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ADA 23 > 4. Comprehensive Medical Evaluation 23 > Flashcards

4. Comprehensive Medical Evaluation 23 Flashcards

1
Q

What is the current understanding regarding booster vaccines for people with diabetes?

A

It is currently unclear how often people with diabetes will require booster vaccines.

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2
Q

According to the article, what effect did remote consultations during the pandemic have on emotional distress related to mental health and diabetes?

A

Remote consultations during the pandemic reduced the prevalence of mental health- and diabetes-related emotional distress.

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3
Q

What are some longer-term psychological impacts of SARS-CoV-2 infection in people with diabetes?

A

fatigue and an increased risk of suicide.

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4
Q

What should health care professionals monitor people with diabetes for during the COVID-19 pandemic?

A

Health care professionals should carefully monitor people with diabetes for diabetic ketoacidosis.

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5
Q

Does Covid 19 increase risk for T1DM?

A

COVID-19 is associated with a significantly increased risk of new-onset type 1 diabetes.

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6
Q

Which type of diabetes has been associated with a higher risk of COVID-19 mortality?

A

Type 1 diabetes

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7
Q

What is the indicator of MORTALITY, in people with diabetes during COVID-19 admission?

A

Higher blood glucose levels both prior to and during COVID-19 admission.

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8
Q

What is the relationship between BMI and COVID-19 mortality in diabetes?

A

The relationship between BMI and COVID-19 mortality in both type 1 and type 2 diabetes is U-shaped.

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9
Q

What is the importance of regular follow-up for people with new-onset diabetes? after covid19

A

Regular follow-up for people with new-onset diabetes is important to determine if diabetes is transient.

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10
Q

What should health care professionals do during the COVID-19 pandemic in relation to people with diabetes?

A

Health care professionals need to carefully monitor people with diabetes for diabetic ketoacidosis during the COVID-19 pandemic.

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11
Q

What should healthcare professionals do to help people with diabetes in relation to glycemic control and COVID-19?

A

Healthcare professionals should help people with diabetes aim to achieve individualized targeted glycemic control to reduce the risk of macrovascular and microvascular complications as well as reduce the risk of COVID-19 and its complications.

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12
Q

Is statin therapy recommended for patients with decompensated cirrhosis?

A

No, statin therapy is not recommended in decompensated cirrhosis.

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13
Q

According to some studies, what impact may the use of certain medications have on people with chronic liver disease?

A

Their use may reduce episodes of hepatic decompensation and/or overall mortality.

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14
Q

What is the potential benefit of using certain medications in people with chronic liver disease?

A

Reduced episodes of hepatic decompensation and/or overall mortality.

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15
Q

Should statin therapy be initiated or continued for cardiovascular risk reduction in adults with type 2 diabetes and NASH?

A

Yes, statin therapy should be initiated or continued for cardiovascular risk reduction as clinically indicated.

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16
Q

Is the use of statin therapy considered safe in adults with type 2 diabetes and NASH?

A

Yes, the use of statin therapy appears to be safe in adults with type 2 diabetes and NASH.

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17
Q

Can metabolic surgery considered with compensated cirrhosis?

A

With CAUTION ONLY.

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18
Q

Who should metabolic surgery not be recommended for?

A

with decompensated cirrhosis who have a much higher risk of postoperative development of liver-related complications.

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19
Q

What are some complications associated with decompensated cirrhosis?

A

Some complications associated with decompensated cirrhosis include variceal hemorrhage, ascites, hepatic encephalopathy, or jaundice.

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20
Q

What percentage of improvement of NASH after metabolic surgery?

A

-50–75%
Seatosis higher

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21
Q

What is the improvement rate for fibrosis after metabolic surgery?

A

30-40%

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22
Q

WHAT IS THE PREFERRED T2DM MED and decompensated cirrhosis?

A

Insulin

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23
Q

Why is insulin the preferred glucose-lowering agent for the treatment of hyperglycemia in adults with type 2 diabetes and decompensated cirrhosis?

A

lack of evidence about the safety and efficacy of oral agents and noninsulin injectables.

