmacy.

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69
Q

What are the potential effects of polypharmacy in patients with type 2 diabetes?

A

Polypharmacy in patients with type 2 diabetes can lead to increased medication interactions, higher risk of adverse drug events, decreased adherence to treatment plans,and potentially worsened glycemic control.

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70
Q

According to ADA recommendations, what is the preferred initial pharmacologic agent for older adults with type 2 diabetes?

A

Metformin is the preferred initial pharmacologic agent for older adults with type 2 diabetes.

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71
Q

What is the recommendation for assessing and managing episodes of hypoglycemia in older adults with type 2 diabetes?

A

Assess and manage episodes of hypoglycemia at routine office visits.

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72
Q

What is the recommendation regarding overtreatment of diabetes in older adults?

A

Avoid overtreatment of diabetes, which is common in older adults.

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73
Q

What factors should be considered in older adults to determine targets and therapeutic approaches for diabetes management?

A

Consider the assessment of functional (self-management abilities), medical, psychological, and social geriatric domains in older adults.

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74
Q

What is one of the recommendations for improving efficacy, durability of treatment effect, and benefits for weight and hypoglycemia with insulin therapy?

A

Combination therapy with a GLP-1 receptor agonist is recommended.

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75
Q

According to ADA guidelines, should metformin be continued upon initiation of insulin therapy?

A

Yes, metformin should be continued for ongoing glycemic and metabolic benefit unless contraindicated or not tolerated.

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76
Q

What are the clinical findings that should prompt evaluation for possible overbasalization with insulin therapy?

A

Clinical findings that should prompt evaluation for possible overbasalization with insulin therapy include: requiring reevaluation to further individualize therapy.

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77
Q

Consideration of early introduction of insulin is recommended in patients with what symptoms?

A

Weight loss or other evidence of ongoing catabolism and symptomatic hyperglycemia (such as polyuria or polydipsia).

HbA1c > 10% (86 mmol/mol) or blood glucose levels ≥ 300 mg/dL (16.7 mmol/L) (Weak recommendation) until glucotoxicity resolves, at which time it is often possible to simplify regimen

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78
Q

According to ADA guidelines, what are the criteria for considering early introduction of insulin in patients with diabetes mellitus type 2?

A

HbA1c > 10% (86 mmol/mol) or blood glucose levels ≥ 300 mg/dL (16.7 mmol/L).

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79
Q

What is the recommended injectable therapy as the first option for patients with diabetes mellitus type 2 who have weight loss or other evidence of ongoing catabolism?

A

Insulin.

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80
Q

What type of therapy is often needed for patients with type 2 diabetes who require greater glucose lowering than can be achieved with oral agents alone?

A

Injectable therapy (such as GLP-1 receptor agonists and/or insulin).

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81
Q

According to ADA guidelines, why are GLP-1 receptor agonists preferred over insulin when possible for patients who require greater glucose lowering than can be achieved with oral agents alone?

A

Due to their favorable effects on weight and hypoglycemia risk.

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82
Q

What is the recommended approach for adults with type 2 diabetes who have HbA1c levels 1.5%-2% above target?

A

Early combination therapy may be appropriate in patients presenting with HbA1c levels 1.5%-2% above target.

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83
Q

What factors are considered in choosing an additional medication for combination therapy in adults with type 2 diabetes?

A

Choice of additional medication is based on presence of comorbidities, risk of adverse drug effects, safety, tolerability, and cost.

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84
Q

How much reduction in HbA1c can be expected when adding a new class of noninsulin drugs to initial therapy in type 2 diabetes?

A

Each new class of noninsulin drugs added to initial therapy is reported to reduce HbA1c by 0.7%-1%.

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85
Q

Which medications have very high weight-loss efficacy for patients with type 2 diabetes and overweight or obesity?

A

GLP-1 agonist semaglutide or dual GIP/GLP-1 agonist tirzepatide.

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86
Q

What are some agents with high weight-loss efficacy for patients with type 2 diabetes and overweight or obesity?

A

GLP-1 agonists dulaglutide or liraglutide.

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87
Q

What are some agents/regimens with very high efficacy for achieving glycemic control in adults with type 2 diabetes?

A

GLP-1 agonists dulaglutide (high-dose) and semaglutide, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonist tirzepatide, insulin oral combination therapy, and injectable combinations (GLP-1 receptor agonist plus insulin)

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88
Q

What are some agents/regimens with high efficacy for achieving glycemic control in adults with type 2 diabetes?

A

GLP-1 agonists exenatide, liraglutide, and lixisenatide, metformin, SGLT2 inhibitors, sulfonylureas, thiazolidinediones

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89
Q

What are some agents/regimens with intermediate efficacy for achieving glycemic control in high-risk patients with type 2 diabetes?

A

Dipeptidyl peptidase IV (DPP-4) inhibitors

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90
Q

What is the recommended treatment for patients with type 2 diabetes and diabetic kidney disease with an estimated GFR ≥ 20 mL/minute/1.73 m2 and urinary albumin ranging from normal to 200 mg/g?

A

A SGLT2 inhibitor should be used to reduce progression of chronic kidney disease and risk for cardiovascular events (ADA Grade B).

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91
Q

What additional treatment options are recommended for patients with type 2 diabetes and diabetic kidney disease with an estimated GFR ≥ 20 mL/minute/1.73 m2?

A

For patients with type 2 diabetes and diabetic kidney disease with an estimated GFR ≥ 20 mL/minute/1.73 m2, a SGLT2 inhibitor, a GLP-1 receptor agonist, or a nonsteroidal mineralocorticoid receptor antagonist (if estimated GFR ≥ 25 mL/minute/1.73 m2) can be considered to reduce cardiovascular risk (ADA Grade A).

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92
Q

What is the recommended treatment for patients with chronic kidney disease and albuminuria who are at increased risk for cardiovascular events or chronic kidney disease progression?

A

A nonsteroidal mineralocorticoid receptor antagonist (finerenone) should be used to reduce chronic kidney disease progression and cardiovascular events (ADA Grade A).

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93
Q

What is the estimated GFR threshold for considering a nonsteroidal mineralocorticoid receptor antagonist as an additional treatment for patients with type 2 diabetes and diabetic kidney disease?

A

An estimated GFR of ≥ 25 mL/minute/1.73 m2 is the threshold for considering a nonsteroidal mineralocorticoid receptor antagonist as an additional treatment (ADA Grade A).

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94
Q

What type of inhibitors are preferred for patients with stable heart failure?

A

SGLT2 inhibitors

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95
Q

In patients with heart failure, what should be the estimated glomerular filtration rate (GFR) if metformin is to be used?

