Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ADA 24 > Dm overview 2024 > Flashcards

Dm overview 2024 Flashcards

محاضرة عبدالعزيز

1
Q

What percentage of individuals with type 2 diabetes in the U.S. have obesity?

A

One-third (33.33%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the recommended screening strategy for LIVER FIBROSIS INpeople with prediabetes and type 2 diabetes in primary care?

A

Using the fibrosis-4 index (FIB-4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why would a screening strategy based only on elevated plasma aminotransferases miss most individuals with NASH?

A

It would miss clinically significant fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the upper limit ranges of normal ALT levels for male and female individuals?

A

29-33 units/L for males, 19-25 units/L for females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When should adults with type 2 diabetes or prediabetes be screened for liver fibrosis?

A

They should be screened even if they have normal liver enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does a negative FIB-4 result rule out regarding liver fibrosis?

A

A negative result rules out fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What additional risk assessmenttool is recommended for individuals with an indeterminate or high FIB-4?

A

Liver stiffness measurement or ELF blood test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What action should be taken for individuals at high risk for significant liver fibrosis?

A

They should be referred to a gastroenterologist or hepatologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is considered low risk and high risk levels for FIB-4 scores?

A

Low risk <1.3, high risk >2.67

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does liver stiffness measurement (LSM) <8.0 kPa indicate?

A

It indicates low risk for clinically significant fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What action is recommended if LSM is >12 kPa for people with diabetes?

A

They should be referred to a hepatologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is considered low risk in the Enhanced Liver Fibrosis (ELF) test?

A

<7.7 in the ELF test is considered low risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is routine screening for coronary artery disease recommended in asymptomatic individuals?

A

No, routine screening is not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does A1C 8.5% correspond to in mmol/mol?

A

69 mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do the initials BGM represent in diabetes management?

A

Blood Glucose Monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Expand CGM in the context of diabetes monitoring.

A

Continuous Glucose Monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define DKA in the diabetic context.

A

Diabetic Ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Expand GLP-1 as used in diabetes treatment.

A

Glucagon-Like Peptide 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does HHNK stand for in the realm of diabetes complications?

A

Hyperosmolar Hyperglycemic Nonketotic Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Expand the abbreviation ‘MDI’ when related to diabetes treatment.

A

Multiple Daily Injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

According to the ADA position statement, who may consider metabolic surgery for Adolescents type 2 diabetes?

A

Adolescents with class 2 obesity, elevated A1C, and serious comorbidities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What BMI threshold is recommended for considering metabolic surgery in adolescents with type 2 diabetes?
BMI?
PERCENTILE?

A

BMI >35 kg/m2 or 120% of 95th percentile for age and sex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In which situations should metabolic surgery be considered for adolescents with type 2 diabetes as per the recommendation?

A

For those with elevated A1C and/or serious comorbidities despite lifestyle and pharmacologic intervention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How many units of short- or rapid-acting insulin should be given for premeal glucose >250 mg/dL?

A

2 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What should be done if more than 50% of premeal nger-stick values over 2 weeks are above the goal?

A

Increase the dose of medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

For premeal glucose >350 mg/dL, how many units of short- or rapid-acting insulin should be given?

A

4 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

..

A

..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

..

A

..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Name two examples of basal insulins.

A

Glargine U-100 and U-300, detemir, degludec, human NPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are examples of prandial insulins?

A

Short-acting (regular human insulin), rapid-acting (lispro, aspart, glulisine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

List three examples of premixed insulins.

A

70/30, 75/25, 50/50 products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Give examples of noninsulin agents for diabetes management.

A

Metformin, SGLT2 inhibitors, DPP-4 inhibitors, GLP-1 receptor agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

..

A

..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When should the screening for thyroid disease start in pediatric type 1 diabetes?

A

Soon after diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What follow-up frequency is recommended for thyroid disease screening in pediatric diabetes?

A

Every 1-2 years if normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the treatment for hypertension in pediatric type 1 diabetes?