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24
Q

Is metformin improve steatohepatitis in paired-biopsy studies?

A

No

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25
Q

Which medications have no RCTs with liver histological end points to prevent nash?

A

Sulfonylureas, glitinides, dipeptidyl peptidase 4 inhibitors, acarbose

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26
Q

Do Tirzepatide, sodium-glucose cotransporter inhibitors, and insulin reduce hepatic steatosis?

A

Yes for seatosis

But not for seatohepatitis!

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27
Q

Did GLP1 RA significantly affect the stage of liver fibrosis?

A

Only at higher doses….

The progression of liver fibrosis with the GLP-1 RA at the highest dose was 4.9% compared to 18.8% on placebo over 72 weeks.

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28
Q

What was the resolution of steatohepatitis in the group treated with semaglutide?

A

Yes

59% of the group treated with semaglutide experienced resolution of steatohepatitis.
compared with 17% in the placebo group

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29
Q

What is the main benefit of GLP-1 RAs in individuals with NASH?

A
  1. Weight Loss: GLP-1 RAs are effective in inducing weight loss.
  2. Improve LFT
  3. reduce steatosis
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30
Q

What did the small RCT find about liraglutide in individuals with NASH?

A

1-improving NASH
2-delay fibrosis

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31
Q

What are some potential side effects of Pioglitazone?

A

1- WT GAIN> dose dependant
2-HF
3- bladder cancer
4-fracture

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32
Q

In pt with NASH , is vitamin E effective?

A

DM pt > not effective

Other pt > effective

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33
Q

Did Vitamin E enhance the efficacy of pioglitazone when used in combination in people with type 2 diabetes?

A

No, it did not enhance pioglitazone’s efficacy.

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34
Q

What is the effect of pioglitazone treatment on NASH?

A

Pioglitazone treatment results in resolution of NASH.

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35
Q

How pioglitazone effect in resolution of NASH?

A

improve glucose and lipid metabolism and reverse steatohepatitis.

in people with prediabetes, type 2 diabetes, or even without diabetes.

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36
Q

What is the number one cause of death in people with type 2 diabetes and NAFLD?

A

Cardiovascular disease.

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37
Q

What are two health conditions associated with type 2 diabetes and NAFLD?

A

Cardiovascular disease and NAFLD.

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38
Q

Which medications have been shown to be effective in treating steatohepatitis?

A

Pioglitazone and some glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been shown to be effective in treating steatohepatitis.

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39
Q

What is the potential impact of pioglitazone and GLP-1 RAs on fibrosis progression?

A

Pioglitazone and GLP-1 RAs may slow fibrosis progression.

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40
Q

What dietary recommendations are effective for improving liver and cardiometabolic health in people with diabetes and obesity?

A

Dietary recommendations should include a reduction of macronutrient content, limiting saturated fat, starch, and added sugar, with adoption of healthier eating patterns such as the Mediterranean diet.

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41
Q

Which type of diet has the best evidence for improving liver and cardiometabolic health? In NAFLD PT ?

A

The Mediterranean diet

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42
Q

What types of exercise have been shown to improve Non-Alcoholic Fatty Liver Disease (NAFLD)?

A

Both aerobic and resistance training have been shown to improve NAFLD.

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43
Q

What is the recommended minimum weight loss goal for improving liver histology in people with overweight or obesity and NAFLD?

A

A minimum weight loss goal of 5%, preferably ≥10%, is needed to improve liver histology.

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44
Q

What effect does obesity have in the setting of type 2 diabetes and NAFLD?

A

Obesity worsens insulin resistance and steatohepatitis, promoting the development of cirrhosis.

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45
Q

What are the possible causes of steatohepatitis and cirrhosis in lean people with diabetes?

A

1-genetic predisposition
2-insulin resistance
3-environmental factors.

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46
Q

In what type of patients is metabolic surgery recommended with caution?

A

Metabolic surgery should be used with caution in adults with type 2 diabetes with compensated cirrhosis from nonalcoholic fatty liver disease.

