6. Glycemic Targets23 Flashcards
What can improve A1C with minimal hypoglycemia in people with type 2 diabetes?
Other strategies to assist them with insulin dosing.
How does real-time CGM help in managing hypoglycemia in people with impaired awareness?
Real-time CGM appears to be a useful tool for decreasing time spent in a hypoglycemic range in people with impaired awareness.
According to a recent meta-analysis, what impact did it reflect on hypoglycemic events in type 2 diabetes?
The recent meta-analysis did not reflect a significant impact on hypoglycemic events in type 2 diabetes.
Has any study reported a decrease in level 3 hypoglycemia? WITH CGM?
No, no study to date has reported a decrease in level 3 hypoglycemia.
According to the article, CGM showed a significant reduction in time spent?
Between 54 and 70 mg/dL
What is the range of improvement in A1C levels observed with CGM in people with type 1 and type 2 diabetes?
CGM improved A1C levels between 0.3 and 0.6%.
What is hypoglycemia unawareness also known as?
Hypoglycemia unawareness is also known as hypoglycemia-associated autonomic failure.
What are MICHANISM for hypoglycemia-associated autonomic failure?
1-Deficient counterregulatory hormone release.
2-diminished autonomic response are two risk factors for hypoglycemia-associated autonomic failure.
What are the different forms of glucagon available for injection?
The different forms of glucagon available for injection are traditional glucagon injection powder, intranasal glucagon, and ready-to-inject glucagon preparations for subcutaneous injection.
What factors should be considered when using glucagon products?
When using glucagon products, factors such as safety, efficacy, ease of use, and ensuring the products are not expired should be considered.
According to the provided content, what are CGM tools used for?
CGM tools are used to assess therapy and detect incipient hypoglycemia.
When is the use of glucagon indicated?
The use of glucagon is indicated for the treatment of hypoglycemia in people unable or unwilling to consume carbohydrates by mouth.
What is the purpose of using glucagon?
The purpose of using glucagon is to treat hypoglycemia in individuals who are unable or unwilling to consume carbohydrates by mouth.
What should an individual do after experiencing recurrent hypoglycemia?
The individual should be counseled to eat a meal or snack to prevent recurrent hypoglycemia.
What may lead to recurrent hypoglycemia unless more food is ingested after recovery?
Ongoing insulin activity or insulin secretagogues.
According to the article, what can increase insulin response without increasing plasma glucose concentrations?
Ingested protein FOR HYPOGLYCEMIA TTT
What should not be used to treat or prevent hypoglycemia, according to the article?
Carbohydrate sources high in protein
What is the potential treatment option for people with type 1 diabetes who have level 3 hypoglycemia and hypoglycemia unawareness that persists despite medical treatment?
Human islet transplantation may be an option, but it remains experimental.
What is the suggested treatment for people with type 1 diabetes who have hypoglycemia unawareness despite medical treatment?
Human islet transplantation, although experimental, may be considered as an option.
What is the proven effectiveness of CGM with automated low glucose suspend and hybrid closed-loop systems?
Reducing hypoglycemia in type 1 diabetes
What interventions may improve PEDIATRIC patient outcomes in HYPOGLYCEMIA?
Individualized glucose targets, patient education, nutrition intervention, physical activity management, medication adjustment, glucose monitoring, and routine clinical surveillance may improve patient outcomes.
What trial found an association of level 3 hypoglycemia with mortality?
The ADVANCE trial found an association of level 3 hypoglycemia with mortality.
What was significantly associated with subsequent episodes of level 3 hypoglycemia in the ACCORD trial?
Cognitive impairment at baseline or decline in cognitive function during the trial.
In the ACCORD trial, what level of hypoglycemia was significantly associated with cognitive impairment at baseline or decline in cognitive function?
Level 3 hypoglycemia.
What did a large cohort study suggest about the association between level 3 hypoglycemia and dementia?
A large cohort study suggested that among older adults with type 2 diabetes, a history of level 3 hypoglycemia was associated with greater risk of dementia.
What are the potential outcomes of level 3 hypoglycemia?
Level 3 hypoglycemia may progress to loss of consciousness, seizure, coma, or death.