A

GFR > 30 mL/minute/1.73 m2

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96
Q

Why should thiazolidinediones not be recommended in patients with symptomatic heart failure?

A

Due to the association with increased risk of heart failure

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97
Q

What are the treatment options for patients with or at high risk for atherosclerotic cardiovascular disease?

A

GLP-1 receptor agonists or SGLT2 inhibitors with demonstrated benefit

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98
Q

What treatment option can be considered if HbA1c remains above target in patients with high risk for atherosclerotic cardiovascular disease?

A

Combination treatment with both a GLP-1 receptor agonist and an SGLT2 inhibitor

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99
Q

What alternative treatment option can be added if combination treatment is not suitable for patients with high risk for atherosclerotic cardiovascular disease?
Sglt2 + glp1

A

Low-dose thiazolidinedione

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100
Q

What are the patient criteria for using SGLT2 inhibitors and/or GLP-1 receptor agonists in type 2 diabetes?

A

Patients with type 2 diabetes and established atherosclerotic cardiovascular disease or indicators of high cardiovascular risk, heart failure, or established kidney disease.

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101
Q

What is the recommended cardiovascular risk reduction strategy for patients with type 2 diabetes?

A

Using a sodium-glucose cotransporter-2 (SGLT2) inhibitor and/or a glucagon-like peptide-1 (GLP-1) receptor agonist with demonstrated cardiovascular disease benefit as part of the glucose lowering regimen.

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102
Q

What is the first-line therapy for the initial pharmacologic management of type 2 diabetes in adults?

A

The first-line therapy for the initial pharmacologic management of type 2 diabetes in adults is metformin or other agents, alone or in combination.

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103
Q

What factors should be considered when choosing the first-line therapy for type 2 diabetes in adults?

A

The choice of first-line therapy for type 2 diabetes in adults should depend on patient comorbidities, patient-centered treatment factors, management needs, healthy lifestyle behaviors, education and support for diabetes self-management, avoidance of clinical inertia, and social determinants of health.

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104
Q

A

A

A

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105
Q

According to the ADA, how often should medication regimen and medication-taking behavior be evaluated?

A

Medication regimen and medication-taking behavior should be evaluated every 3-6 months.

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106
Q

What type of exercises are encouraged for older adults with type 2 diabetes?

A

Regular exercise including aerobic activity, weight-bearing exercise, and/or resistance training.

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107
Q

How often is flexibility and balance training recommended for older adults with type 2 diabetes?

A

2-3 times per week.

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108
Q

What are some examples of exercises that can be included to increase flexibility, muscular strength, and balance in older adults with type 2 diabetes?

A

Yoga and tai chi.

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109
Q

According to the American Diabetes Association, how many minutes of moderate to vigorous intensity aerobic physical activity should adults with type 2 diabetes perform per week?

A

Adults with type 2 diabetes should perform at least 150 minutes/week of moderate to vigorous intensity aerobic physical activity.

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110
Q

How many days per week should physical activity be spread over for adults with type 2 diabetes?

A

Physical activity should be spread over at least 3 days per week for adults with type 2 diabetes.
AND LESS THAN 2 DAYS WITHOUT EXERCISES

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111
Q

How many minutes per week of high-intensity or interval training may be sufficient for younger, more physically fit persons with type 2 diabetes?

A

For younger, more physically fit persons with type 2 diabetes, high-intensity or interval training for shorter durations of at least 75 minutes per week may be sufficient.

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112
Q

According to the ADA, should patients with diabetes limit their sodium consumption?

A

Yes, patients with diabetes are advised to limit their sodium consumption to less than 2,300 mg/day.

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113
Q

What does the ADA recommend regarding the routine use of micronutrients and herbal supplements for glycemic control in patients with diabetes?

A

The ADA does not recommend routine use of micronutrients and herbal supplements for glycemic control due to insufficient evidence for improving diabetes outcomes in patients without underlying deficiencies.

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114
Q

Why should beta-carotene supplementation be avoided in patients with diabetes?

A

Beta-carotene supplementation should be avoided as it is associated with increased risk of lung cancer and cardiovascular mortality according to the ADA.

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115
Q

A

A

A

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116
Q

A

A

A

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117
Q

Why is it important to monitor glucose levels after drinking alcoholic beverages?

A

To reduce the risk of hypoglycemia

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118
Q

What type of diet is recommended to improve glucose metabolism and reduce cardiovascular disease risk in individuals with type 2 diabetes?

A

A Mediterranean-style diet rich in monounsaturated and polyunsaturated fats.

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119
Q

What foods are recommended to prevent or treat cardiovascular disease in individuals with type 2 diabetes?

A

Foods rich in omega-3 fatty acids such as fatty fish, nuts, and seeds.

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120
Q

What is the ADA recommendation for nutrition in patients with type 2 diabetes?

A

The ADA recommends individualizing macronutrient intake based on total calorie and metabolic goals.

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121
Q

How does decreasing overall carbohydrate intake benefit individuals with diabetes?

A

Decreasing overall carbohydrate intake improves glycemia in individuals with diabetes.

122
Q

What types of foods should be emphasized for carbohydrate intake in patients with diabetes?

A

Carbohydrate intake should focus on nutrient-dense foods such as nonstarchy vegetables, fruits, legumes, whole grains, and dairy products with minimal added sugars.

123
Q

What should patients with diabetes replace consumption of sugar-sweetened beverages with?

A

Patients with diabetes should replace consumption of sugar-sweetened beverages with water or low calorie, no calorie beverages to control glycemia and reduce risk for cardiometabolic disease.

124
Q

According to the ADA, which eating patterns are acceptable for management of type 2 diabetes?

A

Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean diet, high-fiber diet, low-fat diet, vegetarian and vegan diets, low-carbohydrate diet.

125
Q

What does ADA Grade A recommend for adults with type 2 diabetes on intensive insulin regimens?

A

ADA Grade A recommends offering real-time CGM (rtCGM) to adults with type 2 diabetes on intensive insulin regimens.

126
Q

How frequently should isCGM devices be scanned according to ADA Grade A?

A

isCGM devices should be scanned frequently, at a minimum once every 8 hours.

127
Q

What is the recommended use of rtCGM for maximum benefit according to ADA Grade A?

A

ADA Grade A recommends using rtCGM as close to daily as possible for maximum benefit.

128
Q

What is one consideration for patients with diabetes using CGM devices according to ADA Grade A?

A

One consideration is ensuring patients with diabetes have uninterrupted access to their supplies to limit gaps in CGM.

