Diagnosis & Monitoring Flashcards
(22 cards)
DM Dx labs
A1C >6.5%
Fbg >7mmol/L
2hr plasma value in 75g OGTT >11.1mmol/L
Random bg >11.1mmol/L
No repeat test needed to confirm is patient symptomatic (on separate day from the first)
Repeat same test of non-symptomatic patients
Do different test for random bg
If results from 2 tests (ie fbg and A1C) are both available and both in diabetic range, Dx can be made without repeat testing
What are glucose cut-offs for diabetes Dx based on?
Threshold of glycemia that are associated with Microvascular disease (especially retinopathy)
Pre-diabetes
Referring to impaired fasting glucose
FBG (or fasting plasma glucose -FPG)
6.1-6.9 mmol/L
A1C 6 - 6.4%
T1DM vs T2DM
1 - insulin deficiency, autoimmune process with unknown triggers
2 - insulin resistance +/- relative insulin deficiency or insulin secretion deficiency
Diabetes Definition
- Defective insulin secretion
- Defective insulin action
- Both
Converting A1C to average BG
( (A1C-6) x2) + 6
Example A1C 6.1%
6.1-6 = 0.1 x2= 0.2 + 6= 6.2mmol/L average BG
Understanding A1C
Lifespan of a RBC?
3-4 months
Through glycosaltion, plasma glucose bonds to hemoglobin in rbc
The higher the sugar, the faster this happens
Glycosation happens in people without diabetes (which is why normal A1C is 4-5.9%
Conditions that could falsely elevate A1C
Affecting RBC turnover:
Anemia (including iron deficiency anemia)
Vitamin B12 deficiency
Folate deficiency
Asplenia
Affecting lab measures:
High TG ( > 1750mg/dL)
Hyperbilirubinemia ( >20mg/dL)
Uremia
Alcoholism
Opioids
Larger doses of aspirin
Conditions that falsely lower A1C
RBC volume loss or decrease lifespan:
Anemia from blood loss
Splenomegaly
Pregnancy (RBC lifespan goes from
120 to 90 days)
End stage renal disease
Hemolytic anemia
Vitamin E (600-1200mg/day)
Vitamin C
Antiretroviral drugs
Rheumatoid arthritis
Chronic liver disease
BG cut off for Dx of in-hospital hyperglycemia
Any glucose value >7.8mmol/L
LDL and TG target
<2
<1.5
Conditions to screen for at Dx of T2DM in children
- PCOS (repeat yearly)
- OSA (repeat yearly)
- Depressing and BED
ECG guideline
Resting ECG
Repeat ever 3-5 years
If :
- Age 40 +
- DM for > 15 years and > 30
- end organ damage (microvascular, cardiovascular)
- > 1 CV risk factor (smoking, HTN, Fx of premature CVD in 1st degree relative, CKD, obesity, ED)
MH screening tools
Problem Areas in Diabetes (PAID) scale
Diabetes Distress Score (DDS)
WHO-5 (Quality of Life)
Hospital Anxiety and Depression Scale (HADS)
Patient Health Questionnaire (PHQ-9)
Beck Depression Inventory (BDI)
Pneumonia vaccine recommendation
> 18 years
Re-vaccinate >65 years
Allow for 5+ years between doses
Guidance on Ax for driving
Persons with DM should undergo a Ax at least every 2 years to assess fitness to drive
Reporting lows w/r to drivers
Any severe hypoglycaemia while driving in the past 12 months
Private drivers - >1 severe low while awake in past 6 months
Commercial- same as above but 12 months
Fasting target if not achieving overall adequate control
4 - 5.5 (if 4-7 is not working)
Targets for CGM (rt and is)
GMI <7
TIR >70% (3.9-10)
TAR <20% (10.1-13.9), <5% (>13.9)
TBR <3% (3-3.8) , <1% (<3)
Data capture >70 of 14 days
Each 10% change in TIR equates to about 0.5% change in A1C
Recommended CGM target for older/high risk individuals (excluding pregnant women, children and teens)
TIR > 50%
TAR <10% >13.9
TBR <1% <3.9
CGM in Pregnancy
TIR >70
TAB <25% >7.8
TBR <3% <3.4-3.1, <1% <3
CBG indication and recommended scanning frequency
Indication: Adults/teens/kids using insulin more than once a day (type 1 and 2)
CBG testing min 3x/day (4x/day min if not meeting targets and other risks) and must include both fasting and ppg measures
In those with type 2 on 1x/day insulin + other agents, at least 1x/day and testing at variable times of day
