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DB Therapeutics > Lecture 2 (Treatment Goals) > Flashcards

Lecture 2 (Treatment Goals) Flashcards

1
Q

List the treatment goals for DM

A
  1. be symptom free
  2. achieve personalized target glucose levels
  3. address modifiable CV risk factors
  4. prevent or slow progression of microvascular complications
  5. empowerment to self manage
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2
Q

List personalized target glucose levels

A

A1C

fasting glucose levels
postprandial glucose levels
time in range

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3
Q

List ways to monitoring glucose control

A

A1C
CBG
CGM
ketone testing

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4
Q

Define A1C

A

a measure of glycemic control over a 3 months

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5
Q

What is a normal A1C level?

A

4-6%

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6
Q

What are the A1C targets?

A

<6 T2D with potential for remission
<6.5 T2D to reduce the risk of chronic kidney disease
<7 most adults with T1D or T2D
7.1-8 functionally dependent
7.1-8.5 for severe cases, frail elderly, limited life expectancy

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7
Q

What is the PPG and 2 hr Post PPG for most pt?

A

4-7
5-10

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8
Q

What is the PPG and 2 hr Post PPG for pt with A1C more than 7?

A

4-5.5
5-8

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9
Q

What is the major takeaways from the trials related to A1C goals?

A

Lowering A1C values to ≤7% provides strong benefits for microvascular complications and, if achieved early enough may also provide macrovascular benefit
More intensive BG lowering is not always better
Rather than causing CV AEs, severe hypoglycemia may be a marker of vulnerability for such events

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10
Q

What is CBG?

A

capillary blood glucose
determines the glucose level in capillary blood via a finger stick

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11
Q

What do you need to know about CBG?

A

1) how to perform CBG

2) how often and when to perform CBG

3) the meaning of various BG levels

4) how behavior and actions affect CBG results
- interpretation of trends

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12
Q

What does FPG mean?

A

reflects glucose derived from hepatic production

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13
Q

What does PPG mean?

A

how meals affect glucose

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14
Q

What is isCGM?

A

intermittently scanned CGM
Measures glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin (sensor-based technology)

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15
Q

What is rtCGM?

A

are stand alone system
measure glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin
continuous data visibility 24/7

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16
Q

What is TIR?

A

time in range
the time that the pt blood glucose levels are in range

17
Q

What are ketone tests?

A

ketones are formed as a by product when body’s fat have to be accessed for energy
it can be used to be a part of self management (not standard anymore)

18
Q

Non pharm for DB

A

diet (focusing on carbs and fibre)
exercise (goal is >150 min of moderate to intense exercise/wk)
spread over >3d/wk
resistance training >2x/wk

19
Q

Define remission of TD2M

A

Achieving specified A1C thresholds without any anti- hyperglycemic medications for a minimum of 3 months:

20
Q

What is the A1C for remission of T2DM for both prediabetes & normal glucose?

A

Remission to prediabetes (A1C between 6.0% and 6.4%)
Remission to normal glucose concentrations (A1C <6.0%)

21
Q

List some individuals that may be considered remission of T2DM

A

Interesting in attempting remission

Who do not have significant eating or mental health disorders

Who do not have a compelling indication for antihyperglycemics (for renal or CV benefit)

Who meet the criteria in the intervention based recommendations

22
Q

What are some options for remission of T2DM?

A

bariatric surgery
health behaviour interventions

23
Q

What is the requirement for bariatric surgery?

A

May induce remission in non-pregnant adults with BMI ≥ 35kg/m2

24
Q

What are the two types of health behavior interventions for remission?

A

low cal diets (850 kcal/d) with meal replacement products for 3-5 months aimed at achieving >15 kg weight loss

calorie restricted diet (aim for 5-7% weight loss) and exercise training (240-420 min/wk over 5 days/wk)

25
Q

What is the role of pharmacist in DM?

A

education
optimize therapy
referrals to HCP
help fill some of the gaps

26
Q

What are some protection strategy?

A

healthy behaviors (weight loss)
smoking cessation
physical activity
BP <130/80
A1C<7
Rx options

DB Therapeutics (5 decks)

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