129
Q

What is the recommended use of rtCGM or isCGM for adults with type 2 diabetes on basal insulin according to ADA Grade C?

A

ADA Grade C recommends offering rtCGM or isCGM to adults with type 2 diabetes on basal insulin who can safely manage the device by themselves or with a caregiver.

130
Q

How do we know of there is contact dermatitis with sensor for 1st time use ?

A

Patch testing can be used to identify the cause of contact dermatitis in select cases.

131
Q

Based on ADA guidelines, when might early initiation of CGM, continuous subcutaneous insulin infusion, and/or automated insulin delivery be appropriate?

A

Early initiation of CGM, continuous subcutaneous insulin infusion, and/or automated insulin delivery may be appropriate depending on a patient’s/caregiver’s needs and preferences.

132
Q

What are some factors that may interfere with the accuracy of glucose meters?

A

Some factors that may interfere with the accuracy of glucose meters include high oxygen tension, low oxygen tension, temperature, and substances such as uric acid, galactose, xylose, acetaminophen, levodopa, and ascorbic acid with glucose oxidase monitors (or icodextrin, used in peritoneal dialysis, with glucose dehydrogenase monitors).

133
Q

What are two factors that may affect the accuracy of glucose meters due to oxygen levels?

A

Two factors that may affect the accuracy of glucose meters due to oxygen levels are high oxygen tension (such as use of arterial blood and oxygen therapy) and low oxygen tension (such as high altitude, hypoxia, or use of venous blood).

134
Q

When may BGM be helpful for patients on noninsulin therapies?

A

BGM SHOW NO CLINICAL SIGINFICACE FOR A1C REDUCTION may be helpful when adjusting diet, physical activity, and/or medications (particularly medications that can cause hypoglycemia) in combination with a treatment adjustment program.

135
Q

What are the recommended plasma glucose targets for preprandial plasma glucose?

A

The recommended plasma glucose targets for preprandial plasma glucose are 80-130 mg/dL (4.4-7.2 mmol/L).

136
Q

What are the peak postprandial plasma glucose targets?

A

The peak postprandial plasma glucose targets are < 180 mg/dL (< 10 mmol/L) 1-2 hours after beginning of meal.

137
Q

What factors should be considered in setting HbA1c goals?

A

The same individual patient characteristics should be considered in setting HbA1c goals.

138
Q

What is the recommended HbA1c goal for many nonpregnant adults without significant hypoglycemia?

A

HbA1c < 7% (53 mmol/mol)

139
Q

What are some factors that should be considered when individualizing the HbA1c goal?

A

Factors such as duration of diabetes, age and life expectancy, important comorbidities, presence of known cardiovascular disease or advanced microvascular complications, risks associated with hypoglycemia and other adverse drug effects, and other individual considerations such as patient preference and abilities, resources, and support system should be considered when individualizing the HbA1c goal.

140
Q

When might a more stringent HbA1c target of <6.5% (48 mmol/mol) be considered?

A

A more stringent HbA1c target may be considered if it can be achieved without significant hypoglycemia or other adverse effects of treatment, and the individual has a short duration of diabetes, long life expectancy, and no significant cardiovascular disease.

141
Q

What HbA1c target may be appropriate for patients with limited life expectancy?

A

A less stringent target of HbA1c < 8% (64 mmol/mol) may be appropriate for patients with limited life expectancy where the harms of treatment are likely to outweigh the benefits, or for those with a history of severe hypoglycemia.

142
Q

According to American Diabetes Association (ADA) recommendations, is routine screening for coronary artery disease recommended in asymptomatic patients with diabetes?

A

No, routine screening for coronary artery disease is not recommended in asymptomatic patients with diabetes.

143
Q

What are some of the indications to consider evaluating for coronary artery disease in patients with diabetes?

A

Some indications to consider evaluating for coronary artery disease in patients with diabetes include atypical cardiac symptoms, findings associated with vascular disease, and abnormal electrocardiogram (ECG) results.

144
Q

What are some examples of atypical cardiac symptoms that may indicate the need to evaluate for coronary artery disease in patients with diabetes?

A

Some examples of atypical cardiac symptoms that may indicate the need to evaluate for coronary artery disease in patients with diabetes include unexplained dyspnea or chest discomfort.

145
Q

In which patients with diabetes may ECG findings include sinus tachycardia, long QTc interval, QT dispersion, changes in heart rate variability, and ST-T abnormalities?

A

Patients with diabetes who present with typical or atypical cardiac symptoms and have abnormal resting ECG.

146
Q

What type of advanced cardiac test can be performed as an initial test for suspected coronary artery disease in patients with diabetes?

A

Exercise ECG with or without echocardiography.

147
Q

Does the American Diabetes Association (ADA) recommend obtaining a resting ECG in asymptomatic patients with diabetes?

A

No, the ADA makes no recommendations about whether or not to obtain resting ECG in asymptomatic patients with diabetes.

148
Q

What is albuminuria defined as?

A

Albuminuria is defined as urine albumin-to-creatinine ≥ 30 mg/g creatinine.

149
Q

What is the degree of albuminuria associated with?

A

The degree of albuminuria is associated with increased mortality, risk for cardiovascular disease, and risk for chronic kidney disease progression.

150
Q

When should a referral to a gastroenterologist be considered for adults with type 2 diabetes?

A

A referral to a gastroenterologist should be considered for adults with type 2 diabetes who have worsening or persistently elevated transaminases (liver enzymes).

151
Q

What percentage of adults with type 2 diabetes in a cohort study had elevated serum alanine aminotransaminase levels?

A

In a cohort study, 12.1% of adults with type 2 diabetes who denied excessive alcohol consumption had elevated serum alanine aminotransaminase levels.

152
Q

What is 1,5-anhydroglucitol (1,5-AG) correlated with?

A

1,5-anhydroglucitol is correlated with glucose levels and predicts postprandial hyperglycemia.

153
Q

In which patients does 1,5-anhydroglucitol correlate with mean glucose and postprandial hyperglycemia?

A

1,5-anhydroglucitol correlates with mean glucose and postprandial hyperglycemia in patients with type 2 diabetes and HbA1c ≤ 8%.

154
Q

Does 1,5-anhydroglucitol levels appear to be influenced by renal dysfunction?

A

No, 1,5-anhydroglucitol levels do not appear to be influenced by mild-to-moderate renal dysfunction.

155
Q

What should be done if 2 different tests give discordant results?

A

If 2 different tests give discordant results, the test should be repeated with results above the diagnostic threshold.