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47
Q

Is metabolic surgery recommended in patients with decompensated cirrhosis?

A

No, metabolic surgery is not recommended in patients with decompensated cirrhosis.

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48
Q

What is one potential treatment option for adults with type 2 diabetes and nonalcoholic steatohepatitis?

A

Metabolic surgery can be considered as an option to treat nonalcoholic steatohepatitis in adults with type 2 diabetes and nonalcoholic steatohepatitis and improve cardiovascular outcome.

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49
Q

What is the recommendation for managing cardiovascular risk factors in adults with type 2 diabetes and nonalcoholic fatty liver disease?

A

Comprehensive management of cardiovascular risk factors is recommended.

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50
Q

Is statin therapy safe for adults with type 2 diabetes and compensated cirrhosis from nonalcoholic fatty liver disease?

A

Yes, statin therapy is safe for adults with type 2 diabetes and compensated cirrhosis from nonalcoholic fatty liver disease.

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51
Q

How should statin therapy be used in people with decompensated cirrhosis?

A

In caution only

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52
Q

What is the preferred agent for the treatment of hyperglycemia in adults with type 2 diabetes with decompensated cirrhosis?

A

Insulin therapy

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53
Q

According to the provided information, which glucose-lowering therapies may be continued as clinically indicated in adults with type 2 diabetes and nonalcoholic steatohepatitis?

A

V pioglitazone
V SGLT2i
V insulin
V DPP4i

! SU > hypos
! METFORMIN > lactic acidosis

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54
Q

Is there evidence of benefit in nonalcoholic steatohepatitis for glucose-lowering therapies other than pioglitazone or glucagon-like peptide 1 receptor agonists?

A

No

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55
Q

What is the preferred treatment for hyperglycemia in adults with type 2 diabetes and nonalcoholic steatohepatitis?

A

Pioglitazone or glucagon-like peptide 1 receptor agonists.

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56
Q

What is the adjunctive therapy recommended for weight loss in adults with type 2 diabetes and nonalcoholic fatty liver disease?

A

GLP1RA

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57
Q

What should be recommended to adults with type 2 diabetes or prediabetes AND NAFLD?

A

LMS for Wt reduction:
-DIET
-Exercises: aerobic and anaerobic.

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58
Q

What is the best-validated imaging technique for fibrosis risk stratification in NAFLD?

A

The best-validated imaging technique for fibrosis risk stratification in NAFLD is transient elastography (LSM).

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59
Q

What does a negative FIB-4 result indicate?

A

FIB-4 < 1.3

A negative FIB-4 result rules out fibrosis.

lacks adequate sensitivity and positive predictive value

60
Q

What does a positive FIB-4 result require?

A

Intermediate risk 1.3-2.67
High risk > 2.67

A positive FIB-4 result requires confirmatory testing.

61
Q

What is considered a low risk of having advanced fibrosis and developing adverse liver outcomes?

A

A value of <1.3 is considered low risk.

62
Q

What is considered a high probability of advanced fibrosis and increased risk of adverse liver outcomes?

A

A value of >2.67 is considered as having a high probability.

63
Q

What is the likelihood of observing clinically significant fibrosis (≥F2) with plasma aminotransferases below 40 units/L?

A

Clinically significant fibrosis (≥F2) is frequently observed with plasma aminotransferases below the commonly used cutoff of 40 units/L.

The American College of Gastroenterology considers the upper limit of normal ALT levels to be 29–33 units/L for male individuals and 19–25 units/L for female individuals

64
Q

What is the most cost-effective strategy for the initial screening of people with prediabetes and cardiometabolic risk factors or with type 2 diabetes in primary care and diabetes clinical settings?

A

FIB-14 index

65
Q

Where is the fibrosis-4 index (FIB-4) recommended to be used for screening?

A

The fibrosis-4 index (FIB-4) is recommended to be used for screening in primary care and diabetes clinical settings.

66
Q

What is the prevalence of steatosis in thin T1DM ?

A

8.8%

67
Q

What is the prevalence of steatosis in people with type 2 diabetes?

