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Geriatrics > DM > Flashcards

DM Flashcards

1
Q

By 2050, the incidence of DM in the US will increase by how much?

A

65-74 years: 220%

>/= 75 years: 449%

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2
Q

What does the 2013 AGS recommend with diabetes?

A

Smoking cessation
ASA
HTN
Glycemic control

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3
Q

In what age group is aspirin use cautioned?

A

80+

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4
Q

When is ASA therapy not recommended?

A

Take other anticoagulant therapy

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5
Q

What is the HTN goal for elderly patients with DM?

A

< 140/90

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6
Q

What SBP has potential for harm in elderly with DM?

A

< 120

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7
Q

What do we monitor with ACE/ARB therapy in DM?

A

Renal function and serum potassium 1-2 weeks after initiation or dose increase and at least yearly

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8
Q

What do we monitor in patients taking thiazide or loop diuretics?

A

Check electrolytes 1-2 weeks after initiation or dose increase and at least yearly

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9
Q

What is the general A1c goals per the AGS 2013 AACE?

A

<7.5 - 8%

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10
Q

What A1c has potential harm per the AGS 2013 AACE?

A

< 6.5%

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11
Q

What is the A1c goal for a healthy patient with few comorbidities, and good functional status per the AGS 2013 AACE?

A

7 - 7.5%

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12
Q

What is the A1c goal in a patient with multiple comorbidities, poor health, and limited life expectancy per the AGS 2013 AACE?

A

8 - 9%

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13
Q

How often do we check A1c if it is unstable per the AGS 2013 AACE?

A

Every 6 months

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14
Q

What is the A1c goal for a healthy patient per the 2017 ADA?

A

< 7.5%

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15
Q

What is the FBG for a healthy patient per the 2017 ADA/AGS?

A

90-130

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16
Q

What is the bedtime glucose for a healthy patient per the 2017 ADA/AGS?

A

90-150

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17
Q

What is the blood pressure for a healthy patient per the 2017 ADA/AGS?

A

< 140/80

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18
Q

Should a healthy patient be given a statin per the 2017 ADA/AGS?

A

Yes unless CI or not tolerated

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19
Q

What is the A1c goal for a complex/intermediate patient per the 2017 ADA/AGS?

A

< 8.0%

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20
Q

What is the FBG goal for a complex/intermediate patient per the 2017 ADA/AGS?

A

90-150

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21
Q

What is the bedtime glucose goal for a complex/intermediate patient per the 2017 ADA/AGS?

A

100-180

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22
Q

What is the BP goal for a complex/intermediate patient per the 2017 ADA/AGS?

23
Q

Should statins be used in complex/intermediate patients per the 2017 ADA/AGS?

A

Yes unless CI or not tolerated

24
Q

What is the A1c goal for a very complex/poor health patient per the 2017 ADA/AGS?

25
Q

What is the FBG goal for a very complex/poor health patient per the 2017 ADA/AGS?

26
Q

What is the bedtime glucose goal for a very complex/poor health patient per the 2017 ADA/AGS?

27
Q

What is the BP goal for a very complex/poor health patient per the 2017 ADA/AGS?

28
Q

Should a statin be used in a very complex/poor health patient per the 2017 ADA/AGS?

A

Consider likelihood of benefit with statin (secondary prevention more so than primary)

29
Q

What are the special considerations groups in geriatrics w/DM?

A

Hypoglycemia
Cognitive dysfunction
Functional impairment
Vision/hearing impairments

30
Q

Why is hypoglycemia dangerous in geriatric patients?

A

Studies show delay in sx recognition but greater deterioration of psychomotor coordination in older adults
Linked to increased risk of dementia (d/t extreme hypoglycemia repeatedly)

31
Q

Why is hyperglycemia dangerous in geriatric patients?

A

Increased risk of dehydration, electrolyte abnormalities when BG is above the renal threshold for glycosuria
May increase risk of hyperglycemia hyperosmolar syndrome (HHS)

32
Q

Why is cognitive dysfunction dangerous in geriatric patients?

A

2x more prevalent with DM

Increased risk of hypoglycemia

33
Q

Why is functional impairment dangerous in geriatric patients?

A

Increased perhaps d/t neuropathy

34
Q

Why are vision/hearing impairments dangerous in geriatric patients?

A

Impacts med and education options (for example, patient can only afford insulin by vial and syringe but can s/he clearly see syringe to draw up appropriate dose?)

35
Q

What are the pros of metformin?

A 
Oral option
Cheap
Low hypoglycemia risk
Weight neutral
1-2% decrease in A1c
36
Q

What are the cons of metformin?

A

Renal adjustments
GI AEs
Increased risk of lactic acidosis in dehydration/worsening renal function

37
Q

What are the pros for sulfonylureas?

A

Decreased macrovascular events
Oral option
Cheap
Effective A1c lowering, especially PPGB

38
Q

What are the cons for sulfonylureas?

A

Hypoglycemia risk
Weight gain
Renal (glimepiride) and hepatic (glipizide) adjustments

39
Q

Why are sulfonylureas on the Beers list?

A

Glyburide for hypoglycemia

40
Q

What are the pros for TZDs?

A 
Oral option
Generic available
Insulin sensitizer
Increases HDL, decreases TG
Cheaper option
41
Q

What are the cons for TZDs?

A

Fluid retention
BBW: HF
Potential risk of edema, fracture, macular edema
Pt has personal h/o bladder cancer

42
Q

What are the pros for DPP-4i?

A 
Oral option
Rarely causes hypoglycemia
Wt gain neutral
Well tolerated
Use in poor renal function (tradjenta dose not require dose adjustments)
43
Q

What are the cons of DPP-4i?

A

Brand name only
Minimal A1c lowering
Pancreatitis concerns
HF hospitalization

44
Q

What are the pros of GLP-1 agonists?

A

Easier to use pen devices
Low hypoglycemia risk
Wt loss
Moderate A1c lowering

45
Q

What is Liraglutide good for in high risk populations?

A

CV benefit

46
Q

What are cons of GLP-1 agonists?

A 
Visual impairment
Dexterity issues
Potential GI AEs
Pancreatitis
Thyroid cancer concerns
Brand
47
Q

What are pros of SGLT-2

A

Oral option
Low hypoglycemia risk
Weiht loss

48
Q

What is empagliflozin and invokana good for in high risk populations?

A

CV benefit

49
Q

What are cons of SGLT-2i?

A 
H/o UTI
Risk of genital mycotic infection
Risk of DKA
Impacts renal function
Brand name
Canagliflozin - hyperkalemia, increased fracture risk, increased amputation risk
50
Q

What did the LIPID trial subgroup determine?

A

Pravastatin reduced risk for all CVD events in both older and younger groups

51
Q

In patients greater than 65, what does increased LDL correlate to?

A

Increased relative risk of death d/t coronary heart disease

52
Q

In patients greater than 80, which part of cholesterol improved 2 year survival?

53
Q

Aronom determined what about statin use in patients with a history of MI and LDL > 125?

A

Reduced risk of death from coronary heart disease and non-fatal MI, stroke, HF
In those > 90, significant reduction in new coronary heart dz
<90, reduced the risk of new stroke

54
Q

What did the PROSPER trial determine?

A

Ages 70-82 years patients
Pravastatin decreased LDL and significant reduction in primary composite endpoint
Increased new cancers

Geriatrics (15 decks)

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