156
Q

When should a test be repeated if the initial test results are near the diagnostic threshold?

A

If the initial test results are near the diagnostic threshold, the test should be repeated in 3-6 months.

157
Q

How is the diagnosis confirmed when using 2 different tests?

A

The diagnosis is confirmed when using 2 different tests if both tests are above the diagnostic threshold.

158
Q

What is the fasting plasma glucose level used to define abnormal results for determining type 2 diabetes?

A

Abnormal results are defined as fasting plasma glucose levels ≥ 126 mg/dL [7 mmol/L].

159
Q

How many abnormal test results are required to confirm the diagnosis of type 2 diabetes?

A

Two abnormal test results are required to confirm the diagnosis of type 2 diabetes, either from two separate test samples or from the same sample.

160
Q

Under what circumstances can a clear clinical diagnosis be made for type 2 diabetes without the need for confirmatory test results?

A

A clear clinical diagnosis can be made for type 2 diabetes without the need for confirmatory test results in cases such as hyperglycemic crisis or when classic symptoms of hyperglycemia are present with random plasma glucose levels ≥ 200 mg/dL.

161
Q

What are the mechanisms of calcitonin-induced hyperglycemia?

A

The mechanisms of calcitonin-induced hyperglycemia include reduction in amount of glycogen in liver, inhibition of insulin-induced glucose consumption by muscular and adipose tissues, slowdown of insulin secretion during glucose loading, and impairment in glucose tolerance.

162
Q

What is the proposed cause of hyperglycemia induced by furosemide?

A

The proposed cause of hyperglycemia induced by furosemide is inhibition of glucose transport rate in adipose tissue and reduction in glucose phosphorylation and glycolysis in skeletal muscle.

163
Q

What is the cause of hyperglycemia induced by indomethacin?

A

The cause of hyperglycemia induced by indomethacin is insulin resistance.

164
Q

What is the respiratory system medications associated with hyperglycemia?

A

the respiratory system medications associated with hyperglycemia is beta-adrenergic stimulants.
THEOPHYLLINE

165
Q

What is the proposed mechanism of phenytoin-induced hyperglycemia?

A

The proposed mechanisms of phenytoin-induced hyperglycemia include insulin resistance (secondary to postbinding defect in insulin action) and inhibition of insulin release.

166
Q

Which class of medications is associated with hyperglycemia due to weight gain and decreased insulin action and secretion?

A

Second-generation antipsychotics.

167
Q

Which type of antidepressant medication is reported to be associated with hyperglycemia due to weight gain and increasing insulin resistance?

A

Tricyclic antidepressants.

168
Q

Which type of antidepressant medication is reported to reduce plasma glucose levels?

A

Selective serotonin reuptake inhibitors and bupropion.

169
Q

What effect do oral contraceptives have on glucose metabolism?

A

Oral contraceptives decrease glucose tolerance and increase insulin resistance in a dose-dependent way.

170
Q

What is the effect of somatostatin analogues on insulin and glucagon secretion?

A

Somatostatin analogues inhibit insulin and glucagon secretion, leading to hyperglycemia.

171
Q

Which generation of somatostatin analogues has reported aggravating effects on glucose metabolism, potentially leading to diabetes?

A

Second-generation somatostatin analogues (pasireotide)

172
Q

Which class of antibiotics is reported to be more commonly associated with hyperglycemia?

A

Fluoroquinolones.

173
Q

Which antiviral medication can affect insulin signaling pathways leading to insulin resistance and hyperglycemia?

A

Protease inhibitors.
OSELTAMIVIR

174
Q

Which antiviral therapy regimens have better metabolic profiles than older regimens?

A

Newer highly active antiretroviral therapy (HAART) regimens such as integrase and CC chemokine receptor 5 inhibitors.

175
Q

Which antimycobacterial medication is most commonly implicated in causing drug-induced hyperglycemia?

A

Isoniazid.

176
Q

What are some immunosuppressive agents associated with hyperglycemia?

A

Interferon-alpha, calcineurin inhibitors (including sirolimus and tacrolimus), adalimumab

177
Q

How does interferon-alpha therapy contribute to hyperglycemia?

A

Immunological beta cell destruction

178
Q

What antineoplastic medications are associated with hyperglycemia?

A

Antineoplastic medications associated with hyperglycemia include androgen deprivation therapy, mammalian target of rapamycin (mTOR) inhibitors, tyrosine kinase inhibitors, cyclophosphamide, asparaginase, checkpoint inhibitors, docetaxel, decitabine, bortezomib, and temozolomide.

179
Q

What is the mechanism behind amiodarone-induced hyperglycemia?

A

The mechanism behind amiodarone-induced hyperglycemia is unknown.

180
Q

What potential mechanisms are associated with thiazide-induced hyperglycemia?

A

Reduction in insulin sensitivity and secretion; diuretic-induced hypokalemia is thought to play a role.

181
Q

Which antihypertensive medication is reported to have a higher incidence of diabetes compared to amlodipine and lisinopril?

A

Chlorthalidone.

182
Q

What is the main mechanism of statin-induced impairment of glucose metabolism?

A

The main mechanism of statin-induced impairment of glucose metabolism includes reduction in adiponectin and alteration in pancreatic beta-cell function, resulting in decreased insulin action and secretion.

183
Q

How does diazoxide lead to hyperglycemia?

A

Diazoxide leads to hyperglycemia by increasing hepatic glucose output and decreasing insulin secretion.

184
Q

What are the mechanisms of beta-blocker-induced hyperglycemia?

A

The mechanisms of beta-blocker-induced hyperglycemia include weight gain, decreased insulin sensitivity, and direct action on inhibition of beta-2-adrenergic-mediated insulin release.

185
Q

What are the mechanisms of glucocorticoid-induced hyperglycemia?

A

The mechanisms of glucocorticoid-induced hyperglycemia include beta-cell dysfunction and insulin resistance in other tissues.

186
Q

What is MODY 6 and what is the main cause of it?

A

MODY 6 is a type of maturity-onset diabetes of the young. It is caused by NEUROD1 mutation, resulting in beta-cell dysfunction.

187
Q

What is maturity-onset diabetes of the young (MODY)?

A

Maturity-onset diabetes of the young (MODY) is a type of diabetes characterized by autosomal dominant transmission, onset usually before age 35 years, normal or high insulin levels, mild hyperglycemia, and extrapancreatic features.

188
Q

What is the most common first-line treatment for MODY 1?

A

The most common first-line treatment for MODY 1 is sulfonylurea.

189
Q

What is the main characteristic of MODY 8 and what causes it?