A

68%

68
Q

What is the prevalence of non-alcoholic fatty liver disease (NAFLD) in people with type 1 diabetes?

A

22%

69
Q

What are some factors that increase the risk of developing NAFLD/ DM?

A
  1. Central obesity
  2. Cardiometabolic risk factors or insulin resistance
  3. Age over 50
  4. Persistently elevated plasma aminotransferases (AST and/or ALT >30 units/L for >6 months)
70
Q

What is NASH and its association with hepatocellular carcinoma?

A

leading cause of hepatocellular carcinoma (HCC).

71
Q

What is the definition of significant alcohol consumption?

A

Significant alcohol consumption is defined as ingestion of >21 standard drinks per week in men and >14 standard drinks per week in women over a 2-year period.

72
Q

What is the purpose of a comprehensive medical evaluation and assessment?

A

The purpose of a comprehensive medical evaluation and assessment is to gather information about a patient’s medical history, current health status, and risk factors for diabetes and its complications.

73
Q

According to the recommendations, when should people with type 1 diabetes be screened for autoimmune thyroid disease?

A

Thyroid screening in type 1 diabetes:

  1. Screen for autoimmune thyroid disease soon after type 1 diabetes diagnosis.
  2. Repeat every 1-2 years if AB NEGATIVE, increase frequency if AB POSITIVE or symptomatic.
74
Q

According to the recommendations, when should adults with type 1 diabetes be screened for celiac disease?

A
  1. At Diagnosis
  2. 2 years after diagnosis
  3. 5 years after diagnosis (or sooner if symptoms develop)
75
Q

What proportion of people with type 2 diabetes and NAFLD are estimated to have steatohepatitis?

A

More than half (50%+)

76
Q

How is NASH histologically defined?

A

NASH is histologically defined as having ≥5% hepatic steatosis and associated with inflammation and hepatocyte injury (hepatocyte ballooning), with or without evidence of liver fibrosis.

77
Q

What are the criteria for diagnosing NASH histologically?

A

The criteria for diagnosing NASH histologically include having ≥5% hepatic steatosis and being associated with inflammation and hepatocyte injury (hepatocyte ballooning), with or without evidence of liver fibrosis.

78
Q

What percentage of people with type 2 diabetes is estimated to have NAFLD in recent studies in the U.S.?

A

More than 70% of people with type 2 diabetes are estimated to have NAFLD.

79
Q

What does NAFLD stand for?

A

NAFLD stands for Non-Alcoholic Fatty Liver Disease.

80
Q

What is the relationship between diabetes and NASH?

A

Diabetes is a major risk factor for developing NASH, disease progression, and worse liver outcomes.

81
Q

What is the recommended screening method for nonalcoholic fatty liver disease in adults with type 2 diabetes or prediabetes?

A

Adults with type 2 diabetes or prediabetes, particularly those with obesity or cardiometabolic risk factors/established cardiovascular disease, should be screened/risk stratified for nonalcoholic fatty liver disease with clinically significant fibrosis using a calculated fibrosis-4 index.

82
Q

What should do if pt with persistent high LFT and low FIB-4 index?

A

They should be evaluated for other causes of liver disease.

83
Q

What additional risk stratification should be done for adults with type 2 diabetes or prediabetes with an indeterminate or high fibrosis-4 index?

A

liver stiffness measurement with transient elastography, or the blood biomarker enhanced liver fibrosis.

84
Q

What should be done for adults with type 2 diabetes or prediabetes with indeterminate results or at high risk for significant liver fibrosis?

A

They should be referred to a gastroenterologist or hepatologist for further workup. Multidisciplinary care is recommended for long-term management.

85
Q

What does the study suggest about people with periodontal disease and incident diabetes?

A

The study suggests that people with periodontal disease have higher rates of incident diabetes.

86
Q

What are some treatments for sleep apnea?

A

Some treatments for sleep apnea include lifestyle modification, continuous positive airway pressure, oral appliances, and surgery.

87
Q

What is the prevalence of obstructive sleep apnea in the population with type 2 diabetes?

