Additional diabetes

Question 1

Normal PG (fast/2hr)

Answer 1

Fast < 5.6

2hr < 7.8

Question 2

What percentage of Australians have pre-diabetes?

Answer 2

16%

Question 3

What is Syndrome X?

Answer 3

Diabetes, obesity, HT, dyslipidaemia

Question 4

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

Answer 4

Diabetes Control and Complications Trial (DCCT) - RCT

Observational follow-up by EDIC

Question 5

In the DCCT trial, what was the method?

Answer 5

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

VS

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

Question 6

What were the results of the DCCT trial?

Answer 6

Stopped after 6.5 yrs - too strong support for intensive.

Intensive = 7.3% HbA1c
Conventional = 9.1% HbA1c

Question 7

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

Answer 7

39% decreased risk of retinopathy

25% nephropathy

Question 8

EDIC showed…

Answer 8

Less progression of retinopathy and nephropathy

Question 9

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

Answer 9

UK Prospective Diabetes Study (UKPDS)

T2DM

Question 10

1% HbA1c drop in T2DM =? (UKPDS)

Answer 10

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

Question 11

What did the UKPDS say about SBP?

Answer 11

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

Question 12

When is assessment needed?

Answer 12

If commencing new exercise that is more intense than brief walking

Question 13

What happened in the Malmö study?

Answer 13

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

Question 14

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

Answer 14

Diabetes Prevention Program Research Group

Question 15

Clinical aims of T2DM Rx

Answer 15

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

Question 16

MDT involvement

Answer 16

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

Question 17

Exercise Ax

Answer 17

• 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)

Question 18

Monitoring for exercise:

Answer 18

BGL before/after
HR
RPE
HbA1c (endocrinologist)

Question 19

Possible goals:

Answer 19

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

Question 20

Reductions in HbA1c with strength or aerobic?

Answer 20

Usually just strength