A

MODY 8 is characterized by both exocrine insufficiency (due to pancreatic atrophy) and endocrine insufficiency (diabetes due to fibrosis and lipomatosis) of the pancreas. It is caused by CEL mutation.

190
Q

What percentage of MODY cases does MODY 3 account for?

A

MODY 3 accounts for 30%-65% of MODY cases.

191
Q

What is the beta-cell dysfunction associated with MODY 5?

A

MODY 5 is associated with beta-cell dysfunction resulting from HNF1B mutation.

192
Q

What is MODY 10 and what is the main cause of it?

A

MODY 10 is a type of maturity-onset diabetes of the young. It is caused by INS mutation, resulting in beta-cell dysfunction. Pathogenic variants in this gene may also be associated with permanent neonatal diabetes mellitus.

193
Q

What is the characteristic feature of MODY 4 in neonates?

A

The characteristic feature of MODY 4 in neonates is pancreatic agenesis.

194
Q

What is MODY 13 and what is the main cause of it?

A

MODY 13 is a type of maturity-onset diabetes of the young. It is caused by KCNJ11 mutation, resulting in ATP-sensitive potassium channel dysfunction. It has a similar clinical presentation as HNF1A-MODY3 and HNF4A-MODY1.

195
Q

What are the diagnostic criteria for type 1 diabetes? DIFFRINTIATE WITH T2DM

A

The diagnostic criteria for type 1 diabetes include having ≥ 2 positive antibodies associated with immune-mediated type 1 diabetes.

196
Q

Should the diagnosis of diabetes in an asymptomatic person be based on a single abnormal plasma glucose or HbA1c value?

A

No, the diagnosis of diabetes in an asymptomatic person should not be based on a single abnormal plasma glucose or HbA1c value. WHO

197
Q

When should plasma glucose criteria be used for diagnosis instead of HbA1c?

A

Plasma glucose criteria should be used for diagnosis instead of HbA1c for patients with known conditions associated with an altered relationship between HbA1c and glycemia.

198
Q

What are some conditions associated with an altered relationship between HbA1c and glycemia?

A

Some conditions associated with an altered relationship between HbA1c and glycemia include pregnancy (second and third trimesters and postpartum period), hemoglobinopathies, glucose-6-phosphate dehydrogenase deficiency, HIV infection, hemodialysis, recent blood loss or transfusion, and erythropoietin therapy.

199
Q

What does ADA Grade B recommend regarding the use of HbA1c and plasma glucose levels for diagnosing diabetes?

A

ADA Grade B recommends using an assay without interference or plasma blood glucose criteria for diagnosing diabetes when there are notable differences between HbA1c and plasma glucose levels. However, for patients with known conditions associated with an altered relationship between HbA1c and glycemia, ADA Grade B suggests using plasma glucose criteria alone for diagnosis.

200
Q

What constitutes a positive HbA1c result?

A

A HbA1c result of 6.5% or higher (48 mmol/mol) is considered positive for diabetes mellitus type 2 in adults.

201
Q

What are the recommended testing methods for HbA1c?

A

HbA1c tests should be performed in a laboratory using a method certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized or traceable to the Diabetes Control and Complications Trial (DCCT) reference assay. Point-of-care HbA1c assays should be limited to FDA-approved devices at laboratories experienced in performing testing of moderate or higher complexity by trained personnel.

202
Q

What are the diagnostic criteria for diabetes mellitus according to the ADA?

A

The diagnostic criteria for diabetes mellitus according to the ADA include random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) with symptoms of hyperglycemia or hyperglycemic crisis, or 2 abnormal test results from fasting plasma glucose ≥ 126 mg/dL (7 mmol/L) or 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT).

203
Q

What is the recommended carbohydrate intake prior to an oral glucose tolerance test (OGTT) for screening diabetes according to ADA guidelines?

A

The recommended carbohydrate intake prior to an oral glucose tolerance test (OGTT) for screening diabetes according to ADA guidelines is ≥ 150 g/day.

204
Q

What are the symptoms of hyperglycemia associated with diabetes mellitus?

A

The symptoms of hyperglycemia associated with diabetes mellitus include polyuria (increased urination) and polydipsia (increased thirst).

205
Q

What is the fasting plasma glucose level that indicates diabetes according to the ADA diagnostic criteria?

A

The fasting plasma glucose level that indicates diabetes according to the ADA diagnostic criteria is ≥ 126 mg/dL (7 mmol/L) with no caloric intake for ≥ 8 hours.

206
Q

According to ADA recommendations, how often should patients with type 2 diabetes be screened for diabetic peripheral neuropathy?

A

Patients with type 2 diabetes should be screened for diabetic peripheral neuropathy at least annually.

207
Q

What assessments should be included in screening for distal symmetric polyneuropathy according to ADA recommendations?

A

Screening for distal symmetric polyneuropathy should include thorough patient history and assessment of temperature discrimination or pinprick sensation (for small-fiber function) and vibration sensation using a 128 Hz tuning fork (for large-fiber function)

208
Q

When should electrophysiological testing or referral to a neurologist be considered in diabetic peripheral neuropathy screening?

A

Electrophysiological testing or referral to a neurologist is rarely needed unless the patient has unusual clinical features or the diagnosis is unclear.

209
Q

How often should patients aged 65 and above be assessed for cognitive impairment and dementia according to ADA recommendations?

A

Patients aged 65 and above should be assessed for cognitive impairment and dementia at the initial visit, annually, and as appropriate.

210
Q

What are the recommended assessments for initial screening of peripheral arterial disease?

A

Lower-extremity pulses, capillary refill time, rubor with the leg in the dependent position, pallor with the leg elevated, and venous filling time should be assessed.

211
Q

When should ankle-brachial index and additional vascular assessment be performed for patients with diabetes mellitus type 2?

A

Ankle-brachial index and additional vascular assessment should be performed in patients with a history of leg fatigue, claudication, and rest pain relieved when the leg is held down in a dependent position or when pedal pulses are diminished or absent.

212
Q

What is the recommended grading for the initial screening and referral for peripheral arterial disease in patients with diabetes mellitus type 2?

A

The recommended grading is Grade B according to the ADA guidelines.

213
Q

According to ADA recommendations, how often should a comprehensive foot exam be performed in patients with diabetes?

A

At least annually

214
Q

What are some risk factors that should be assessed during a comprehensive foot exam in patients with diabetes?

A

History of ulceration, evidence of sensory loss, cigarette use, retinopathy, kidney disease, symptoms of neuropathy, and symptoms of vascular disease

215
Q

What are the components of a comprehensive foot exam in patients with diabetes?