A

23%

88
Q

What is the prevalence of any sleep-disordered breathing in the population with type 2 diabetes?

A

-any sleep-disordered breathing 58%
-OSA 23%

89
Q

What is the recommended method to determine free testosterone concentration in men with total testosterone levels close to the lower limit?

A

It is reasonable to determine free testosterone concentrations either directly from equilibrium dialysis assays or by calculations that use total testosterone, sex hormone binding globulin, and albumin concentrations.

90
Q

What are the potential benefits of testosterone replacement in men with symptomatic hypogonadism?

A

The potential benefits of testosterone replacement in men with symptomatic hypogonadism include improved sexual function, well-being, muscle mass and strength, and bone density.

91
Q

What is the focus of comprehensive medical evaluation and assessment?

A

The focus of comprehensive medical evaluation and assessment is to assess various aspects of an individual’s health and identify any underlying medical conditions or potential risk factors.

92
Q

Does men with DM HAVE LOW TESTOSTERONE LEVEL?

A

Yes, compared to age-matched men without diabetes.

93
Q

Reason of low testosterone in DM PT ?

A

Obesity is a major confounder.

94
Q

What is the recommended screening test for men with diabetes who have symptoms or signs of hypogonadism?

A

Morning serum testosterone level

95
Q

What are some symptoms or signs of hypogonadism in men with diabetes?

A

Decreased sexual desire (libido) or activity, or erectile dysfunction

96
Q

What is the relationship between diabetes and hearing impairment?

A

twice as likely to have hearing impairment compared to those without diabetes, even after adjusting for age and other risk factors.

97
Q

Which two medications should be used with caution for patients with type 2 diabetes with fracture risk factors?

A

-Thiazolidinediones
-sodium–glucose cotransporter 2 inhibitors. > مصادر تقول ماله علاقة بس الكانا عليه كلام

98
Q

Which type of diabetes is associated with osteoporosis?

A

-Type 1 diabetes is associated with osteoporosis.
-Low BMD and osteoporosis
-hip fractures more 6 times

99
Q

HOW T2DM AFFECT ON BMD?
Any risk for fractures?

A

BMD INCREASED!
But the have risk hip fracture.

100
Q

What is the relative risk of hip fractures in people with type 2 diabetes compared to the general population?

A

In T2DM is 1.7 times higher than the general population.
اقل من مرضى T1DM

101
Q

What percentage of patients undergoing total pancreatectomy with islet autotransplantation are insulin free 1 year postoperatively?

A

Approximately one-third (33.33%).

102
Q

What is the potential side effect of incretin-based therapies?

A

Pancreatitis may occur more frequently with these medications, but causality has not been established.

103
Q

What is the increased risk of developing acute pancreatitis for people with diabetes?

A

People with diabetes are at an approximately twofold higher risk of developing acute pancreatitis.

104
Q

What was the effect of successful eradication of HCV infection on glucose-lowering medication use?

A

reduced requirement for glucose-lowering medication use.

105
Q

How can HCV impair glucose metabolism?

A

HCV can impair glucose metabolism through several mechanisms.

106
Q

According to a systematic review, what effect do data on statins have on cognition?

A

Data do not support an adverse effect of statins on cognition.

107
Q

Is there o recommend dietary changes for the prevention or treatment of cognitive dysfunction?

A

No.

108
Q

What did one study find about the Mediterranean diet and cognitive function?

A

Following the Mediterranean diet correlated with improved cognitive function.

109
Q

According to the ACCORD trial, what was the relationship between cognitive function and the risk of severe hypoglycemia?

A

As cognitive function decreased, the risk of severe hypoglycemia increased.

110
Q

According to the ACCORD study, what was the outcome in terms of cognitive function for individuals with type 2 diabetes?

A

The ACCORD study found no difference in cognitive outcomes in participants randomly assigned to intensive and standard glycemic management.

111
Q

Is recommended intensive glucose management for the improvement of cognitive function in individuals with type 2 diabetes?

A

Not advised

112
Q

What did the ACCORD study find regarding cognitive function?