A

Optimize glycemia, lifestyle modification, ACE inhibitor or ARB therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How often should screening for hypertension be optimized in pediatric diabetes if normal?

A

Every 2 years if normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the recommended LDL level in pediatric diabetes?

A

LDL <100 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What classes of drugs are recommended for treating hypertension in individuals with diabetes?

A

ACE inhibitors, ARBs, dihydropyridine calcium channel blockers, and thiazide-like diuretics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When should serum creatinine and potassium levels be monitored after initiation of ACE inhibitor, ARB, MRA, or diuretic therapy?

A

Within 7-14 days after initiation and at least annually thereafter.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is chronic kidney disease (CKD) classified based on GFR and albuminuria levels?

A

CKD is classified based on GFR categories (G1-G5) and albuminuria levels (A1-A3).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What lifestyle reassessments are recommended for individuals at regular risk? At each visit?

A

Healthy diet, physical activity, smoking cessation, weight management every 3-6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What drug is suggested as first-line therapy in individuals with CKD, hypertension, and eGFR 30 or above?
4

A

SGLT2 inhibitors, metformin, RAS inhibitors at maximum tolerated dose, high-intensity statins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the monitoring recommendations for prevalent CKD based on GFR and albuminuria?

A

Monitoring varies from once per year to every 1-3 months based on risks of CKD progression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Which drug is recommended for individuals with ACR ≥30 mg/g and normal potassium to achieve clinical ASCVD risk?

A

Nonsteroidal MRA or dihydropyridine CCB or antiplatelet agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What test should be done if risk-based glycemic target and lipids are indicated?

A

Regular reassessment of glycemia, albuminuria, BP, CVD risk, and lipids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the recommendations for screening and treatment of complications in pediatric type 2 diabetes?

A

Screening and treatment include monitoring blood pressure, foot exams, dilated fundoscopy, lipid profiles, AST and ALT levels, and more.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the goal for blood pressure management in pediatric type 2 diabetes?

A

The goal is to maintain blood pressure below the 90th percentile for age, sex, and height.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How often should individuals with pediatric type 2 diabetes have their blood pressure checked if it’s normal?

A

If normal, blood pressure should be checked annually.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the treatment approach for neuropathy in pediatric type 2 diabetes?

A

Optimize glycemia and provide referral to neurology if positive symptoms are present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

When should lifestyle modification be initiated in pediatric type 2 diabetes?

A

Lifestyle modification should be initiated at diagnosis for optimal management.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What should be the treatment strategy if LDL levels remain elevated in pediatric type 2 diabetes after 6 months?

A

Initiate statin therapy if LDL levels remain elevated above 130 mg/dL after 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is recommended for new-onset diabetes in youth with overweight or obesity and clinical suspicion of type 2 diabetes?

A

Initiate lifestyle management, educate about diabetes, and determine A1C levels for appropriate management.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the recommended approach in case of acidosis and/or DKA and/or HHNK in new-onset diabetes in youth?

A

Administer metformin up to 2,000 mg per day and consider long-acting insulin until acidosis resolves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What should be done if A1C goals are not met in new-onset diabetes in youth with overweight or obesity suspicion of type 2 diabetes?

A

Consider adding GLP-1 receptor agonist or SGLT2 inhibitor approved for youth with type 2 diabetes if A1C goals are not met.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What lifestyle changes are recommended for preventing type 2 diabetes?

A

Intensive lifestyle behavior change program: weight reduction and physical activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How much weight reduction is recommended to reduce the risk of incident type 2 diabetes?

A

At least 7% of initial body weight.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What activity level per week reduces the incidence of type 2 diabetes by 44%?

A

At least 150 minutes of physical activity per week.

59
Q

Which medication is considered for prevention in adults at high risk of type 2 diabetes?

A

Metformin.

60
Q

What are the common categories of medications shown to lower the incidence of diabetes in specific populations?

A

a-glucosidase inhibitors, incretin receptor agonists, thiazolidinedione, and insulin.

61
Q

In the prevention of type 1 diabetes, what drug is used to delay the onset in selected individuals?

A

Teplizumab.

