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PT in Specific Groups > Additional diabetes > Flashcards

Additional diabetes Flashcards

1
Q

Normal PG (fast/2hr)

A

Fast < 5.6

2hr < 7.8

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2
Q

What percentage of Australians have pre-diabetes?

A

16%

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3
Q

What is Syndrome X?

A

Diabetes, obesity, HT, dyslipidaemia

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4
Q

Which trial grouped people into 3-4 injections vs 1-2?

A

Diabetes Control and Complications Trial (DCCT) - RCT

Observational follow-up by EDIC

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5
Q

In the DCCT trial, what was the method?

A

3-4 insulin injections/day + 4x monitoring/day

VS

1-2 insulin injections/day + 1x BGL monitoring/day

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6
Q

What were the results of the DCCT trial?

A

Stopped after 6.5 yrs - too strong support for intensive.

Intensive = 7.3% HbA1c
Conventional = 9.1% HbA1c
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7
Q

If HbA1c dropped by 10% in the DCCT trial, what risks changed?

A

39% decreased risk of retinopathy

25% nephropathy

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8
Q

EDIC showed…

A

Less progression of retinopathy and nephropathy

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9
Q

Which study assessed the effects of a 1% HbA1c drop, and who did it examine?

A

UK Prospective Diabetes Study (UKPDS)

T2DM

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10
Q

1% HbA1c drop in T2DM =? (UKPDS)

A 
(Less)
43% PVD (= less amputation/death)
37% microvascular disease
21% diabetes-related deaths
14% MI
12% stroke
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11
Q

What did the UKPDS say about SBP?

A

For each 10mmHg reduction in SBP
• 25% ¯ risk for PVD
• 15% ¯ diabetes-related death
• 13% ¯ risk for microvascular complications
• 12% ¯ risk for any diabetic complication
• 11% ¯ risk for MI

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12
Q

When is assessment needed?

A

If commencing new exercise that is more intense than brief walking

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13
Q

What happened in the Malmö study?

A

Early T2DM, IGT, non-diabetic

Diet and exercise (2x60min/wk)

After 5yrs

  • reduced CV risk
  • Improved fitness
  • 55% with T2DM no longer reached diagnostic levels
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14
Q

Who looked at brisk walking and diet in pre-diabetes?

A

Diabetes Prevention Program Research Group

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15
Q

Clinical aims of T2DM Rx

A 
1. HbA1c reduction
2.
- insulin sensitivity
- active lifestyle
- diet
- BMI etc
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16
Q

MDT involvement

A
  • Endocrinologist (insulin)
  • GP
  • Dietician
  • PT/ex phys
  • Diabetes educator
  • Podiatrist
  • Home nursing
  • OT
17
Q

Exercise Ax

A
  • 1RM for each major mm group
  • Aerobic capacity (6mWT, HR/BP on bike)
  • Questionnaire (levels of activity
  • Blood lipid profile

Consider need for formal exercise stress test (with 12 lead ECG)

18
Q

Monitoring for exercise:

A

BGL before/after
HR
RPE
HbA1c (endocrinologist)

19
Q

Possible goals:

A 
Balance
Walk distance
Gait aid
Contracture
Respiratory
ADLs
Stairs
HbA1c
Insulin sensitivity
20
Q

Reductions in HbA1c with strength or aerobic?

A

Usually just strength

PT in Specific Groups (5 decks)

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