A

Visually evaluating foot, inspecting skin, assessing for callous formation, skin integrity, and diabetic foot ulcer, assessing for foot deformities, performing a neurological exam, and conducting a vascular assessment of pulses in the legs and feet

216
Q

What are some symptoms of neuropathy that should be asked about during a foot exam in patients with diabetes?

A

Pain, burning, and numbness

217
Q

According to the American Diabetes Association (ADA), how often should patients with type 2 diabetes have an initial dilated and comprehensive eye exam?

A

Patients with type 2 diabetes should have an initial dilated and comprehensive eye exam performed at the time of diabetes diagnosis.

218
Q

What are some indications for referring a patient with type 2 diabetes for an ophthalmologist experienced in management of diabetic retinopathy?

A

Some indications for referring a patient with type 2 diabetes to an ophthalmologist are macular edema of any degree, moderate-to-severe nonproliferative diabetic retinopathy, and any proliferative diabetic retinopathy.

219
Q

What is the recommended frequency of eye exams for patients with diabetic retinopathy?

A

Patients with diabetic retinopathy should have eye exams at least once a year.

220
Q

According to the American Diabetes Association (ADA), how often should patients with well-controlled glycemia and no evidence of retinopathy at annual eye exams consider screening for diabetic retinopathy?

A

Patients with well-controlled glycemia and no evidence of retinopathy at annual eye exams should consider screening every 1-2 years.

221
Q

What are the skin findings associated with type 2 diabetes?

A

The skin findings associated with type 2 diabetes include acanthosis nigricans, skin tags (acrochordons), diabetic dermopathy, eruptive xanthoma, diabetic thick skin, and calciphylaxis.

222
Q

Where are acanthosis nigricans skin tags typically found in individuals with type 2 diabetes?

A

Acanthosis nigricans skin tags are usually found on the eyelids, neck, and axillae (armpit) in individuals with type 2 diabetes.

223
Q

What can orthostatic hypotension and/or resting tachycardia suggest?

A

Orthostatic hypotension and/or resting tachycardia may suggest cardiovascular autonomic neuropathy.

224
Q

How should blood pressure measurement be done at routine visits?

A

Blood pressure should be measured at every routine visit.

225
Q

How should elevated blood pressure be confirmed before diagnosing hypertension?

A

Elevated blood pressure should be confirmed with multiple readings 2 OR MORE on a separate day.

226
Q

How can hypertension be diagnosed in patients?

A

Hypertension can be diagnosed in patients based on an average of 2 readings taken on 2 separate days, with systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 80 mm Hg.

227
Q

When can hypertension be diagnosed at a single visit?

A

Hypertension can be diagnosed at a single visit for patients with blood pressure ≥ 180/110 mm Hg and cardiovascular disease.

228
Q

Based on ADA guidelines, what is the recommended frequency for evaluating weight in individuals with type 2 diabetes?

A

ADA recommends evaluating weight more frequently based on clinical considerations, including the presence of comorbid heart failure or significant weight gain or loss (ADA Grade B).

229
Q

How often should height and weight be measured for adults with type 2 diabetes?

A

At least annually.

230
Q

Which class of medications is associated with hyperglycemia?

A

Thiazide diuretics, beta-blockers, calcium channel blockers, niacin, diazoxide, glucocorticoids, oral contraceptives, second-generation antipsychotics, anti-infectives (including antiretrovirals, isoniazid, and pentamidine), and phenytoin are associated with hyperglycemia.

231
Q

What symptoms may be associated with chronic hyperglycemia?

A

Peripheral neuropathy, frequent infections, visual impairment, sexual dysfunction, bowel or bladder dysfunction, kidney dysfunction, and cardiovascular dysfunction.

232
Q

What are some symptoms of significant hyperglycemia?

A

Polyuria, polydipsia, polyphagia, blurred vision, spontaneous weight loss, hyperosmolar hyperglycemic state, and diabetic ketoacidosis (DKA).

233
Q

What are the variable combinations that result in insulin resistance in type 2 diabetes?

A

Insulin resistance in type 2 diabetes results from variable combinations of resistance to insulin action and inadequate compensatory insulin secretory response.

234
Q

What is the etiology of the secretory defect in type 2 diabetes?

A

The etiology of the secretory defect in type 2 diabetes is unclear, but it is not due to autoimmune beta-cell destruction, as in type 1 diabetes.

235
Q

What is a common cause of insulin resistance in type 2 diabetes?

A

Obesity or increased percentage of body fat is often a common cause of insulin resistance in type 2 diabetes.

236
Q

What are some other conditions associated with type 2 diabetes?

A

Nonalcoholic fatty liver disease, HIV, pancreatitis, periodontal disease, hearing impairment, psychosocial/emotional disorders (anxiety disorders, depression), disordered eating behavior, and serious mental illness (including schizophrenia and other thought disorders) are some of the associated conditions.

237
Q

What is the association between increased adiponectin levels and risk for type 2 diabetes?

A

Increased adiponectin levels are associated with reduced risk for type 2 diabetes.

238
Q

What is the prevalence of type 2 diabetes in patients with familial hypercholesterolemia compared to unaffected relatives?

A

The prevalence of type 2 diabetes appears lower in patients with familial hypercholesterolemia than in unaffected relatives.

239
Q

What is the association between increased levels of transpalmitoleic acid and risk of type 2 diabetes?

A

Increased levels of transpalmitoleic acid are associated with reduced risk of type 2 diabetes.

240
Q

Are glutamic acid decarboxylase autoantibodies associated with the development of type 2 diabetes?

A

No, the presence of glutamic acid decarboxylase autoantibodies is not associated with the development of type 2 diabetes in patients with impaired glucose tolerance.

241
Q

What is the association between lactation intensity and duration and the risk of developing type 2 diabetes in women with a history of gestational diabetes?

A

Greater lactation intensity and duration are associated with a reduced risk of developing type 2 diabetes in women with a history of gestational diabetes.

242
Q

What are some serum biomarkers associated with diabetes?

A

Elevated C-reactive protein (CRP), elevated liver enzymes (gamma-glutamyltransferase [GGT] and alanine aminotransferase [ALT]), low potassium levels, increased iron stores, low ghrelin levels, markers of endothelial dysfunction (elevated E-selectin and intracellular adhesion molecule 1 [ICAM-1]), low endogenous sex hormone levels (testosterone, estradiol, sex-hormone binding globulin), elevated fetuin-A (hepatic protein) levels, low serum vitamin C levels, and elevated serum uric acid levels.