A

The ACCORD study found that each 1% higher A1C level was associated with lower cognitive function in individuals with type 2 diabetes.

113
Q

What does a recent meta-analysis for risk of dementia, Alzheimer’s in DM PT?

A

All increased

73% increased risk of all types of dementia, 56% increased risk of Alzheimer dementia, and 127% increased risk of vascular dementia compared with individuals without diabetes.

114
Q

What should be done with diabetes treatment plans in the presence of cognitive impairment?

A

Diabetes treatment plans should be simplified as much as possible and tailored to minimize the risk of hypoglycemia.

115
Q

Why should diabetes treatment plans be simplified and tailored in the presence of cognitive impairment?

A

To minimize the risk of hypoglycemia.

116
Q

What cancers are associated with diabetes?

A

Cancers of the liver, pancreas, endometrium, colon/rectum, breast, and bladder.

117
Q

Why is routine screening for thyroid dysfunction recommended for all people with type 1 diabetes?

A

Routine screening for thyroid dysfunction is recommended for all people with type 1 diabetes due to the high prevalence, nonspecific symptoms, and insidious onset of primary hypothyroidism.

118
Q

When should screening for celiac disease be considered in adults with diabetes?

A
  1. Suggestive symptoms:
    • Diarrhea
    • Malabsorption
    • Abdominal pain
  2. Suggestive signs:
    • Osteoporosis
    • Vitamin deficiencies
    • Iron deficiency anemia
119
Q

Who should consider measurement of vitamin B12 levels for people with type 1 diabetes?

A

-peripheral neuropathy
-unexplained anemia.

120
Q

In what context may type 1 diabetes occur with other autoimmune diseases?

A

Type 1 diabetes may occur with other autoimmune diseases in the context of specific genetic disorders or polyglandular autoimmune syndromes.

121
Q

What are some possible genetic disorders or syndromes that may be associated with type 1 diabetes and other autoimmune diseases?

A

Some possible genetic disorders or syndromes that may be associated with type 1 diabetes and other autoimmune diseases are specific genetic disorders or polyglandular autoimmune syndromes.

122
Q

What are some autoimmune diseases that people with type 1 diabetes are at increased risk for?

A
  1. Thyroid disease
  2. Celiac disease
  3. Pernicious anemia (vitamin B12 deficiency)
  4. Autoimmune hepatitis
  5. Primary adrenal insufficiency (Addison’s disease)
  6. Collagen vascular diseases
  7. Myasthenia gravis
123
Q

What is the recommendation for screening autoimmune thyroid disease in people with type 1 diabetes?

A

People with type 1 diabetes should be screened for autoimmune thyroid disease soon after diagnosis and periodically thereafter.

124
Q

When should adults with type 1 diabetes be screened for celiac disease?

A

Adults with type 1 diabetes should be screened for celiac disease in the presence of gastrointestinal symptoms, signs, laboratory manifestations, or clinical suspicion suggestive of celiac disease.

125
Q

What is the grade of recommendation for screening autoimmune thyroid disease in people with type 1 diabetes?

A

The grade of recommendation for screening autoimmune thyroid disease in people with type 1 diabetes is B.

126
Q

What may be the reason for higher rates of hepatitis B in people with type 1 or type 2 diabetes?

A

The higher rates of hepatitis B in people with type 1 or type 2 diabetes may be due to contact with infected blood or through improper equipment use such as glucose monitoring devices or infected needles.

127
Q

What is the recommended interval between PCV15 and PPSV23?

A

The recommended interval between PCV15 and PPSV23 is ≥1 year.

128
Q

What is the recommendation for adults aged ≥65 years whose vaccine status is unknown or who have not received pneumococcal vaccine?

A

They should receive one dose of PCV15 or PCV20, followed by PPSV23 if PCV15 is used.

129
Q

What is the additional benefit of the high-dose quadrivalent inactivated influenza vaccine for individuals ≥65 years of age?

A

The high-dose quadrivalent inactivated influenza vaccine may provide additional benefit for individuals ≥65 years of age.

130
Q

Which age group should receive routinely recommended vaccinations for diabetes?