62
Q

What were the median times to stage 3 type 1 diabetes diagnosis for individuals in the teplizumab and placebo groups?

A

Teplizumab group: 48.4 months, Placebo group: 24.4 months.

63
Q

What were the common adverse reactions to teplizumab described in the study?

A

Transient lymphopenia (73%) and rash (36%).

64
Q

What should be assessed in the assessment and treatment plan for diabetes complications?

A

ASCVD, heart failure history, kidney disease, hypoglycemia risk, retinopathy, neuropathy, NAFLD/NASH.

65
Q

What are the general risk factors for bone health mentioned in the notes?

A

Osteoporotic fracture, low T-score, age over 65, low BMI.

66
Q

What should be done if pancreatitis is suspected during clinical trials?

A

Discontinue the medication

67
Q

What is the advice regarding gallbladder disease if suspected during treatment?

A

Evaluate for gallbladder disease

68
Q

What is the renal dose consideration for a certain medication?

A

See label for renal dose considerations

69
Q

For patients with renal impairment, what is the guidance regarding escalating doses?

A

Consider slower dose titration

70
Q

Why is dual GIP and GLP-1 Receptor Agonist not recommended for individuals with a history of gastroparesis?

A

Their use is not recommended due to this history.

71
Q

What potential issue has been noted in rodents regarding a certain medication?

A

High risk of thyroid C-cell tumors

72
Q

What dietary modifications should be advised to mitigate GI side effects?

A

Guidance on dietary modifications (reduction in meal size, avoiding high-fat or spicy foods)

73
Q

What adverse effect has been reported in clinical trials with DPP-4 inhibitors?

A

Pancreatitis

74
Q

What caution is advised when using sulfonylureas in persons at risk for hypoglycemia?

A

Use with caution to avoid hypoglycemia

75
Q

For patients with a history of gastroparesis, what is the recommendation for insulin therapy?

A

Start conservatively to avoid issues.

76
Q

What should be monitored regularly in people with diabetes during treatment with a specific medication?

A

Monitor renal function

77
Q

What special warning is associated with sulfonylureas based on studies?

A

Increased risk of CV mortality

78
Q

What should be considered regarding screening in special conditions related to diabetes?

A

Consider screening for prediabetes or diabetes for individuals on certain medications.

79
Q

What should be considered for monitoring of diabetes according to Dr. Abdulaziz Alharbi’s notes?

A

Serum Glycated Protein Assays as Alternatives to A1C, with Fructosamine and glycated albumin being approved measures.

80
Q

What factors should be assessed when diagnosing suspected type 1 diabetes in adults?

A

Testing for islet autoantibodies and C-peptide levels along with considering features of monogenic diabetes.

81
Q

When should individuals be screened for diabetes in special conditions like those prescribed second-generation antipsychotic medications?

A

Baselining and screening after 12-16 weeks, then annually, as clinically indicated.

82
Q

What is the importance of C-peptide testing in diagnosis according to the notes?

A

It helps differentiate between type 1 and type 2 diabetes and aids in treatment decisions.

83
Q

What are recommended screening guidelines for people with HIV according to the notes?

A

Screen for diabetes before starting antiretroviral therapy and 3-6 months after, then annually if initial results are normal.

84
Q

What conditions warrant screening for diabetes, following an episode of acute pancreatitis?

A

People should be screened within 3-6 months post-acute pancreatitis episode and annually thereafter.

85
Q

What does the head-to-head trial suggest about TCAs, SNRIs, and gabapentinoids for DPN pain?

A

Therapeutic equivalency and support for combination therapy over monotherapy.

86
Q

What limitation may occur with tricyclic antidepressants in individuals over 65 years of age?

A

Anticholinergic side effects may be dose limiting.

87
Q

How are tramadol classified in terms of their mechanism of action?

A

Centrally acting opioid analgesics.

88
Q

What FDA-approved treatment exists for pain in DPN using a capsaicin patch?

A

8% capsaicin patch.

89
Q

What is the recommended use of lidocaine patches in the context of DPN?