243
Q

Which serum biomarker is associated with elevated liver enzymes in diabetes?

A

Gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT)

244
Q

What are some medications that may contribute to the development of type 2 diabetes in adults?

A

Some medications that may contribute to the development of type 2 diabetes in adults include atypical antipsychotics, such as olanzapine, thiazide diuretics, beta-blockers, glucocorticoids, progestin-only contraceptives, antiretroviral therapy, concomitant selective serotonin reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) use, and statins.

245
Q

Name some risk factors for type 2 diabetes.

A

Some risk factors for type 2 diabetes include metabolic conditions, prediabetes, obesity, metabolic syndrome, polycystic ovary syndrome, and gestational diabetes mellitus (GDM).

246
Q

What are the criteria for diagnosing impaired fasting glucose as per the ADA?

A

The criteria for diagnosing impaired fasting glucose according to the ADA are plasma glucose levels between 100-125 mg/dL (5.6-6.9 mmol/L)

247
Q

What is the range for impaired glucose tolerance during a 75 g oral glucose tolerance test as per WHO and ADA criteria?

A

The range for impaired glucose tolerance during a 75 g oral glucose tolerance test according to both WHO and ADA criteria is 140-199 mg/dL (7.8-11 mmol/L)

248
Q

What is the HbA1c range for diagnosing prediabetes according to ADA criteria?

A

The HbA1c range for diagnosing prediabetes according to ADA criteria is 5.7%-6.4%

249
Q

What is brittle diabetes?

A

Brittle diabetes is a historic term used to refer to patients with insulin-dependent diabetes (usually type 1) who experience significant glucose variability resulting in disruption in activities of everyday life and recurrent and/or prolonged hospitalizations.

250
Q

What are some symptoms that can be seen in patients with brittle diabetes?

A

Patients with brittle diabetes can present with frequent, severe, unpredictable episodes of hypoglycemia and recurrent diabetic ketoacidosis (DKA).

251
Q

What is the diagnostic criteria for LADA?

A

The diagnostic criteria for LADA include onset of diabetes at age > 30 years, presence of circulating islet autoantibodies, and insulin independence for ≥ 6 months after diagnosis.

252
Q

What is LADA?

A

LADA stands for latent autoimmune diabetes of the adult, which is a slowly progressive subtype of immune-mediated diabetes mellitus type 1 that occurs in adults.

253
Q

What is the recommended daily dose of aspirin for patients with diabetes and increased cardiovascular risk?

A

The recommended daily dose of aspirin is 75-162 mg.

254
Q

Who is metabolic (bariatric) surgery recommended for to improve glycemic control?

A

Metabolic (bariatric) surgery is recommended for appropriate surgical candidates with a body mass index (BMI) of 40 kg/m2 or higher (37.5 kg/m2 or higher in Asian American patients), or a BMI of 35-39.9 kg/m2 (32.5-37.4 kg/m2 in Asian American patients) who do not achieve sustainable weight loss and improvement in comorbidities with nonoperative management.

255
Q

What are the criteria for considering aspirin in patients with diabetes and increased cardiovascular risk?

A

Aspirin should be considered in patients with diabetes and increased cardiovascular risk who are most patients ≥ 50 years old with no increased risk of bleeding and with ≥ 1 additional major risk factor.

256
Q

What is the recommended treatment for nonpregnant patients with diabetes and hypertension who have a urinary albumin-to-creatinine ratio of 30-299 mg/g creatinine?

A

Either an ACE inhibitor or an ARB is recommended.

257
Q

What is the recommended treatment for nonpregnant patients with diabetes and hypertension who have a urinary albumin-to-creatinine ratio ≥ 300 mg/g creatinine and/or estimated GFR < 60 mL/minute/1.73 m²?

A

Either an ACE inhibitor or an ARB is strongly recommended.

258
Q

Are ACE inhibitors or ARBs recommended for the primary prevention of chronic kidney disease in patients with diabetes?

A

No, ACE inhibitors or ARBs are not recommended for the primary prevention of chronic kidney disease in patients with diabetes.

259
Q

What is the recommended medication for lowering LDL cholesterol in adults with diabetes and without cardiovascular risk factors?

A

Statins

260
Q

What is the recommended intensity of statin therapy for most adults aged 40-75 years with diabetes and without cardiovascular risk factors?

A

Moderate-intensity statin

261
Q

What is the recommended LDL cholesterol reduction target for patients aged 40-75 years at increased cardiovascular risk?

A

< 70 mg/dL

262
Q

Which agent has very high weight-loss efficacy in managing type 2 diabetes?

A

The agent with very high weight-loss efficacy in managing type 2 diabetes is either semaglutide or tirzepatide.

263
Q

Which agent has high weight-loss efficacy in managing type 2 diabetes?

A

The agent with high weight-loss efficacy in managing type 2 diabetes is either dulaglutide or liraglutide.

264
Q

Which agents have neutral efficacy in managing type 2 diabetes?

A

The agents with neutral efficacy in managing type 2 diabetes are DPP-4 inhibitors and metformin.

265
Q

What is the recommended target glucose range for most patients when using continuous IV insulin?

A

The recommended target glucose range for most patients when using continuous IV insulin is 140-180 mg/dL (7.8-10 mmol/L).

266
Q

What are the more stringent target glucose values that may be appropriate for selected patients if significant hypoglycemia can be avoided?

A

The more stringent target glucose values that may be appropriate for selected patients if significant hypoglycemia can be avoided are 110-140 mg/dL (6.1-7.8 mmol/L).

267
Q

What is the preferred route of insulin for critically ill patients?

A

The preferred route of insulin for critically ill patients is continuous IV insulin.

268
Q

What is the recommended target glucose range for most hospitalized patients with diabetes mellitus type 2?

A

A target glucose of 140-180 mg/dL (7.8-10 mmol/L) is recommended for most patients.

269
Q

What is the recommended insulin regimen for noncritically ill patients with persistent hyperglycemia in the hospital?

A

For noncritically ill patients with persistent hyperglycemia ≥ 180 mg/dL (10 mmol/L), insulin therapy is recommended.

270
Q

What is the Strong recommendation for insulin therapy in patients with poor oral intake or those who are taking nothing by mouth?

A

For patients with poor oral intake or those who are taking nothing by mouth, use basal insulin or a basal plus bolus correction insulin regimen.

271
Q

What is the preferred initial pharmacologic agent for older adults with type 2 diabetes?

A

Metformin

272
Q

What HbA1c goal is recommended for older adults who are cognitively and functionally intact and have few existing chronic illnesses?

