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ADA2025 Flashcards

1
Q

¿Por que se caracteriza la diabetes mellitus?

A

Desórdenes del metabolismo de carbohidratos que llevan a la baja utilización de glucosa como fuente de energía y una sobreproducción de de esta debido a gluconeogenesis y glucogenolisis resultando en hiperglucemia.

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2
Q

¿Cuales son las principales categorías clínicas de la diabetes?

A
  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes mellitus
  • Other specific types (e.g., monogenic diabetes, exocrine pancreatic disorders)
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3
Q

¿Cuales son los tests que se usan para tamizaje y diagnostico de diabetes?

A
  • Glucosa en ayuno (FPG)
  • Glucosa plasmática después de 2 horas de 75g en una CTOG
  • HbA1C
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4
Q

Cuales son los valores de HbA1C para diagnosticar DM?

A

A1C ≥ 6.5% (≥ 48 mmol/mol).

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5
Q

Valores de glucosa plasmática en ayuno para diagnosticar diabetes?

A

FPG ≥ 126 mg/dL (≥ 7.0 mmol/L).

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6
Q

Valores de la TCOG en 2 horas para diagnosticar diabetes?

A

2-h PG ≥ 200 mg/dL (≥ 11.1 mmol/L).

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7
Q

¿Que nos indican los niveles >200 mg/dL de glucosa plasmatica aleatoria?

A

Indican diabetes SI están acompañados de síntomas de hiperglucemia o una crisis hiperglucémica.

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8
Q

Que es prediabetes en terminos de HbA1C?

A

A1C of 5.7–6.4% (39–47 mmol/mol).

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9
Q

Que niveles definimos por glucosa plasmática en ayuno alterada?

A

FPG of 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L).

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10
Q

Niveles de intolerancia a la glucosa:

A

2-h PG during OGTT of 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L).

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11
Q

¿Qué factores pueden alterar los resultados de la HbA1C?

A
  • Hemoglobin variants
  • Anemia
  • Erythropoietin therapy
  • Recent blood loss or transfusion
  • Hemolysis
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12
Q

¿Como se define el ayuno?

A

Se define como la ausencia de ingesta calorica 8 horas antes de la prueba

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13
Q

¿Que puede aumentar los niveles de glucosa falsamente durante una CTOG?

A

Antecedente de restricción de carbohidratos en los dias anteriores a la prueba.

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14
Q

¿Cuantos gramos de carbohidratos es recomendado consumir antes de la CTOG?

A

Mínimo 150g en los 3 días antes de la prueba.

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15
Q

¿Que mide indirectamente la HbA1C?

A

Exposición a la glucosa.

A1C levels can be influenced by factors such as hemoglobin concentrations or erythrocyte turnover

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16
Q

¿En qué condiciones la HbA1C podría NO ser útil para diagnóstico de diabetes?

A

Anemia, tratamiento con EPO, hemodialysis, HIV treatment

These conditions can affect hemoglobin variants, leading to inaccurate A1C results

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17
Q

¿Qué fármacos aumentan el riesgo de prediabetes o diabetes?

A

Glucocorticoides, estatinas, tiazidas, ttx. para VIH, antipsicóticos.

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18
Q

What genetic variant is associated with decreased A1C levels in African American individuals?

A

X-linked glucose-6-phosphate dehydrogenase G202A

This variant decreases A1C by about 0.8% in homozygous men and 0.7% in homozygous women

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19
Q

¿Que se requiere para confirmar diagnóstico de diabetes si no hay síntomas clásicos?

A

Dos pruebas de tamizaje anormales.

Tests can be from the same time or different time points

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20
Q

¿Que se debería de hacer si tenemos dos resultados discordantes dos de pruebas diferentes?

A

Repetir la prueba con el resultado más alto.

Factors affecting A1C or glucose levels should be taken into account

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21
Q

¿Cual es un sintoma caracteristico de diabetes tipo 1 en niños?

A

Polyuria/polydipsia

Approximately half present with diabetic ketoacidosis (DKA)

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22
Q

Para que se usa la evaluación AABBCC?
¿Y que es?

A

Distinguishing diabetes type

It considers Age, Autoimmunity, Body habitus (IMC), Background, Control, and Comorbidities

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23
Q

¿Cuál es el rango de edad máximo para la seroconversión en la diabetes tipo 1?

A

9 to 24 months

Seroconversion usually does not occur before 6 months of age

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24
Q

What does LADA stand for?

