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PSBEDM Review > 35 Therapeutics of Type 2 Diabetes Mellitus > Flashcards

35 Therapeutics of Type 2 Diabetes Mellitus Flashcards

1
Q

Country with the highest prevalence of diabetes at 23-35%

A

Micronesia

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2
Q

Diabetes increases risk of heart disease and stroke to:

A

2-4x

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3
Q

Primary endpoint to evaluate the relationship between glucose levels and complications

A

Retinopathy

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4
Q

Diagnostic cutoff for prediabetes:
Fasting plasma glucose

A

100-125 mg/dL or 5.6-6.9 mmol/L

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5
Q

Diagnostic cutoff for prediabetes:
2 hour plasma glucose after 75 g oral glucose

A

140-199 mg/dL or 7.8-11.0 mmol/L

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6
Q

Diagnostic cutoff for prediabetes:
HbA1c

A

5.7-6.4% or 39-47 mmol/mol

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7
Q

Diagnostic cutoff for diabetes:
Fasting plasma glucose

A

126 mg/L or 7 mmol/L or higher

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8
Q

Diagnostic cutoff for diabetes:
2 hour plasma glucose after 75 g oral glucose

A

200 mg/dL or 11.1 mmol/L or higher

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9
Q

Diagnostic cutoff for diabetes:
Random plasma glucose with classic symptoms

A

200 mg/dL or 11.1 mmol/L or higher

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10
Q

Diagnostic cutoff for diabetes:
HbA1c

A

6.5% or 48 mmol/L or higher

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11
Q

Risk factors in criteria for testing for diabetes:
Blood pressure

A

> /= 140/90

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12
Q

Risk factors in criteria for testing for diabetes:
Lipid profile

A

HDL <35 mg/dL or TAG >250 mg/dL

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13
Q

Testing frequency for diabetes:
Women with GDM

A

Test every 3 years

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14
Q

Testing frequency for diabetes:
Prediabetes

A

Test yearly

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15
Q

Testing frequency for diabetes:
If results are normal

A

Repeat testing at least every 3 years

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16
Q

Testing for diabetes in adults without risk factors should begin at what age? (ADA 2023)

A

35 years

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17
Q

UKPDS: Intervention in the conventional group

A

Lifestyle therapy alone
Pharmacological therapy only if FBG >270 mg/dL or if with symptoms

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18
Q

UKPDS: Intervention in the intensive group

A

Either SU or insulin as initial therapy
Aim of maintaining FBG <108 mg/dL

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19
Q

Treatment effect of SU or insulin in UKPDS (end of randomized treatment 1997):
Any diabetes-related endpoint

A

RRR 12%

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20
Q

Treatment effect of SU or insulin in UKPDS (end of randomized treatment 1997):
Microvascular disease

A

RRR 25%

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21
Q

Treatment effect of SU or insulin in UKPDS (end of randomized treatment 1997):
Myocardial infarction

A

Not significant

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22
Q

Treatment effect of SU or insulin in UKPDS (end of randomized treatment 1997):
All-cause mortality

A

Not significant

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23
Q

Treatment effect of SU or insulin in UKPDS (end of further observation 2007):
Any diabetes-related endpoint

A

RRR 9%

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24
Q

Treatment effect of SU or insulin in UKPDS (end of further observation 2007):
Microvascular disease

A

RRR 24%

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25
Q

Treatment effect of SU or insulin in UKPDS (end of further observation 2007):
Myocardial infarction

A

RRR 15%

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26
Q

Treatment effect of SU or insulin in UKPDS (end of further observation 2007):
All-cause mortality

A

RRR 13%

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27
Q

Treatment effect of metformin in UKPDS (end of randomized treatment 1997):
Any diabetes-related endpoint

A

RRR 32%

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28
Q

Treatment effect of metformin in UKPDS (end of randomized treatment 1997):
Microvascular disease

A

Not significant

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29
Q

Treatment effect of metformin in UKPDS (end of randomized treatment 1997):
Myocardial infarction

A

RRR 39%

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30
Q

Treatment effect of metformin in UKPDS (end of randomized treatment 1997):
All-cause mortality

A

RRR 36%

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31
Q

Treatment effect of metformin in UKPDS (end of further observation 2007):
Any diabetes-related endpoint

A

RRR 21%

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32
Q

Treatment effect of metformin in UKPDS (end of further observation 2007):
Microvascular disease

A

Not significant

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33
Q

Treatment effect of metformin in UKPDS (end of further observation 2007):
Myocardial infarction

A

RRR 33%

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34
Q

Treatment effect of metformin in UKPDS (end of further observation 2007):
All-cause mortality

A

RRR 27%

35
Q

Effect of intensive therapy on mortality in ACCORD

A

22% increase in total mortality

36
Q

ADA target for preprandial plasma glucose

A

80-130 mg/dL or 4.4-7.2 mmol/L

37
Q

ADA target for peak postprandial glucose

A

<180 mg/dL or <10 mmol/L

38
Q

ADA target for mean plasma glucose computed from glucose profile values

A

<154 mg/dL or <8.6 mmol/L

39
Q

ADA target for HbA1c

A

<7% or <53 mg/dL

40
Q

ACE target for HbA1c

A

<6.5%

41
Q

ACE target for preprandial plasma glucose

A

<110 mg/dL

42
Q

ACE target for peak postprandial glucose

A

<140 mg/dL or <7.8 mmol/L

43
Q

A preprandial plasma glucose of <110 mg/dL would be expected with an HbA1C of:

A

~5.5%

44
Q

A postprandial plasma glucose of <140 mg/dL would be expected with an HbA1C of:

A

~5%

45
Q

Effect of increased red cell turnover such as iron treatment for IDA or occult blood loss on HbA1C

A

Falsely low

46
Q

Effect of decreased red cell turnover such as untreated IDA on HbA1c

A

Falsely high

47
Q

Criteria for clinically significant hypoglycemia

A

54 mg/dL or <3 mmol/L or less

48
Q

Medical nutrition therapy has been shown to decrease HbA1c by

A

0.3-2%

49
Q

Weight loss target in type 2 DM

A

> 5%

50
Q

At least how much high-quality protein per day is recommended in type2 DM

A

At least 0.8 g/kg

51
Q

Recommended fiber intake in T2DM

A

> 15 g/1000 kcal

52
Q

Sodium restriction in diabetes

A

<2300 mg/day

53
Q

Recommended duration of moderate intensity exercise per week

A

150 mins

54
Q

Recommended duration of vigorous intensity exercise per week

A

75 mins

55
Q

HR in moderate intensity physical activity

A

50-70% of max HR

56
Q

HR in vigorous physical activity

A

> 70% of max HR

57
Q

Mean HbA1c reduction in combined aerobic and resistance exercise

A

0.4-0.9%

58
Q

With metformin therapy, vitamin B12 supplementation at this dose may be prudent

A

1000 mcg daily

59
Q

Ischemic preconditioning is an adverse effect of these (2) sulfonylureas

A

Glyburide
Tolbutamide

60
Q

Only GLP1 agonist approved for weight loss regardless of diabetes status

A

Liraglutide

61
Q

When a GLP1 is added to insulin, what is the recommended reduction in insulin dosage?

A

20% reduction (unless HbA1c is >8%)

62
Q

Most common form of monogenic diabetes

A

HNF-1A

63
Q

Drug approved for treatment of abnormal lipids associated with HIV lipodystrophy

A

Tesamorelin (GHRH analogue)

64
Q

Life expectancy is reduced by how many years in people with diabetes

A

~10 years

65
Q

Amount of glucose filtered at the glomerulus and reabsorbed in the proximal tubule under normal conditions

A

180 g

66
Q

Ischemic preconditioning has been confirmed in these two (2) sulfonylureas

A

Tolbutamide
Glyburide

67
Q

Effect of TZDs on triglycerides (2)

A

Pioglitazone: ⬇️ 20%
Rosiglitazone: ⬆️ 5%

68
Q

This antidiabetic agent reduces subsequent occurrence of stroke or myocardial infarction in nondiabetic patients with a recent ischemic stroke or TIA

A

Pioglitazone

69
Q

This trial suggested an increased risk of myocardial infarction with the use of rosiglitazone

A

RECORD trial

70
Q

Antidiabetic agents (2) avoided in those with history of bladder cancer

A

Pioglitazone
Dapagliflozon

71
Q

HbA1c reduction with the use of colesevelam

A

0.5%

72
Q

Lipid profile effects (2) of colesevelam

A

LDL ⬇️ 15%
Triglycerides ⬆️ 5-20%

73
Q

GLP1 agonist that is renally cleared

A

Exenatide

74
Q

Individuals with this type of MODY will not develop chronic complications of diabetes and treatment will not likely render significant changes in glucose control

A

GCK-MODY

75
Q

Usual titration target of blood glucose when initiating basal insulin in most clinical trials

A

<100 mg/dL

76
Q

Initial fasting CBG target in individuals initiated on insulin with an HbA1C >8%

A

<120 mg/dL

77
Q

Initial dosage for the first prandial insulin injection can be 4-6 units, with systematic titration aiming for glucose prior to the next meal (or at bedtime if the dose is prior to dinner) approaching:

A

120 mg/dL

78
Q

GLP1RAs (3) with proven CVD benefit (Williams)

A

Liraglutide > Semaglutide > Exenatide ER

79
Q

SGLT2Is (2) with proven CVD benefit (Williams)

A

Empagliflozin > Dapagliflozin

80
Q

SGLT2Is (2) with proven HF and CKD benefits (Williams)

A

Empagliflozin
Dpaatliflozin

81
Q

Basal insulin (2) with demonstrated CVD safety

A

Degludec
Glargine U100

82
Q

Basal insulins (3) with lower risk of hypoglycemia

A

Degludec / Glargine U300 < Glargine U100 < NPH insulin

83
Q

GLP1RAs (5) with good efficacy for weight loss

A

Semaglutide > Liraglutide > Dulaglutide > Exenatide > Lixisenatide

PSBEDM Review (20 decks)

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