Prevention of Diabetes

Question 1

What proportion of the US population has diabetes?

Answer 1

10%

Question 2

Of those who technically have pre-diabetes, how many “know it?”

Answer 2

10%

Question 3

Diabetes is the leading cause of what complications.

Answer 3

1) ESRD
2) new cases of blindness
3) non-traumatic limb amputations

Question 4

Describe the pathophysiology of Type I Diabetes

Answer 4

autoimmune response destroys pancreatic beta-cells

Question 5

Describe the pathophys of T2DM

Answer 5

not enough insulin or insulin resistance

Question 6

T1DM makes up what proportion of all diabetes cases

Answer 6

10%

Question 7

Describe the fasting plasma glucose test

Answer 7

measures the amount of glucose in the blood after an 8-10h fast

Question 8

Describe the oral glucose tolerance test

Answer 8

after FPG, glucose is consumed and plasma drawn 1 & 2h later

Question 9

Describe the glycosylated hemoglobin test

Answer 9

measures the % Hb bound to glucose to give the average plasma glucose concentration over the past 2-3 months

Question 10

What is the name of the lab value determined from glycosylated hemoglobin test?

Answer 10

HbA1C or A1C

Question 11

What is the normal range for FPG

Answer 11

<100 mg/dL

Question 12

What is the normal range for OGTT @2h?

Answer 12

<140 mg/dL

Question 13

what is the normal range for A1C?

Answer 13

< 5.7

Question 14

What is the pre-diabetes range for FPG?

Answer 14

100-125 mg/dL

Question 15

What is the pre-diabetes range for OGTT @ 2h?

Answer 15

140-199 mg/dL

Question 16

What is the pre-diabetes range for A1C?

Answer 16

5.7 - 6.4

Question 17

If FPG is in the pre-diabetic range you have…

Answer 17

IFG – Impaired Fasting Glucose

Question 18

If OGTT is within the pre-diabetic range, you have…

Answer 18

IGT – Impaired Glucose Tolerance

Question 19

How is pre-diabetes diagnosed?

Answer 19

IFG or IGT

Question 20

Describe the prognosis for pre-diabetics

Answer 20

3-5y: 25% diabetic, 25% normal

5+ y: majority diabetic

Question 21

If both IFG & IGT, what is the prognosis for diabetes?

Answer 21

50% of pts will go diabetic

Question 22

How often should diabetes testing take place?

Answer 22

Every 3 years

every 1 year for pre-diabetics

Question 23

Who should be tested for diabetes?

Answer 23

1) all > 45yo
2) overweight + 1 risk factor
3) symptomatic
4) overweight KIDS + 2 risk factors

Question 24

What are risk factors for diabetes?

Answer 24

1) f/h
2) overweight (>25)
3) h/o CVD
4) prior IFG, IGT, AIZ > 5.7
5) HDL < 35 mg/dL
6) TG > 250 mg/dL
7) GDM or baby > 9#

Question 25

Using the risk assessment tool for diabetes, what is “very low risk?”

Answer 25

0-2

Question 26

using the risk assessment tool for diabetes, what is “low-medium” risk?

Answer 26

3-9

Question 27

Using the risk assessment tool for diabetes, what is “high risk?”

Answer 27

10+

Question 28

Describe the point-breakdown for the diabetes risk assessment tool.

Answer 28

9 pts: 65+ yo
5 pts: BMI 25+, 45-64yo
1 pt: parent, sibling, child >9#, exercise <4h/wk & 65+

Question 29

What are the signs and symptoms of T2DM?

Answer 29

1) Thirst
2) + Urination
3) Hunger & Fatigue
4) Blurred vision
5) eczema
6) dry, itchy skin
7) slow thinking

can be asymptomatic

Question 30

What was the conclusion of the DPP study?

Answer 30

1) metformin .5*effectiveness of BMOD

2) metformin better in young, obese pts

Question 31

What was the conclusion of the ORIGIN study?

Answer 31

long-acting insulin reduced pre-diabetic to diabetic progression

Question 32

How much does the NDPP lower diabetes risk?

Answer 32

50%

Question 33

What are the 2014 ADA standards of care for prediabetes?

Answer 33

1) counsel if BMI > 25
2) weight loss (7%)
3) 150 mins/wk exercise
4) metformin if > 60, obese, prior GDM
5) treat underlying CV dz

Question 34

How does the AACE define prediabetes?

Answer 34

IFG, IGT, or metabolic syndrome

Question 35

How should a prediabetic pt be educated regarding exercise?

Answer 35

1) 150 min/wk
2) no more than 2 non-consecutive days
3) resistance training 3x/week

Question 36

How should a prediabetic pt be educated regarding nutrition?

Answer 36

1) this is for all t1 & t2 dm pts
2) should receive individualized medical nutrition therapy
3) limit/avoid sugar-sweetened beverages
4) Na < 2300 mg/day

Question 37

How should a prediabetic pt be educated regarding supplements?

Answer 37

1) no benefit from omega-3 supplements for CV
2) no conclusive vitamin/mineral evidence
3) insufficient cinnamon/herb evidence

Question 38

How should a prediabetic pt be educated regarding weight management?

Answer 38

For t2dm, 5-10% at 1-2 #/wk