A

Latent autoimmune diabetes in adults

This classification highlights the slow autoimmune destruction of beta cells in adults

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25
What distinguishes type 1 diabetes from type 2 diabetes regarding age of onset?
Type 1 can occur at any age; Type 2 is traditionally thought to onset only in adults ## Footnote Both types can present in all age groups
26
What are features that suggest type 1 diabetes?
Younger age at diagnosis (<35 years), lower BMI (<25 kg/m²), unintentional weight loss, ketoacidosis, plasma glucose >360 mg/dL ## Footnote These features are more useful in determining type 1 diabetes
27
What is the clinical priority with the detection of LADA?
Awareness that slow autoimmune b-cell destruction can occur in adults
28
What classification includes all forms of diabetes mediated by autoimmune b-cell destruction?
Type 1 diabetes
29
What is the common denominator in type 2 diabetes?
Deficient b-cell insulin secretion, frequently in the setting of insulin resistance
30
What factors are associated with insulin secretory defects in type 2 diabetes?
Genetic predisposition, epigenetic changes, inflammation, and metabolic stress
31
What is recommended for screening presymptomatic type 1 diabetes?
Detection of autoantibodies to insulin, GAD, IA-2, or ZnT8 (son los mismos para la DM1)
32
Who should be offered autoantibody-based screening for presymptomatic type 1 diabetes?
Those with a family history of type 1 diabetes or known elevated genetic risk
33
What is Stage 1 of type 1 diabetes characterized by? Mention the diagnostic criteria for it.
Presence of two or more autoantibodies and normoglycemia. DC: Multiple islet autoantibodies, normal A1C, no IFG, no IGT
34
What defines Stage 2 of type 1 diabetes? Mention the diagnostic criteria:
Multiple islet autoantibodies and dysglycemia not yet diagnostic of diabetes. DC: Multiple islet autoantibodies, FPG: 100-125 mg/dL, IGT: 2h 140-199mg/dL or A1C: 5.7-6.4% or >10% increase in A1C
35
What defines Stage 3 of type 1 diabetes? Mention the diagnostic criteria:
Overt hyperglycemia, symptomatic. DC: Autoantibodies may become absent and diabetes by standard criteria.
36
What characterizes immune-mediated diabetes?
Autoimmune destruction of pancreatic b-cells
37
What is the link between type 1 diabetes and HLA associations?
Strong linkage to DQB1 and DRB1 haplotypes
38
What is the significance of the cytokine storm in COVID-19 concerning diabetes?
It could contribute to b-cell damage
39
What characterizes idiopathic type 1 diabetes?
Permanent insulinopenia with no evidence of b-cell autoimmunity
40
What percentage of individuals with type 1 diabetes have no known relative with the disease?
90%
41
What is recommended after the first autoantibody-positive test?
Confirm with a second test within 3 months
42
At what age should screening for type 2 diabetes begin for those without prediabetes? (And asymptomatic patients)
Before age 35
43
What tests are appropriate for screening prediabetes and type 2 diabetes?
FPG, 2-h PG during 75-g OGTT, and A1C ## Footnote These tests help diagnose abnormal glucose metabolism.
44
What is the definition of prediabetes?
Glucose or A1C levels that do not meet diabetes criteria but indicate dysglycemia ## Footnote Defined by IFG, IGT, or A1C 5.7–6.4%.
45
What is the A1C range that identifies individuals at high risk for diabetes?
A1C range of 5.7–6.4% (39–47 mmol/mol) ## Footnote This group is also at risk for cardiovascular outcomes.
46
What are the risk factors for screening for diabetes in asymptomatic adults?
Overweight or obesity and one or more risk factors such as: * First-degree relative with diabetes * High-risk race or ethnicity * History of cardiovascular disease * Hypertension * Low HDL cholesterol * Physical inactivity * Other conditions associated with insulin resistance ## Footnote These factors increase the likelihood of developing diabetes.
47
What is the significance of gestational diabetes mellitus (GDM) in diabetes screening?
Individuals diagnosed with GDM should be tested at least every 1–3 years ## Footnote GDM increases the risk of developing type 2 diabetes later.
48
What is the relationship between obesity and type 2 diabetes?
Most individuals with type 2 diabetes have overweight or obesity, which causes insulin resistance ## Footnote Abdominal fat distribution can also contribute to metabolic issues.
49
True or False: DKA commonly occurs spontaneously in type 2 diabetes.
False ## Footnote DKA is rare in type 2 diabetes and usually arises under specific conditions.
50
What are the screening considerations for youth at risk of type 2 diabetes?
Screen if they have overweight or obesity and one or more additional risk factors such as: * Maternal history of diabetes * Family history of type 2 diabetes * Signs of insulin resistance ## Footnote Screening should start after puberty or age 10.