A

Children and adults with diabetes should receive routinely recommended vaccinations as indicated by their age.

131
Q

At what age is zoster VACCINE IS TAKEN?

A

aged 50 or above.

132
Q

What is the recommended vaccination age-group for Hepatitis B? Also mention the GRADE evidence type for this recommendation.

A

Hepatitis B vaccination is highly recommended for individuals <60 years of age and ≥60 years of age. The GRADE evidence type for this recommendation is 2.

133
Q

What is the recommended pneumococcal vaccination schedule for adults who previously received PCV13?

A

If PCV13 was previously received, it is recommended to follow with PPSV23 ≥1 year later.

134
Q

For which age-groups is vaccination against Human papillomavirus (HPV) recommended? How many doses are required for female individuals and male individuals?

A
  • HPV vaccination recommended ≤26 years of age.
  • Individuals aged 27–45 may be vaccinated after discussion with healthcare professionals.
  • Females and males require three doses of HPV vaccine.
135
Q

What is the recommended pneumococcal vaccination for adults aged 19-64 years with an immunocompromising condition?

A

One dose of PCV15 or PCV20 is recommended for adults aged 19-64 years with an immunocompromising condition.

136
Q

What is the recommended vaccination frequency for the influenza vaccine for people with diabetes?

A

People with diabetes are advised to receive the influenza vaccine annually.

137
Q

What is the recommended pneumococcal vaccination for adults aged 65 years and older who are immunocompetent?

A

One dose of PCV15 or PCV20 is recommended for adults aged 65 years and older who are immunocompetent. PCSV23 may be given ≥8 weeks after PCV15.

138
Q

WHAT should referrals for initial care management be made?

A

Eye care professional for annual dilated eye exam
 • Family planning for individuals of childbearing potential
 • Registered dietitian nutritionist for medical nutrition therapy
 • Diabetes self-management education and support
 • Dentist for comprehensive dental and periodontal examination
 • Mental health professional, if indicated
 • Audiology, if indicated
 • Social worker/community resources, if indicated

139
Q

What are some factors that increase the risk of treatment-associated hypoglycemia?

A

Factors that increase risk of treatment-associated hypoglycemia include the use of insulin or insulin secretagogues, impaired kidney or hepatic function, longer duration of diabetes, frailty and older age, cognitive impairment, impaired counterregulatory response, hypoglycemia unawareness, physical or intellectual disability that may impair behavioral response to hypoglycemia, alcohol use, polypharmacy, and history of severe hypoglycemic event.

140
Q

How often should interval follow-up visits occur?

A

Interval follow-up visits should occur at least every 3–6 months individualized to the person and then at least annually.

141
Q

What is the relationship between sleep quality and A1C in people with type 2 diabetes?

A

Poor sleep quality, short sleep, and long sleep were associated with higher A1C levels in people with type 2 diabetes.

142
Q

What factors should guide ongoing management of diabetes?

A

The assessment of overall health status, diabetes complications, cardiovascular risk, hypoglycemia risk, and shared decision-making should guide ongoing management of diabetes.

143
Q

What is the purpose of a comprehensive medical evaluation in diabetes management?

A

The purpose of a comprehensive medical evaluation is to assess overall health status, diabetes complications, cardiovascular risk, hypoglycemia risk, and to facilitate shared decision-making in setting therapeutic goals.

144
Q

What are the purposes of a complete medical evaluation at the initial visit for diabetes?

A

To confirm the diagnosis and classify diabetes, evaluate for diabetes complications and potential comorbid conditions, review previous treatment and risk factor management, begin engagement in formulating a care management plan, and develop a plan for continuing care.

145
Q

What style of communication should be used to optimize health outcomes in diabetes care?

A

A person-centered communication style using person-centered, culturally sensitive, and strength-based language and active listening should be used.

146
Q

What are some potential barriers to care that should be assessed in diabetes management?

A

Some potential barriers to care that should be assessed in diabetes management are literacy, numeracy, and other potential barriers to care.

ADA 23 (9 decks)

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