A

HbA1c goal < 7%-7.5% (53-58 mmol/mol)

273
Q

What glycemic goals should be used for adults with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence?

A

Less stringent glycemic goals, such as HbA1c < 8% (64 mmol/mol)

274
Q

What should be considered when determining treatment goals for diabetes in older adults?

A

The patient’s capability for glucose monitoring and insulin dose adjustment, diabetes-related complications and comorbidities, and the risk of hypoglycemia.

275
Q

How often should the medication regimen for type 2 diabetes in adults be evaluated and adjusted?

A

The medication regimen should be evaluated every 3-6 months and adjusted as needed.

276
Q

What are some factors that may require reevaluation to individualize insulin therapy?OVERBASALIZATION

A

Factors that may require reevaluation to individualize insulin therapy include basal insulin dose > 0.5 units/kg/day, high bedtime-morning or postpreprandial glucose differential, awareness or unawareness of hypoglycemia, and high glycemic variability.

277
Q

What is the recommendation regarding metformin when starting insulin therapy for type 2 diabetes in adults?

A

Continue metformin unless it is contraindicated or not tolerated for ongoing glycemic and metabolic benefit.

278
Q

What is the recommended combination therapy for improving efficacy, durability of treatment effect, and benefits for weight and hypoglycemia when using insulin?

A

The recommended combination therapy is with a GLP-1 receptor agonist.

279
Q

According to the recommendations, when should early introduction of insulin be considered as the first injectable therapy in patients with diabetes mellitus type 2 in adults?

A

Early introduction of insulin should be considered as the first injectable therapy in patients with diabetes mellitus type 2 in adults who have weight loss or other evidence of ongoing catabolism, symptomatic hyperglycemia (such as polyuria or polydipsia), HbA1c > 10% (86 mmol/mol), or blood glucose levels ≥ 300 mg/dL (16.7 mmol/L).

280
Q

Why are GLP-1 receptor agonists preferred over insulin when greater glucose lowering is required?

A

GLP-1 receptor agonists are preferred due to their favorable effects on weight and hypoglycemia risk.

281
Q

Why is injectable therapy often needed in patients with type 2 diabetes?

A

Injectable therapy is often needed due to greater potency compared to oral medications, especially in patients with a longer duration of diabetes.

282
Q

What is the recommended therapy for patients with type 2 diabetes and HbA1c ≥ 1.5% above glycemic target?

A

Many patients with type 2 diabetes and HbA1c ≥ 1.5% above glycemic target will require combination therapy (≥ 2 agents) to achieve their glycemic target.

283
Q

Which agents/regimens have very high efficacy in achieving glycemic control?

A

GLP-1 agonists dulaglutide (high-dose), semaglutide, and tirzepatide; insulin; oral combinations; injectable combinations (GLP-1 receptor agonist plus insulin)

284
Q

What is the primary treatment goal for glycemic control in type 2 diabetes in adults?

A

Glycemic control

285
Q

What type of medications are recommended for reducing cardiorenal risk in patients with type 2 diabetes?

A

Sodium-glucose cotransporter-2 (SGLT2) inhibitors and/or glucagon-like peptide-1 (GLP-1) receptor agonists with demonstrated cardiovascular disease benefit.

286
Q

Which patients with type 2 diabetes may benefit from sodium-glucose cotransporter-2 (SGLT2) inhibitors?

A

Patients with established atherosclerotic cardiovascular disease or indicators of high cardiovascular risk, heart failure, or established kidney disease.

287
Q

What factors should be considered when selecting medication for patients with type 2 diabetes and established kidney disease?

A

The medication selection depends on the estimated GFR (glomerular filtration rate).

288
Q

Can medications that reduce cardiorenal risk be used with or without metformin?

A

Yes, medications that reduce cardiorenal risk can be used with or without metformin.

289
Q

What is the recommended glycemic goal (HbA1c level) for many nonpregnant adults without significant hypoglycemia?

A

HbA1c < 7% (53 mmol/mol)

290
Q

What are the conditions under which a more stringent glycemic goal (HbA1c level) may be reasonable for selected patients?

A

Patients with short duration of diabetes, long life expectancy, and no significant cardiovascular disease

291
Q

What are the conditions under which a less stringent glycemic goal (HbA1c level) may be appropriate?

A

Patients with limited life expectancy, harms of treatment likely to outweigh the benefits, and a history of severe hypoglycemia

292
Q

What tests are recommended to identify feet at risk of ulceration and amputation in individuals with type 2 diabetes?

A

Distal symmetric polyneuropathy test with a 10-g monofilament and one of the following: temperature discrimination or pinprick sensation, vibration sensation using a 128 Hz tuning fork.

293
Q

How often should the tests for distal symmetric polyneuropathy be conducted in individuals with type 2 diabetes?

A

At the time of diagnosis and annually.

294
Q

What is the purpose of testing for distal symmetric polyneuropathy in individuals with type 2 diabetes?

A

To identify feet at risk of ulceration and amputation.

295
Q

How often should a dilated and comprehensive eye examination be performed at the time of diabetes diagnosis?

A

A dilated and comprehensive eye examination should be performed at the time of diabetes diagnosis.

296
Q

How often should patients with well-controlled glycemia and no evidence of retinopathy at annual eye exams be screened for retinopathy?

A

Patients with well-controlled glycemia and no evidence of retinopathy at annual eye exams should consider screening every 1-2 years.

297
Q

What is the recommended frequency of subsequent dilated retinal exams if any evidence of retinopathy is detected?

A

Subsequent dilated retinal exams should be repeated at least annually.

298
Q

How often should urinary albumin and estimated glomerular filtration rate be assessed in patients with type 2 diabetes?

A

Urinary albumin and estimated glomerular filtration rate should be assessed at least annually in all patients with type 2 diabetes, regardless of treatment.

299
Q

When should liver transaminases be assessed in patients with type 2 diabetes?

A

Liver transaminases should be assessed at diagnosis and annually thereafter in patients with type 2 diabetes.

300
Q

When should lipid levels be measured in adults under 40 with type 2 diabetes?

A

Lipid levels should be measured at time of diabetes diagnosis, at initial medical evaluation, and at 5-year intervals, or more frequently if indicated, in adults under 40 with type 2 diabetes who are not taking statins or other lipid-lowering therapy.

301
Q

How often should HbA1c be assessed for patients with stable glycemic control and meeting treatment goals?

A

At least 2 times per year

302
Q

How often should HbA1c be assessed for patients not meeting treatment goals or experiencing therapy changes?

A

At least every 3 months (quarterly) and as needed.

T2DM (6 decks)

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