Diabetes Guidelines and Monitoring

Question 1

2 Goals of Therapy by ADA

Answer 1

1. More strict and lower A1c goal less than 6.5% if possible without significant hypoglycemia or AE
2. Less strict and higher A1c goal less than 8% may be appropriate for specific patients

Question 2

What patients would receive the less than 8% goal?

Answer 2

• History of severe hypoglycemia
• Limited life expectancy
• Advanced micro or macrovascular complications
• Extensive comorbid conditions
• DM long duration and difficult to achieve despite appropriate care

Question 3

Normal FBG Goal

Answer 3

90-130

Question 4

Normal Bedtime glucose Goal

Answer 4

90-150

Question 5

Estimated Average Glucose Formula

Answer 5

(28.7*HbA1c)-46.7

Question 6

A1c of 6 =

Answer 6

126

Question 7

A1c of 7 =

Answer 7

154

Question 8

Monitoring of A1c?

Answer 8

If at goal and stable: twice yearly

If not at goal or change in therapy: quartly

Question 9

Advantages of A1c

Answer 9

 Results not significantly affected by acute stress

 More stable compared to FPG or OGTT

Question 10

False Low A1c

Answer 10

Blood loss
Sickle Cell Anemia
HyperTG

Question 11

Falsely High A1c

Answer 11

Iron or B12 deficiency

Chronic alcohol intake

Question 12

ADA Treatment Guidelines- First line

Answer 12

Lifestyle Changes

Question 13

ADA Treatment Guidelines A1c

Answer 13

A1c

Question 14

AACE/ACE Treatment Guidelines A1c

Answer 14

A1c 9% + symptomatic : Consider insulin ± other agents

Question 15

VA/DoD Treatment Guidelines A1c

Answer 15

A1c ≤ 2% above target
• Monotherapy
• Metformin or SU (unless contraindicated)
• Alternative agents: AGI, DPP4I, GLP-1RA, glinide, TZD

A1c > 2% above target : Consider insulin ± other agents

Question 16

SU efficacy, hypo risk, weight, side effects, cost

Answer 16

High
Moderate risk
Gain
Hypoglycemia
Low

Question 17

TZDs efficacy, hypo risk, weight, side effects, cost

Answer 17

High
Low risk
Gain
Edema, HF
Low

Question 18

DPP-4 Inhibitor efficacy, hypo risk, weight, side effects, cost

Answer 18

Intermediate
Low risk
Neutral
Rare
High

Question 19

SGLT-2 inhibitor efficacy, hypo risk, weight, side effects, cost

Answer 19

Intermediate
Low risk
Lose
GU, dehydration
High

Question 20

GLP-1 Agonists efficacy, hypo risk, weight, side effects, cost

Answer 20

Hihg
Low risk
Loss
GI
High

Question 21

Insulin efficacy, hypo risk, weight, side effects, cost

Answer 21

Highest
High risk
Gain
Hypoglycemia
Variable

Question 22

Macrovascular Risks

Answer 22

Increased risk of CVD through MI, stroke, dyslipidemia, hypertension

Question 23

HTN goal with DM

Answer 23

140/90

Question 24

Microvascular Risk

Answer 24

Nephropathy
Retinopathy
Neuropathy

Question 25

Required Vaccinations?

Answer 25

Pneumococcal and Hepatitis B

Question 26

Pneumococcal Dosing Strategies

Answer 26

• ≥ 2 years of age: PPSV23
• ≥ 65 years of age (not previously vaccinated): PCV13, then PPSV23 after 6-12 months
• ≥ 65 years of age (prior PPSV23 vaccine at ≥ 65 years of age): PCV13 after ≥ 12 months
• ≥ 65 years of age (prior PPSV23 vaccine at

Question 27

Hepatitis B Vaccination Strategy

Answer 27

Administer to anyone who is unvaccinated between 19-59