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DM Flashcards

(54 cards)

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1
Q

By 2050, the incidence of DM in the US will increase by how much?

A

65-74 years: 220%

>/= 75 years: 449%

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2
Q

What does the 2013 AGS recommend with diabetes?

A

Smoking cessation
ASA
HTN
Glycemic control

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3
Q

In what age group is aspirin use cautioned?

A

80+

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4
Q

When is ASA therapy not recommended?

A

Take other anticoagulant therapy

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5
Q

What is the HTN goal for elderly patients with DM?

A

< 140/90

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6
Q

What SBP has potential for harm in elderly with DM?

A

< 120

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7
Q

What do we monitor with ACE/ARB therapy in DM?

A

Renal function and serum potassium 1-2 weeks after initiation or dose increase and at least yearly

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8
Q

What do we monitor in patients taking thiazide or loop diuretics?

A

Check electrolytes 1-2 weeks after initiation or dose increase and at least yearly

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9
Q

What is the general A1c goals per the AGS 2013 AACE?

A

<7.5 - 8%

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10
Q

What A1c has potential harm per the AGS 2013 AACE?

A

< 6.5%

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11
Q

What is the A1c goal for a healthy patient with few comorbidities, and good functional status per the AGS 2013 AACE?

A

7 - 7.5%

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12
Q

What is the A1c goal in a patient with multiple comorbidities, poor health, and limited life expectancy per the AGS 2013 AACE?

A

8 - 9%

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13
Q

How often do we check A1c if it is unstable per the AGS 2013 AACE?

A

Every 6 months

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14
Q

What is the A1c goal for a healthy patient per the 2017 ADA?

A

< 7.5%

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15
Q

What is the FBG for a healthy patient per the 2017 ADA/AGS?

A

90-130

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16
Q

What is the bedtime glucose for a healthy patient per the 2017 ADA/AGS?

A

90-150

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17
Q

What is the blood pressure for a healthy patient per the 2017 ADA/AGS?

A

< 140/80

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18
Q

Should a healthy patient be given a statin per the 2017 ADA/AGS?

A

Yes unless CI or not tolerated

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19
Q

What is the A1c goal for a complex/intermediate patient per the 2017 ADA/AGS?

A

< 8.0%

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20
Q

What is the FBG goal for a complex/intermediate patient per the 2017 ADA/AGS?

A

90-150

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21
Q

What is the bedtime glucose goal for a complex/intermediate patient per the 2017 ADA/AGS?

A

100-180

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22
Q

What is the BP goal for a complex/intermediate patient per the 2017 ADA/AGS?

23
Q

Should statins be used in complex/intermediate patients per the 2017 ADA/AGS?

Study These Flashcards
A

Yes unless CI or not tolerated

24
Q

What is the A1c goal for a very complex/poor health patient per the 2017 ADA/AGS?

25
What is the FBG goal for a very complex/poor health patient per the 2017 ADA/AGS?
100-180
26
What is the bedtime glucose goal for a very complex/poor health patient per the 2017 ADA/AGS?
110-200
27
What is the BP goal for a very complex/poor health patient per the 2017 ADA/AGS?
<150/90
28
Should a statin be used in a very complex/poor health patient per the 2017 ADA/AGS?
Consider likelihood of benefit with statin (secondary prevention more so than primary)
29
What are the special considerations groups in geriatrics w/DM?
Hypoglycemia Cognitive dysfunction Functional impairment Vision/hearing impairments
30
Why is hypoglycemia dangerous in geriatric patients?
Studies show delay in sx recognition but greater deterioration of psychomotor coordination in older adults Linked to increased risk of dementia (d/t extreme hypoglycemia repeatedly)
31
Why is hyperglycemia dangerous in geriatric patients?
Increased risk of dehydration, electrolyte abnormalities when BG is above the renal threshold for glycosuria May increase risk of hyperglycemia hyperosmolar syndrome (HHS)
32
Why is cognitive dysfunction dangerous in geriatric patients?
2x more prevalent with DM | Increased risk of hypoglycemia
33
Why is functional impairment dangerous in geriatric patients?
Increased perhaps d/t neuropathy
34
Why are vision/hearing impairments dangerous in geriatric patients?
Impacts med and education options (for example, patient can only afford insulin by vial and syringe but can s/he clearly see syringe to draw up appropriate dose?)
35
What are the pros of metformin?
``` Oral option Cheap Low hypoglycemia risk Weight neutral 1-2% decrease in A1c ```
36
What are the cons of metformin?
Renal adjustments GI AEs Increased risk of lactic acidosis in dehydration/worsening renal function
37
What are the pros for sulfonylureas?
Decreased macrovascular events Oral option Cheap Effective A1c lowering, especially PPGB
38
What are the cons for sulfonylureas?
Hypoglycemia risk Weight gain Renal (glimepiride) and hepatic (glipizide) adjustments
39
Why are sulfonylureas on the Beers list?
Glyburide for hypoglycemia
40
What are the pros for TZDs?
``` Oral option Generic available Insulin sensitizer Increases HDL, decreases TG Cheaper option ```
41
What are the cons for TZDs?
Fluid retention BBW: HF Potential risk of edema, fracture, macular edema Pt has personal h/o bladder cancer
42
What are the pros for DPP-4i?
``` Oral option Rarely causes hypoglycemia Wt gain neutral Well tolerated Use in poor renal function (tradjenta dose not require dose adjustments) ```
43
What are the cons of DPP-4i?
Brand name only Minimal A1c lowering Pancreatitis concerns HF hospitalization
44
What are the pros of GLP-1 agonists?
Easier to use pen devices Low hypoglycemia risk Wt loss Moderate A1c lowering
45
What is Liraglutide good for in high risk populations?
CV benefit
46
What are cons of GLP-1 agonists?
``` Visual impairment Dexterity issues Potential GI AEs Pancreatitis Thyroid cancer concerns Brand ```
47
What are pros of SGLT-2
Oral option Low hypoglycemia risk Weiht loss
48
What is empagliflozin and invokana good for in high risk populations?
CV benefit
49
What are cons of SGLT-2i?
``` H/o UTI Risk of genital mycotic infection Risk of DKA Impacts renal function Brand name Canagliflozin - hyperkalemia, increased fracture risk, increased amputation risk ```
50
What did the LIPID trial subgroup determine?
Pravastatin reduced risk for all CVD events in both older and younger groups
51
In patients greater than 65, what does increased LDL correlate to?
Increased relative risk of death d/t coronary heart disease
52
In patients greater than 80, which part of cholesterol improved 2 year survival?
High HDL
53
Aronom determined what about statin use in patients with a history of MI and LDL > 125?
Reduced risk of death from coronary heart disease and non-fatal MI, stroke, HF In those > 90, significant reduction in new coronary heart dz <90, reduced the risk of new stroke
54
What did the PROSPER trial determine?
Ages 70-82 years patients Pravastatin decreased LDL and significant reduction in primary composite endpoint Increased new cancers

Geriatrics (15 decks)

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