51
What is the definition of insulin resistance?
Decreased biological responses to insulin ## Footnote It is a key factor in the development of type 2 diabetes.
52
What is the relationship between A1C levels and diabetes risk?
As A1C rises, the diabetes risk increases disproportionately ## Footnote This highlights the importance of monitoring A1C levels.
53
What is the primary characteristic of type 2 diabetes?
Relative insulin deficiency and insulin resistance ## Footnote It is the most common form of diabetes, accounting for 90–95% of cases.
54
Fill in the blank: Individuals diagnosed with GDM should have testing at least every _______.
1–3 years
55
What is the relationship between age and diabetes type according to Thomas NJ et al. (2019)?
Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age
56
What are immune checkpoint inhibitors associated with regarding diabetes?
Risk of type 1 diabetes
57
What does the term 'autoimmune polyendocrine syndrome' refer to?
A condition involving multiple autoimmune disorders
58
What does the term 'beta-cell autoimmunity' refer to?
The immune response that targets insulin-producing beta cells in the pancreas ## Footnote Kimpimäki et al. (2002) discussed the natural history of this autoimmunity in young children.
59
True or False: Diabetic ketoacidosis is a complication associated with type 1 diabetes.
True ## Footnote Umpierrez and Korytkowski (2016) discussed various diabetic emergencies including ketoacidosis.
60
What are SGLT2 inhibitors known for in the context of diabetes?
They are associated with a risk of diabetic ketoacidosis ## Footnote Fadini et al. (2017) reported on data from the FDA Adverse Event Reporting System regarding this risk.
61
What does 'metabolic surgery' aim to achieve in type 2 diabetes treatment?
It aims to provide remission of type 2 diabetes ## Footnote Cresci et al. (2020) conducted a network meta-analysis on the effectiveness of metabolic surgery.
62
What is the impact of bariatric surgery on diabetes?
It can lead to remission or improvement of type 2 diabetes symptoms ## Footnote Conte et al. (2020) reported on the outcomes of bariatric surgery on diabetes remission.
63
What is posttransplant diabetes mellitus?
Diabetes that occurs after transplantation, with implications for treatment and outcomes ## Footnote Discussed in various studies and reviews
64
What are some causes of posttransplant diabetes mellitus?
Multiple factors including immunosuppressive therapy and genetic predisposition ## Footnote Detailed in the literature on kidney transplantation
65
What is one recommendation for managing post-transplant diabetes mellitus?
Focus on glycemic control and monitoring clinical outcomes ## Footnote Emphasized in clinical guidelines and studies
66
What is the relationship between glycemic control and clinical outcomes after kidney transplantation?
Poor glycemic control is associated with adverse clinical outcomes ## Footnote Explored in research studies
67
What are risk factors for post-transplantation diabetes mellitus?
Immunosuppressive medication, obesity, and family history of diabetes ## Footnote Identified in various studies on kidney transplantation
68
What is maturity-onset diabetes of the young (MODY)?
A form of monogenic diabetes characterized by specific genetic mutations ## Footnote Includes mutations in genes like HNF1A and GCK
69
What are the criteria for diagnosing gestational diabetes?
Based on glucose tolerance tests during pregnancy ## Footnote IADPSG criteria recommended for diagnosis
70
What is the association between gestational diabetes and childhood obesity?
Gestational diabetes is linked to increased childhood adiposity ## Footnote Found in studies examining long-term effects of maternal diabetes
71
What is the significance of first-trimester hemoglobin A1c levels?
Associated with adverse pregnancy outcomes ## Footnote Explored in a population-based study
72
What is the significance of newborn adiposity in the study by Josefson et al. in 2021?
Mediators of the maternal metabolic environment and childhood adiposity ## Footnote Diabetes Care 2021;44:1194–1202
73
What are the findings of Tam et al. regarding maternal hyperglycemia?
In utero exposure increases childhood cardiometabolic risk ## Footnote Diabetes Care 2017;40:679–686
74
Genes involucrados en la patogénesis del MODY:
HNF1A, HNF4A, HNF1B, GCK.
75
Valores diagnósticos de DMG en la prueba de un paso:
Prueba de un paso: FG: 92 mg/dL CTOG 75g: 1h= 180mg/dL, 2h= 153 mg/dL Durante las semanas 24-28.
76
Valores diagnósticos de DMG en la prueba de dos pasos:
Prueba de dos pasos: P1: CTOG 50g a las 24-28 semanas(no ayuno): 1h= >130 mg/dL realizar una CTOG con 100 mg/dL. P2: CTOG 100 g (ayuno): FG= 95 mg/dL 1h= 180 mg/dL 2h= 155 mg/dL 3h= 140 mg/dL

Endocrinología (4 decks)

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