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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
Treatment effect of SU or insulin in UKPDS (end of further observation 2007): Myocardial infarction
RRR 15%
26
Treatment effect of SU or insulin in UKPDS (end of further observation 2007): All-cause mortality
RRR 13%
27
Treatment effect of metformin in UKPDS (end of randomized treatment 1997): Any diabetes-related endpoint
RRR 32%
28
Treatment effect of metformin in UKPDS (end of randomized treatment 1997): Microvascular disease
Not significant
29
Treatment effect of metformin in UKPDS (end of randomized treatment 1997): Myocardial infarction
RRR 39%
30
Treatment effect of metformin in UKPDS (end of randomized treatment 1997): All-cause mortality
RRR 36%
31
Treatment effect of metformin in UKPDS (end of further observation 2007): Any diabetes-related endpoint
RRR 21%
32
Treatment effect of metformin in UKPDS (end of further observation 2007): Microvascular disease
Not significant
33
Treatment effect of metformin in UKPDS (end of further observation 2007): Myocardial infarction
RRR 33%
34
Treatment effect of metformin in UKPDS (end of further observation 2007): All-cause mortality
RRR 27%
35
Effect of intensive therapy on mortality in ACCORD
22% increase in total mortality
36
ADA target for preprandial plasma glucose
80-130 mg/dL or 4.4-7.2 mmol/L
37
ADA target for peak postprandial glucose
<180 mg/dL or <10 mmol/L
38
ADA target for mean plasma glucose computed from glucose profile values
<154 mg/dL or <8.6 mmol/L
39
ADA target for HbA1c
<7% or <53 mg/dL
40
ACE target for HbA1c
<6.5%
41
ACE target for preprandial plasma glucose
<110 mg/dL
42
ACE target for peak postprandial glucose
<140 mg/dL or <7.8 mmol/L
43
A preprandial plasma glucose of <110 mg/dL would be expected with an HbA1C of:
~5.5%
44
A postprandial plasma glucose of <140 mg/dL would be expected with an HbA1C of:
~5%
45
Effect of increased red cell turnover such as iron treatment for IDA or occult blood loss on HbA1C
Falsely low
46
Effect of decreased red cell turnover such as untreated IDA on HbA1c
Falsely high
47
Criteria for clinically significant hypoglycemia
54 mg/dL or <3 mmol/L or less
48
Medical nutrition therapy has been shown to decrease HbA1c by
0.3-2%
49
Weight loss target in type 2 DM
>5%
50
At least how much high-quality protein per day is recommended in type2 DM
At least 0.8 g/kg
51
Recommended fiber intake in T2DM
>15 g/1000 kcal
52
Sodium restriction in diabetes
<2300 mg/day
53
Recommended duration of moderate intensity exercise per week
150 mins
54
Recommended duration of vigorous intensity exercise per week
75 mins
55
HR in moderate intensity physical activity
50-70% of max HR
56
HR in vigorous physical activity
>70% of max HR
57
Mean HbA1c reduction in combined aerobic and resistance exercise
0.4-0.9%
58
With metformin therapy, vitamin B12 supplementation at this dose may be prudent
1000 mcg daily
59
Ischemic preconditioning is an adverse effect of these (2) sulfonylureas
Glyburide Tolbutamide
60
Only GLP1 agonist approved for weight loss regardless of diabetes status
Liraglutide
61
When a GLP1 is added to insulin, what is the recommended reduction in insulin dosage?
20% reduction (unless HbA1c is >8%)
62
Most common form of monogenic diabetes
HNF-1A
63
Drug approved for treatment of abnormal lipids associated with HIV lipodystrophy
Tesamorelin (GHRH analogue)
64
Life expectancy is reduced by how many years in people with diabetes
~10 years
65
Amount of glucose filtered at the glomerulus and reabsorbed in the proximal tubule under normal conditions
180 g
66
Ischemic preconditioning has been confirmed in these two (2) sulfonylureas
Tolbutamide Glyburide
67
Effect of TZDs on triglycerides (2)
Pioglitazone: ⬇️ 20% Rosiglitazone: ⬆️ 5%
68
This antidiabetic agent reduces subsequent occurrence of stroke or myocardial infarction in nondiabetic patients with a recent ischemic stroke or TIA
Pioglitazone
69
This trial suggested an increased risk of myocardial infarction with the use of rosiglitazone
RECORD trial
70
Antidiabetic agents (2) avoided in those with history of bladder cancer
Pioglitazone Dapagliflozon
71
HbA1c reduction with the use of colesevelam
0.5%
72
Lipid profile effects (2) of colesevelam
LDL ⬇️ 15% Triglycerides ⬆️ 5-20%
73
GLP1 agonist that is renally cleared
Exenatide
74
Individuals with this type of MODY will not develop chronic complications of diabetes and treatment will not likely render significant changes in glucose control
GCK-MODY
75
Usual titration target of blood glucose when initiating basal insulin in most clinical trials
<100 mg/dL
76
Initial fasting CBG target in individuals initiated on insulin with an HbA1C >8%
<120 mg/dL
77
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:
120 mg/dL
78
GLP1RAs (3) with proven CVD benefit (Williams)
Liraglutide > Semaglutide > Exenatide ER
79
SGLT2Is (2) with proven CVD benefit (Williams)
Empagliflozin > Dapagliflozin
80
SGLT2Is (2) with proven HF and CKD benefits (Williams)
Empagliflozin Dpaatliflozin
81
Basal insulin (2) with demonstrated CVD safety
Degludec Glargine U100
82
Basal insulins (3) with lower risk of hypoglycemia
Degludec / Glargine U300 < Glargine U100 < NPH insulin
83
GLP1RAs (5) with good efficacy for weight loss
Semaglutide > Liraglutide > Dulaglutide > Exenatide > Lixisenatide

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