A

Not effective for widespread pain; may be useful for nocturnal neuropathic foot pain.

90
Q

What is the diagnostic gold standard for gastroparesis?

A

Measurement of gastric emptying with scintigraphy of digestible solids.

91
Q

Which drug is approved by the FDA for severe cases of gastroparesis?

A

Metoclopramide.

92
Q

What is the fasting goal range for individuals on complex insulin therapy?

A

90-150 mg/dL (5.0-8.3 mmol/L).

93
Q

How should prandial insulin doses be adjusted when adding noninsulin agents in complex insulin therapy?

A

Titrate down prandial insulin doses as noninsulin agent doses increase.

94
Q

When should rapid- and short-acting insulin not be used in complex insulin therapy?

A

At bedtime.

95
Q

How should insulin dosing be initiated?

A

Begin with 4 units per day or 10% of basal insulin dose.

96
Q

What is the recommended approach for insulin titration?

A

Increase dose by 1-2 units or 10-15% twice weekly.

97
Q

What should the total insulin dose be in initiating therapy?

A

Total dose should be 80% of current bedtime NPH dose.

98
Q

How can hypoglycemia cause adjustments in insulin dosing?

A

Lower the basal dose by 4 units per day or 10% of basal dose.

99
Q

What is the suggested split of insulin doses in the morning and at bedtime?

A

2/3 of insulin given in the morning and 1/3 at bedtime.

100
Q

How should insulin be adjusted for patients above A1C target levels?

A

Consider self-mixed/split insulin regimen for better control.

101
Q

What is the recommended NPH dose for a full basal-bolus regimen?

A

80% of the current NPH dose given before breakfast and dinner.

102
Q

What should be added to each insulin injection for a basal-bolus regimen?

A

Add 4 units of short/rapid-acting insulin or 10% of reduced NPH dose.

103
Q

How should SGLT2 inhibitors be monitored and managed for risks?

A

Monitor for DKA risk, rare in T2DM, and discontinue if suspected.

104
Q

What is an important consideration when using GLP-1 receptor agonists?

A

Counsel patients about potential GI side effects and dietary modifications.

105
Q

What is recommended bone mineral density screening interval for individuals with type 2 diabetes?

A

At least 5 years after diagnosis and every 2-3 years thereafter.

106
Q

In individuals undergoing bariatric surgery, how often should bone mineral density screening be performed according to EASO guidelines?

A

Every two years.

107
Q

Why is a T-score adjustment of -0.5 proposed for fracture prediction by DXA?

A

To improve fracture prediction.

108
Q

What is the significance of a hip or vertebral fracture with low trauma in people aged 65 years or above?

A

It is diagnostic for osteoporosis and a strong risk factor for subsequent fractures.

109
Q

How often should bone mineral density monitoring be performed in high-risk older adults with diabetes?

A

Every 2-3 years.

110
Q

What should clinicians consider regarding pharmacological options for lowering glucose levels in people with diabetes?

A

The potential adverse impact on bone health.

111
Q

Why should individuals with diabetes be advised on their intake of calcium and vitamin D?

A

To ensure they meet the recommended daily allowance for those at risk of fracture.

112
Q

How can bone health risks be managed when setting glycaemic management goals for individuals with a high fracture risk?

A

Individualizing management goals and prioritizing glucose-lowering medications with low risk of hypoglycemia.

113
Q

What fraction of people with type 2 diabetes is estimated to have NAFLD according to recent studies in the U.S.?

A

More than 70%.

114
Q

How prevalent is NAFLD in individuals with type 1 diabetes according to recent meta-analysis?

A

Reported as 22%.

115
Q

When are investigations for CAD recommended?

A

Investigations for CAD are recommended in the presence of atypical cardiac symptoms or signs of associated vascular disease.

116
Q

when PAD should be screened in DM pt?

A

Screening for PAD should be considered in individuals with diabetes duration ≥10 years.

117
Q

What is recommended for adults with diabetes to prevent stage C heart failure?

A

Consider screening adults with diabetes by measuring a natriuretic peptide to facilitate prevention of stage C heart failure.

