Lecture 2 (Treatment Goals) Flashcards
(26 cards)
List the treatment goals for DM
- be symptom free
- achieve personalized target glucose levels
- address modifiable CV risk factors
- prevent or slow progression of microvascular complications
- empowerment to self manage
List personalized target glucose levels
A1C
fasting glucose levels
postprandial glucose levels
time in range
List ways to monitoring glucose control
A1C
CBG
CGM
ketone testing
Define A1C
a measure of glycemic control over a 3 months
What is a normal A1C level?
4-6%
What are the A1C targets?
<6 T2D with potential for remission
<6.5 T2D to reduce the risk of chronic kidney disease
<7 most adults with T1D or T2D
7.1-8 functionally dependent
7.1-8.5 for severe cases, frail elderly, limited life expectancy
What is the PPG and 2 hr Post PPG for most pt?
4-7
5-10
What is the PPG and 2 hr Post PPG for pt with A1C more than 7?
4-5.5
5-8
What is the major takeaways from the trials related to A1C goals?
Lowering A1C values to ≤7% provides strong benefits for microvascular complications and, if achieved early enough may also provide macrovascular benefit
More intensive BG lowering is not always better
Rather than causing CV AEs, severe hypoglycemia may be a marker of vulnerability for such events
What is CBG?
capillary blood glucose
determines the glucose level in capillary blood via a finger stick
What do you need to know about CBG?
1) how to perform CBG
2) how often and when to perform CBG
3) the meaning of various BG levels
4) how behavior and actions affect CBG results
- interpretation of trends
What does FPG mean?
reflects glucose derived from hepatic production
What does PPG mean?
how meals affect glucose
What is isCGM?
intermittently scanned CGM
Measures glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin (sensor-based technology)
What is rtCGM?
are stand alone system
measure glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin
continuous data visibility 24/7
What is TIR?
time in range
the time that the pt blood glucose levels are in range
What are ketone tests?
ketones are formed as a by product when body’s fat have to be accessed for energy
it can be used to be a part of self management (not standard anymore)
Non pharm for DB
diet (focusing on carbs and fibre)
exercise (goal is >150 min of moderate to intense exercise/wk)
spread over >3d/wk
resistance training >2x/wk
Define remission of TD2M
Achieving specified A1C thresholds without any anti- hyperglycemic medications for a minimum of 3 months:
What is the A1C for remission of T2DM for both prediabetes & normal glucose?
Remission to prediabetes (A1C between 6.0% and 6.4%)
Remission to normal glucose concentrations (A1C <6.0%)
List some individuals that may be considered remission of T2DM
Interesting in attempting remission
Who do not have significant eating or mental health disorders
Who do not have a compelling indication for antihyperglycemics (for renal or CV benefit)
Who meet the criteria in the intervention based recommendations
What are some options for remission of T2DM?
bariatric surgery
health behaviour interventions
What is the requirement for bariatric surgery?
May induce remission in non-pregnant adults with BMI ≥ 35kg/m2
What are the two types of health behavior interventions for remission?
low cal diets (850 kcal/d) with meal replacement products for 3-5 months aimed at achieving >15 kg weight loss
calorie restricted diet (aim for 5-7% weight loss) and exercise training (240-420 min/wk over 5 days/wk)
