Family Med SG13

Question 1

How to diagnose DM with the criteria above

Answer 1

Either random glucose over 200 with sx; Or combination of any of the other 2 on two different visit

Question 2

According to the American Diabetes Asssoc, who do you screen for DM?

Answer 2

Patients with BMI over 25 and also all patients over 45 yo

Question 3

If you screen a person for DM and results are normal, when do you screen them next?

Answer 3

Every 3 years. However, do it more frequently if the patient is high risk

Question 4

Who does the USPSTF say you should screen for DM?

Answer 4

Any adult with BP over 135/80

Question 5

What races are at increased risk for DM?

Answer 5

Non-caucasions

Question 6

Foot exam in diabetics should be done how often and what does it entail?

Answer 6

Annual; Requires a 10g monofilament plus any of the following 3: 128 hz tuning fork, pinprick sensation, or ankle reflex. You must also assess pedal and posterior tibial pulses as well as inspect for any ulcers/skin changes

Question 7

Once a pt is stable on a DM regimen, how often should an A1C be checked?

Answer 7

Every 6 mos

Question 8

How often should a patient with DM be checked for nephropathy?

Answer 8

At diagnosis, and then annually with a spot urine to Cr ratio. Also do a Cr and GFR

Question 9

Who do you do annual TSH in?

Answer 9

There are not very good guidelines for this. Type 1 DM (bc of autoimmune risk factor), anyone newly diagnosed with dyslipidemia, also in women over 50 yo

Question 10

Interventions that improve cardiovasc disease outcomes in diabetics

Answer 10

1. Getting BP less than 140/90 2. Moderate intens statin if LDL >70 3. High intens statin if LDL >70 and >7.5% estimated 10 years ASCVD risk 4. Treating dyslipidemia through diet and exercise 5. Aspirin if the patient has a hx of CVD 6. Quitting (not just cutting back on) smoking

Question 11

How to treat hypertension in DM?

Answer 11

Patients with DM who are over 18 yo should initiate meds to lower BP

Question 12

Which meds are recommended for treating hypertension in diabetics?

Answer 12

ACE/ARB, CCB, Thiazide diuretics (but african americans should avoid ACEs and ARBs)

Question 13

How to treat hyperlipidemia in DM?

Answer 13

Note, that for non-diabetic patients, you wait until LDL is over 190 until starting on a statin (and you use a high intensity statin). However, because diabetes is such a strong risk factor for CVD disease, you treat patients with LDL over 70- with mild intens if CV risk is less than 7.5%, or with high if greater than 7.5%

Question 14

Do you use aspirin in diabetic patients?

Answer 14

We do not need to specificially target patients with DM for aspirin therapy. Aspirin does not reduce the likelihood of CV events in patients with DM without pre-existing CV disease (except to decrease the risk of MI in men). We certainly use ASA as a secondary prevention in patients who have already had a CV event and as primary prevention in patients with increased CV risk

Question 15

What does the USPSTF say about aspirin use?

Answer 15

Recommended in men 45-79 when the risk of MI is greater than the risk of GI bleed and in women 55-79 when the risk of stroke is greater than the risk of GI bleed

Question 16

Glycemic control with HbA1c uner 7% is supported by what?

Answer 16

It decreases microvasc complications but no evidence about macrovascular (like stroke) or death

Question 17

Vaccines for patients with DM

Answer 17

Flu shot annually; Pneumococcal in all patients with DM over the age of 2 yo with revaccination over 65 yo if haven’t had it in the last 5 yeasrs or have nephrotic syndrome, CKD, or immunocompromised state

Question 18

Who should get the Hep B vaccine?

Answer 18

All unvaccinated adult with diabetes, HIV, immunosuppression, or liver disease

Question 19

Optimal range for blood glucose

Answer 19

80-120 fasting and less than 180 post prandial (1-2 hours later)

Question 20

USPSTF chlamydia screening guidelines

Answer 20

Nothing special about pregnant woemn. Screen all girls who are sexually active up to age 24, but then anyone over 25 who is high risk.

Question 21

Screening men for chlamydia?

Answer 21

Insufficient evidence for or against screening for men