118
Q

How is screening for PAD recommended in asymptomatic individuals with diabetes age ≥50 years?

A

Screening for PAD with ankle-brachial index testing is recommended in asymptomatic individuals with diabetes age ≥50 years.

119
Q

What physical behaviors are important for type 2 diabetes?

A

Sitting less, doing moderate-to-vigorous activity, and regular physical exercises are important for type 2 diabetes.

120
Q

What is the association between sleep quantity and A1C levels?

A

Both long (>8 hours) and short (<6 hours) sleep negatively impact A1C levels.

121
Q

What is the impact of evening chronotypes on glycemic levels?

A

Evening chronotypes may have poorer glycemic levels compared to morning chronotypes.

122
Q

What is recommended as initial pharmacologic treatments for neuropathic pain in diabetes?

A

Gabapentinoids, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers.

123
Q

When should adults with type 1 diabetes have an initial eye examination?

A

Within 5 years after the onset of diabetes.

124
Q

What is the only nonsteroidal mineralocorticoid receptor antagonist with proven clinical kidney and cardiovascular benefits?

A

Finerenone.

125
Q

Why should individuals with pre-existing type 1 or type 2 diabetes have an eye exam before pregnancy?

A

To monitor their eye health and reduce the risk of complications during pregnancy.

126
Q

When should individuals with pre-existing type 1 or type 2 diabetes receive an eye exam during pregnancy?

A

Before pregnancy, in the first trimester, every trimester, and 1 year postpartum.

127
Q

What is indicated to reduce the risk of vision loss in individuals with high-risk PDR?

A

Panretinal laser photocoagulation therapy.

128
Q

What is the frequency of eye screening recommended for individuals with no evidence of retinopathy and within goal range?

A

Every 1-2 years may be considered.

129
Q

What should be considered as first-line therapy for hypertension when albuminuria is present?

A

ACE inhibitors or ARBs (angiotensin receptor blockers).

130
Q

What should be monitored in individuals with pre-existing type 1 or type 2 diabetes during pregnancy?

A

Their eye health, every trimester, and for 1 year postpartum.

131
Q

What are the key 24-hour physical behaviors important for type 2 diabetes?

A

Sitting/breaking up, prolonged sitting, stepping, sweating, strengthening, adequate sleep

132
Q

What does T indicate in the context of physical behaviors for type 2 diabetes?

A

Higher levels/improvement in physical function and quality of life

133
Q

What do yellow arrows indicate in Figure 5.1 regarding physical behaviors for type 2 diabetes?

A

Medium-strength evidence

134
Q

What metric measures the spread of glucose values in CGM metrics?

A

Glycemic variability (%CV)

135
Q

What percentage of time in range is considered a goal for glucose readings in adults?

A

Above 70%

136
Q

How should clinicians assess individuals at risk for hypoglycemia?

A

History of hypoglycemia, awareness assessment, review of risk factors

137
Q

What are the major social, cultural, and economic risk factors for hypoglycemia risk?

A

Food insecurity, low-income status, homelessness, fasting for reasons

138
Q

What should clinicians consider for individuals treated with insulin regarding hypoglycemia?

A

Risk factors, awareness, interfering anxiety symptoms

139
Q

What are some GLP-1 RA options for patients with A1C above target?

A

Metformin, Dulaglutide, Liraglutide

140
Q

When should a GLP-1 RA or SGLTi be considered independent of metformin use?

A

In people with HF, CKD, established CVD, or multiple risk factors for CVD.

141
Q

What cardiorenal risk reduction may be achieved with GLP-1 RA and SGLTi?

A

Reducing the risk of composite MACE, CV death, all-cause mortality, MI, HHF, and renal outcomes in T2D.

142
Q

How should GLP-1 RA be used in adults with advanced CKD?

A

A GLP-1 RA is preferred due to lower risk of hypoglycemia and for cardiovascular event reduction.

143
Q

What social determinants should be considered for goal achievement in diabetes management?

A

Identify and address SDOH that impact goal achievement.

ADA 24 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions