kania pt 1

Question 1

major cause of death in T1DM

Answer 1

diabetic kidney disease nephropathy

Question 2

diabetic kidney disease nephropathy characteristics

Answer 2

persistent proteinuria
decreased eGFR
increased arterial BP

Question 3

prevention of diabetic kidney disease nephropathy

Answer 3

screen for microalbuminuria annually in T1DM over 5 years and in T2DM; twice annually if UACR > 300 mg/g or eGFR <60mL

Question 4

treatment of diabetic kidney disease nephropathy

Answer 4

ACEi or ARB if UACR > 300mg/g or eGFR <60mL/min
SGLT2I if eGFR > 20mL and UACR > 200mg/g wiht T2DM
GLP-1RA if SGLT2I is CI or not tolerated

Question 5

finerenone

Answer 5

use to reduce CV risk if eGFR is <25mL/min

Question 6

goal if UACR is > 300mg/g

Answer 6

30% reduction

Question 7

ocular complications

Answer 7

blurred vision (likely due to decreased BP or BG)
retinopathy (if present screen 1x year), cataracts, glaucoma

Question 8

treatment of ocular complications

Answer 8

photocoagulation therapy
anti-vascular endothelial growth factors (aflibercept or ranibizumab)`

Question 9

peripheral neuropathy

Answer 9

annual monofilament test
initial treatment –> pregabalin, cymbalta, gabapentin

Question 10

lsat resort of peripheral neuropathy

Answer 10

centrally acting opioid analgesic

Question 11

ASCVD

Answer 11

atherosclerotic cardiovascular disease (coronary heart disease)
leading cause of morbidity and mortality

Question 12

treatment of diabetes and CV complications

Answer 12

SGLT-2Is
GLP-1Ras

Question 13

risk factors for CVD

Answer 13

obesity, HTN, HLD, smoking, and CKD
also metabolic syndrome

Question 14

goal BP

Answer 14

< 130/80 for T2DM/T1DM
110 -135 / 85 for DM + pregnancy
maybe <140 for elderly patients

Question 15

use of preferred antihypertensive agents for CV and diabetes

Answer 15

ACEis OR ARBs
use at max tolerated doses but not together due to risk of hyperkalemia, syncope, and renal dysfunction
if needed, add a second agent

Question 16

other antihypertensive options

Answer 16

HCTZ
chlorothalidone
amlodipine
MRAs (spironolactone or eplerenone)

Question 17

when to use none/moderate statin dose?

Answer 17

if patient is 20–39 with no ASCVD
monitor annually after

Question 18

when to use moderate statin dose?

Answer 18

if patient is age 40-75 with no ASCVD

Question 19

when to use high intensity stain dose?

Answer 19

if patient is age 40-75 with over 1 risk factor
if patient has DM and ASCVd in all agents (also lifestyle modifications)
**decrease LDL by over 50% and taget LDL under 70

Question 20

statin use in over 75 yoa

Answer 20

if on a statin –> continue
if not on a statin –> moderate intensity after discussion

Question 21

when should ezemtimibe or a PCSK9 inhibitor be added?

Answer 21

when pt has DM + ASCVD and currently on a statin, if LDL is still elevated despite maximal tolerated statin dose

Question 22

target LDL level for DM + ASCVD

Answer 22

target decrease by greater than 50%
LDL under 55

Question 23

high intensity statins

Answer 23

atorvastatin 40-80mg
rosuvastatin 20-40mg

Question 24

moderate intensity statins

Answer 24

pitavastatin 1-4mg
rosuvastatin 5-10mg
atorvastatin 10-20mg
simvastatin 20-40mg
pravastatin 40-80mg
lovastatin 40mg
fluvastatin XL 80mg

Question 25

low intensity statins

Answer 25

simvastatin 10mg pravastatin 10-20mg lovastatin 20mg fluvastatin 20-40mg

Question 26

prevention of muscle pain

Answer 26

often common with a statin start at low dose of statin and generally work your way up

Question 27

what should a patient use if they are intolerant of statins to treat CV complications?

Answer 27

bempedoic acid

Question 28

antiplatelets

Answer 28

use aspirin as secondary prevention (clopidrogel if allergy, sometimes both) hard to find a happy medium aspirin plus rivaroxaban could be considered for pts with PAD and low bleeding risk

Question 29

antiplatelets for primary prevention

Answer 29

consider in m/f over 50yoa with one major risk factor probably not if over age of 70 do not use if there are no major CVD risk factors (risk of bleeding outweighs benefits)

Question 30

different SMBG measuring times

Answer 30

intensive insulin regimens --> basically prior to everything also suspicion of hypoglycemia and after treatment basal insulin/non-insulin medications --> once daily non-insulin regimens --> prn

Question 31

ADA target fasting

Answer 31

80 to 130 mg/dL

Question 32

taret bedtime gluose

Answer 32

90 to 150 mg/dL

Question 33

A1C target

Answer 33

ADA --> under 7%, consider under 6% in pregnancy AACE --> under or equal to 6.5%

Question 34

A1C

Answer 34

normal is 4-6% average blood glucose concentration over 8-12 weeks does not lie!

Question 35

diabetes control and complications trial (DCCT)

Answer 35

T1DM patients 60% reduction in microvascular complications and 40-55% in CV complications in intensive treatment

Question 36

UK Prospective Diabetes Study (UKPDS)

Answer 36

T2DM patients every 1% drop in A1c --> 18% reduction in risk of CVD event saw reductions in MI due to sulfonylureas, insulin, and metformin 10 years after

Question 37

Action to Control CV Risk in Diabetes (ACCORD)

Answer 37

CVD or 2+ major risk factors study terminated early due to increase risk of mortality in intensively manage patinets not statistically significant at termination

Question 38

Action in diabetes and vascular disease - preterax and diamicron modified release controlled evaluation (ADVANCE)

Answer 38

significant reduction in microvascular outcomes without a change in macrovascular events in intensively managed patients no increase in CV mortality

Question 39

VA diabetes trial (VADT)

Answer 39

more CVD deaths in the intensive arm vs standard, but not statistically significant severe hypoglycemia associated with increased CVD mortality

Question 40

When should A1C be targeted aggressively?

Answer 40

when a patient is newly diagnosed, no history of severe hypoglycemia, and no CVD use in caution for patient with history of severe hypoglycemia, history of CVD or other extensive co-morbid conditions, and advanced disease where goal is difficult to achieve ***should be individualized regardless

Question 41

what does a 1% change in A1C signal?

Answer 41

a 25 to 35 mg/dL change in mean blood glucose (eAG)

Question 42

advantages of A1C

Answer 42

can be measured without fasting levels are not subject to acute changes in insulin dosing, exercise, or diet

Question 43

disadvantages of A1C

Answer 43

does not replace SMBG or CGM remember --> its an average of all numbers conditions that affect red blood cell turnover may impact result

Question 44

when to measure A1C?

Answer 44

twice a year if meeting treatment goals quarterly if therapy has changed or not meeting treatment goals