Module 10 - DM (Part I & II)

Question 1

Criteria for Diagnosis * (4)

Answer 1

1. A1C more than 6.5%
2. FPG more than 126
3. 2 hr plasma glucose > 200 during OGTT
4. Random plasma glucose more than 200 PLUS symptoms of hypo/hyperglycemia

• For DM2: document 2 abnormal labs on seperate dates
  OR
  2 different tests on same sample (ie HBA1C and FBG)

Question 2

Criteria for Pre Diabetes *

Answer 2

1. A1C 5.7 - 6.4%
2. FPG 100 - 125
3. 2 hr plasma glucose 140-199 during OGTT (75g)

Question 3

Classification of Diabetes *
Type 1 vs Type 2

Answer 3

Type 1: B cell destruction
Type 2: Progressive insulin secretory defect

Question 4

A1C Information

Answer 4

• Decreasing A1C by 1% may decrease microvascular risk by 10% (ie diabetic eye, nerves, kidneys)
• A1C Checks:
  1. stable DM: check A1C q 6mo
  2. unstable DM: check A1C q 3mo

Question 5

Screening for DM *

Answer 5

Overweight (BMI > 25) who have 1 or more of following risk factors (regardless of age)

• 1st degree relative with DM
• high risk race (black, latino, native american, asian, pacific islander)
• history of CVD
• HTN >140/90 or on treatment
• HDL < 35
• Triglyceride > 250
• PCOS
• Physical Inactivity
• Insulin resistance (obesity, acanthosis nigricans)

Patients with A1C > 5.7%: testing annually

Women with history of GDM test lifelong q 3 years

TEST ALL PATIENTS @ 35YO
- If result is normal repeat q 3 yrs

HIV

Question 6

Analogs *
“What is the difference between human insulin and analogs?”

Answer 6

• means “similar to something else”
• analogs mimic bodys natural pattern of insulin release and are synthetic insulins
• have minor amino acid changes for more desirable effects
• absorbed from SQ tissue more predictability (leads to less hypoglycemia)

Question 7

Symptoms of DM2 in older adults?

Answer 7

?

Question 8

Glycemic recommendations for DM diagnosed adults *

Answer 8

1. A1C < 7%
2. preprandial capillary glucose 80-130
3. peak post prandial cap glucose <180

(only 37% with T2DM will achieve A1C of < 7)

Question 8

Glycemic recommendations for DM diagnosed adults *

Answer 8

1. A1C < 7%
2. preprandial capillary glucose 80-130
3. peak post prandial cap glucose <180

(only 37% with T2DM will achieve A1C of < 7)

Question 9

Key Clinical Considerations

Answer 9

• The early introduction of insulin should be considered if there is evidence of ongoing catabolism (weight loss), if symptoms of hyperglycemia are present, or when A1C levels (>10%) or blood glucose levels (≥300 mg/dL) are very high.
• Consider initiating dual therapy in patients with newly diagnosed type 2 diabetes who have A1C ≥1.5% above their glycemic target.
• A patient-centered approach should be used to guide the choice of pharmacologic agents. Considerations include comorbidities (ASCVD, heart failure, CKD), hypoglycemia risk, impact on weight, cost, risk for side effects, and patient preferences.
• Among patients with type 2 diabetes who have established ASCVD - SGLT2 or GLP-1 receptor agonists with demonstrated CVD benefit are recommended as part of the antihyperglycemic regimen.
• Among patients with ASCVD at high risk of heart failure or in whom heart failure coexists, SGLT2 inhibitors are preferred
• For patients with type 2 diabetes and CKD, consider use of an SGLT2 or GLP-1 shown to reduce risk of DKD progression, cardiovascular events, or both.
• In most patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 are preferred to insulin.
• Intensification of treatment for patients with type 2 diabetes not meeting treatment goals should not be delayed

Question 10

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Answer 10

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