Med Eval of CoMorbidities Flashcards
Given a patient with diabetes, identify the symptoms consistent with hyperglycemia
- increased thirst that is not normal
- increased need to urinate, especially at night
- unintended weight loss
- repeated vaginal yeast infection (2-3+ in 6 months) or yeast/fungal infections on other body parts (ex: otitis media)
- repeated UTIs
- sores that do not heal
- erectile dysfunction
- blurred vision
Given a patient with diabetes, select the diagnostic modality
- Fasting plasma glucose (commonly done)
- 2-hour plasma glucose value after 75g oral glucose tolerance test (OGTT)-not very common
- Fasting blood glucose (no caloric intake for the past 8 hours)
- Fasting plasma glucose (venous blood draw)
- Fingerstick blood glucose (definitive, inexpensive)
- Hemoglobin A1c (doesn’t required fasting, less influenced by day-to-day changes, results in 6 minutes)—most affected by what happened in the last 30 days
Select the diagnostic criteria for prediabetes
-fasting blood glucose
≥ 100 mg/dL and < 125 mg/dL
Select the diagnostic criteria for prediabetes
-A1c
5.7%-6.4%
Select the diagnostic criteria for prediabetes
-OGTT
140-199 mg/dL
Select the diagnostic criteria for diabetes
-fasting blood glucose
> 126 mg/dL
Select the diagnostic criteria for diabetes
-A1c
> 6.5%
NOTE: a 1% increase in A1c = 25-35mg/dL increase in blood glucose
Select the diagnostic criteria for diabetes
-OGTT
≥ 200 mg/dL
Explain why A1c is used to diagnose diabetes/prediabetes in adults
- does not require fasting
- less influenced by day-to-day changes in blood glucose
- less sensitive that fasting blood glucose
- get results in 6 minutes
Identify the conditions that impact the interpretation of A1c testing
- hemoglobinopathies
- abnormal hemoglobin turner rate (sickle cell, hemolytic anemia)
- conditions associated with increased cell turnover (pregnancy)
- hemodialysis
- recent blood loss/transfusion
- erythropoietin therapy
Explain the role of autoantibodies in the diagnosis in type 1 diabetes
Autoimmune markers include: 1. islet cell autoantibodies
- autoantibodies to GAD65
- insulin antibodies
- tyrosine phosphatases IA-2 and IA-2β
- and ZnT8
Given a pregnant woman who is 24-28 weeks gestation, outline the two-step approach to screening for gestational diabetes
- 50g non-fasting screen: plasma glucose measurement at 1 hour
- if glucose is ≥140 mg/dL then perform 100g OGTT
- 100g OGTT for those that screen positive
- Measure fasting, 1h, 2h, 3h, after OGTT
- Diagnosis made if 2+ measurements exceed:
- -Fasting 95 mg/dL
- -1 hour 180 mg/dL
- -2 hour 155 mg/dL
- -3 hour 140 mg/dL
What patient meets the criteria for testing for pre-diabetes or diabetes?
- everyone ≥ 45 years: screen at 45 and then every 3 years
- 20% of prediabetics turn into diabetics every year (test every year)
Criteria for testing for pre-diabetes or diabetes for anyone that’s overweight and has 1+ of…
- Physically inactive
- 1st degree relative with diabetes
- Member of high-risk ethnic population (AA, Hispanic, Native American, Asian American, Pacific Islander)
- Hypertensive ≥ 140/90 or on therapy for HTN
- Impaired glucose tolerance or impaired fasting glucose (b/w 100-125 mg/dL) or A1c ≥5.7% on previous testing
- Women with PCOS
- Other clinical conditions associated with insulin resistance (severe obesity or Acanthosis nigricans)
- H/o CVD
Determine whether or not the child meets the criteria for testing for type 2 diabetes
Overweight (BMI >85th percentile or weight >120% ideal) and 2+ of:
- Family history in 1st or 2nd degree relative
- Member of an at-risk ethnic group
- Signs of insulin resistance conditions associated with insulin resistance:
- -HTN
- -PCOS
- -Dyslipidemia
- -Acanthosis nigricans
- -Small for gestational age/birth weight
- H/o maternal diabetes/gestational diabetes
Outline the recommended screening for prediabetes/diabetes in patients with HIV treated with an antiretroviral agent
- screen with fasting glucose level every 6-12 months before starting antiretroviral therapy and 3 months after starting/changing therapy
- if normal, check annually
- if prediabetes found, measure every 3-6 months to monitor for progression to diabetes
Given a patient with diabetes, identify the appropriate information to gather regarding their eating patterns
- How often they eat
- Times they eat
- Home versus eating out
- Food insecurity
- Who prepares/purchases the food?
- Do they live in a food desert?
- Do they have transportation to get to the grocery store?
- When do they take their glucose lowering medication in relation to eating a meal?
Given a patient with diabetes, identify the appropriate information to gather regarding their physical activity/exercise regimen
- Activity versus exercise
- Type of activity – aerobic vs. anaerobic
- Frequency
- Duration
- Intensity
- Time spend during sedentary, working at computer, watching TV, playing video games
Given a medication history, identify the areas to assess the medication regimen
Medications to lower blood glucose:
- Results of glucose monitoring and patient use of data
- Hypoglycemia episodes, awareness, frequency, causes
- Satisfaction with glucose lowering regimen
- Does it fit their lifestyle?
- Blood pressure lowering medication: response
- Dyslipidemia: lipid levels and response
- Contraceptive use in women: contraception plans (need for preconception planning)
- Complementary/alternative medicine use
- Herbal products
Identify the co-morbid diseases that are covered in the medical history of a person with new onset diabetes
- HTN, lipid disorder
- CV/peripheral vascular disease
- Chronic renal insufficiency
- H/o gestational diabetes, h/o PCOS
- Fatty liver disease
- Depression, dental disease
- H/o tobacco/alcohol/substance use: type/amount/etc
- Microvascular complications: retinopathy, nephropathy, neuropathy (sensory- h/o foot lesions; autonomic- sexual dysfunction, gastroparesis)
- Macrovascular complications: coronary heart disease, cerebrovascular disease, peripheral arterial disease
Indicate the immunizations recommended for people with diabetes
- Routine vaccinations for children/adults based on age-related recommendations
- Influenza vaccine annually
- Pneumococcal polysaccharide vaccine PPSV23
- Hepatitis B 3 vaccine series
Identify the lab evaluation to include in the work-up a person with new onset diabetes
- A1c (if it’s been >3 months or patient had serious illness/trauma/rapid onset of symptoms): diagnosis, glycemic control
- Fasting lipid profile (total cholesterol, LDL, HDL, triglycerides): dyslipidemia, monitor response to medications
- Spot urinary albumin-to-creatinine ratio: screen for nephropathy
- Serum creatinine and estimated glomerular filtration rate: screen for renal impairment
- Thyroid-stimulating hormone in patients with type 1 diabetes: common concomitant condition
Identify the parts of a comprehensive foot examination
- Inspection
- Palpation of dorsalis pedis and posterior tibial pulses
- Presence/absence of patellar/Achilles reflexes
- Determination of proprioception, vibration and monofilament sensation
Given a person with new onset diabetes, indicate the appropriate referrals for the patient
- Eye care professional for annual dilated eye exam
- Registered dietitian for medical nutrition therapy
- Diabetes self-management education
- Family planning for women of reproductive age
- Dentist for comprehensive dental/periodontal exam
- Mental health professional
Explain what the Diabetes Standards of Care are, when they are published, and where to locate them each year
Published annually in January on the American Diabetes Associate Site