What is the definition of level 3 hypoglycemia?
Level 3 hypoglycemia is defined as a severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery.
What are adrenergic and neuroglycopenic symptoms?
Adrenergic symptoms refer to the physiological responses such as sweating, trembling, and increased heart rate that occur during hypoglycemia. Neuroglycopenic symptoms, on the other hand, involve cognitive dysfunction, confusion, and altered mental status.
At what blood glucose concentration do neuroglycopenic symptoms begin to occur?
Neuroglycopenic symptoms begin to occur at a blood glucose concentration below 54 mg/dL (3.0 mmol/L).
What immediate action is required to resolve a hypoglycemic event at a blood glucose concentration below 54 mg/dL (3.0 mmol/L)?
Immediate action is required to resolve a hypoglycemic event at a blood glucose concentration below 54 mg/dL (3.0 mmol/L).
What blood glucose concentration is recognized as a threshold for neuroendocrine responses in people without diabetes?
70 mg/dL (3.9 mmol/L)
In which population has a blood glucose concentration of 70 mg/dL (3.9 mmol/L) been recognized as a threshold for neuroendocrine responses?
People without diabetes
What is the range for level 1 hypoglycemia?
The range for level 1 hypoglycemia is a measurable glucose concentration <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L).
What is suggested for ongoing assessment of cognitive function?
Ongoing assessment of cognitive function is suggested.
Who should be vigilant for hypoglycemia in relation to cognitive function?
The clinician, patient, and caregivers should be vigilant for hypoglycemia.
According to the article, when should insulin-treated patients with hypoglycemia unawareness raise their glycemic targets?
Insulin-treated patients with hypoglycemia unawareness should raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks.
What is the purpose of raising glycemic targets for insulin-treated patients with hypoglycemia unawareness?
The purpose is to partially reverse hypoglycemia unawareness and reduce the risk of future episodes.
What should trigger hypoglycemia avoidance education and treatment plan adjustment?
Hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia.
What is the purpose of hypoglycemia avoidance education and treatment plan adjustment?
To decrease hypoglycemia.
Who should be prescribed glucagon?
Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia.
Who should know how to administer glucagon?
Caregivers, school personnel, or family members providing support to these individuals should know how to administer glucagon.
Is glucagon administration limited to healthcare professionals?
No, glucagon administration is not limited to healthcare professionals.
What should be considered when assessing hypoglycemia?
Occurrence and risk for hypoglycemia should be reviewed at every encounter and investigated as indicated. Awareness of hypoglycemia should be considered using validated tools.
What is the preferred treatment for a conscious individual with blood glucose <70 mg/dL?
Glucose (approximately 15–20 g) is the preferred treatment for a conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate that contains glucose may be used.
What should be done if blood glucose monitoring shows continued hypoglycemia after treatment?
If blood glucose monitoring shows continued hypoglycemia after treatment, the treatment should be repeated. Once the blood glucose monitoring or glucose pattern is trending up, the individual should consume a meal or snack to prevent recurrence of hypoglycemia.
When should postprandial glucose be checked?
Postprandial glucose should be checked in individuals who have premeal glucose values within target but A1C values above target.
What is the recommended range for postprandial plasma glucose values?
The recommended range for postprandial plasma glucose values is <180 mg/dL (10.0 mmol/L)
What is the purpose of measuring postprandial plasma glucose when intensifying insulin therapy?
The purpose of measuring postprandial plasma glucose when intensifying insulin therapy is to help lower A1C by using treatments aimed at reducing postprandial plasma glucose values.
According to the article, what is considered the primary predictor of complications in diabetes?
A1C is considered the primary predictor of complications in diabetes.
Are postprandial glucose levels shown to be a cardiovascular risk factor independent of A1C?
No, intervention trials have not shown postprandial glucose to be a cardiovascular risk factor independent of A1C.
What has elevated postchallenge glucose values been associated with?
Increased cardiovascular risk independent of fasting plasma glucose
في وحدة عكسها
What is the peak postprandial capillary plasma glucose target?
The peak postprandial capillary plasma glucose target is <180 mg/dL (10.0 mmol/L).
What is the recommended A1C target for many nonpregnant adults with diabetes?
The recommended A1C target for many nonpregnant adults with diabetes is <7.0% (53 mmol/mol).
What is the recommended range for preprandial capillary plasma glucose for many nonpregnant adults with diabetes?
The recommended range for preprandial capillary plasma glucose for many nonpregnant adults with diabetes is 80-130 mg/dL (4.4-7.2 mmol/L).
What is the recommendation for people already on dual therapy or multiple glucose-lowering therapies who are not on an SGLT2 inhibitor or GLP-1 receptor agonist?
Consider switching to one of these agents with proven cardiovascular benefit.
What are the two agents with proven cardiovascular benefit that can be considered for people already on dual therapy or multiple glucose-lowering therapies?
SGLT2 inhibitors or GLP-1 receptor agonists.
When should SGLT2 inhibitors or GLP-1 receptor agonists be introduced in people with cardiovascular disease (CVD)?
At A1C goal, independent of metformin, for cardiovascular benefit, independent of baseline A1C or individualized A1C target.
What do the mortality findings in ACCORD and subgroup analyses of VADT suggest about the potential risks and benefits of intensive glycemic control?
The mortality findings suggest that the potential risks of intensive glycemic control may outweigh its benefits in higher-risk individuals.
What were the findings of the 0-year follow-up of the VADT cohort?
The findings demonstrated a reduction in the risk of cardiovascular event.
What evidence was found regarding cardiovascular benefit or harm in the ADVANCE trial? T2DM
Longer-term follow-up has shown no evidence of cardiovascular benefit, or harm, in the ADVANCE trial.
Did the ACCORD, ADVANCE, and VADT studies find a significant reduction in CVD outcomes with intensive glycemic control?T2DM
No, the ACCORD, ADVANCE, and VADT studies did not find a significant reduction in CVD outcomes with intensive glycemic control.
What was the reduction in CVD events during the UKPDS?
There was a 16% reduction in CVD events.
In the 9-year post-DCCT follow-up, what was the risk reduction percentage for nonfatal myocardial infarction, stroke, or cardiovascular death for participants previously randomized to the intensive arm compared to the standard arm? T1DM
Participants previously randomized to the intensive arm had a significant 57% reduction in the risk of nonfatal myocardial infarction, stroke, or cardiovascular death compared to those previously randomized to the standard arm.
In populations with diabetes, what is a more common cause of death than microvascular complications?
CVD (Cardiovascular Disease)
What were the three landmark trials conducted to test the effects of near normalization of blood glucose on cardiovascular outcomes?
The three landmark trials were ACCORD, ADVANCE, and VADT.
glucagon-like peptide 1 (GLP-1) receptor agonists and sodium–glucose cotransporter 2 (SGLT2) inhibitors were not approved at the time of these trials.
What is the association between lowering A1C from 7% to 6% (53 mmol/mol to 42 mmol/mol) and the risk of microvascular complications?
Lowering A1C from 7% to 6% (53 mmol/mol to 42 mmol/mol) is associated with a further reduction in the risk of microvascular complications.
What has been shown to reduce microvascular complications of type 1 and type 2 diabetes when instituted early in the course of disease?
Achieving A1C targets of <7% (53 mmol/mol)
What is the importance of glycemic control in people with short-duration type 2 diabetes?The Kumamoto Study and UK Prospective Diabetes Study (UKPDS)
Glycemic control significantly decreases rates of microvascular complications.
What were the findings of the DCCT trial in relation to glycemic control and microvascular complications in type 1 diabetes?
The DCCT trial found that better glycemic control, with A1C levels around 7%, was associated with a 50-76% reduction in rates of development and progression of microvascular complications such as retinopathy, neuropathy, and diabetic kidney disease in people with type 1 diabetes.
What were the microvascular complications studied in the DCCT trial?
The microvascular complications studied in the DCCT trial were retinopathy, neuropathy, and diabetic kidney disease.
What are some circumstances where less stringent A1C goals may be appropriate?
Less stringent A1C goals may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits.
What should healthcare professionals consider in patients with inappropriate stringent A1C targets?
Healthcare professionals should consider deintensification of therapy if appropriate to reduce the risk of hypoglycemia.
What is the recommended A1C goal for patients where the harms of treatment are greater than the benefits?
A1C goals of <8% (64 mmol/mol) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits.
What is the recommended target time in range for many nonpregnant adults using ambulatory glucose profile/glucose management indicator?
For many nonpregnant adults, the recommended target time in range is >70%.
What is the recommended time below range for many nonpregnant adults using ambulatory glucose profile/glucose management indicator?
The recommended time below range for many nonpregnant adults is <4%.
What is the recommended target time in range for those with frailty or at high risk of hypoglycemia using ambulatory glucose profile/glucose management indicator?
For those with frailty or at high risk of hypoglycemia, the recommended target time in range is >50%.
What is the recommended A1C goal for many nonpregnant adults without significant hypoglycemia?
The recommended A1C goal for many nonpregnant adults without significant hypoglycemia is <7% (53 mmol/mol).
What is the glycemic target for the ‘very low’ category?
The glycemic target for the ‘very low’ category is less than 1%.
What is the glycemic target for the ‘low’ category?
The glycemic target for the ‘low’ category is less than 4%.
What is the correlation between TIR and A1C?
Retrospective studies suggest a strong correlation between TIR and A1C.
What is the goal of 70% TIR aligned with?
A goal of 70% TIR is aligned with an A1C of ∼7%.
What is the primary measure used to guide glucose management?
The primary measure used to guide glucose management is A1C.
What are the CGM metrics that provide insights for personalized diabetes management?
The CGM metrics that provide insights for personalized diabetes management are TIR (time in range), time below range, and time above range.
What has become a standard method for glucose monitoring for most adults with type 1 diabetes?
CGM (Continuous Glucose Monitoring)
What is the recommended duration for wearing a CGM device?
The recommended duration for wearing a CGM device is 14 days.
What is the target percentage of time the CGM device should be active?
The target percentage of time the CGM device should be active is 70% of data from 14 days.
What does TIR stand for and what is its target range?
TIR stands for Time In Range. Its target range is 70-180 mg/dL (3.9-10.0 mmol/L).
What is one parameter that can be used for the assessment of glycemic control?
Time in range
What are time below range and time above range useful parameters for?
Evaluation of the treatment plan
How much lower is the A1C in African American individuals heterozygous for the common hemoglobin variant HbS?
About 0.3 percentage points lower.
Were there any significant differences among racial and ethnic groups in the regression lines between A1C and mean glucose?
No, there were no significant differences among racial and ethnic groups in the regression lines between A1C and mean glucose.
What conditions may result in discrepancies between the A1C result and the patient’s true mean glycemia?
Conditions that affect red blood cell turnover (hemolytic and other anemias, glucose-6-phosphate dehydrogenase deficiency, recent blood transfusion, use of drugs that stimulate erythropoiesis, end-stage kidney disease, and pregnancy) may result in discrepancies between the A1C result and the patient’s true mean glycemia.
How frequently should unstable or intensively managed patients or people not at goal with treatment adjustments require testing?
They may require testing every 3 months with interim assessments as needed for safety.
Who may require testing every 3 months with interim assessments as needed for safety?
Unstable or intensively managed patients or people not at goal with treatment adjustments.
How often should people with type 2 diabetes with stable glycemia well within target get A1C testing or other glucose assessment?
Twice per year.
Can a 14-day CGM assessment of TIR and GMI be used as a surrogate for A1C in clinical management?
Yes, a 14-day CGM assessment of TIR and GMI can serve as a surrogate for A1C in clinical management.
How frequently should A1C testing be done to determine glycemic targets?
A1C testing should be done approximately every 3 months to determine whether patients’ glycemic targets have been reached and maintained.
How often should glycemic status be assessed in patients who are meeting treatment goals and have stable glycemic control?
At least two times a year.
How often should glycemic status be assessed in patients whose therapy has recently changed and/or who are not meeting glycemic goals?
At least quarterly and as needed.
What are the recommended glycemic measurements for assessing glycemic status?
A1C or other glycemic measurement such as time in range or glucose management indicator.
