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SOC 3 Flashcards

1
Q

Goals of dpp

A 
7% weight loss (max prevention at 10%)
150 minutes moderate intensity PA
Lose 1-2 lbs/week to meet goals within first 6 months
500-1000 kcal deficit
start with reducing fat intake
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2
Q

3, 10,15 year outcome of DPP program

A

3- 58% reduction
10- 1/3 reduction
15- 1/4 reduction

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3
Q

PA goals of DPP

A

150 minutes/week MIPA; PA expenditure of 700 kcals/week
similar to brisk walking
minimum 3x/week- avoid more than 2 days without exercise
minimum duration- 10 minutes
up to 75 minutes of strength training will be counted toward 160 minutes

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4
Q

What was the structure of the DPP program?

A

Phase 1: Structured core curriculum:
1st 16 sessions in 25 weeks were individual
topics: lower kcal, increase PA, SM, healthy behaviors, psychological/social/motivational changes

Phase 2: flexible maintenance
- individual or group
motivational campaigns
re-start opportunities

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5
Q

How can you measure diet quality?

A

Healthy Eating Index
Alternative Healthy Eating Index
DASH score

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6
Q

Name a few of many dietary approaches that are appropriate

A

Mediterranean
Low kcal
Low fat

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7
Q

What are additional alternatives to weight loss?

A

Prescription weight loss meds

Bariatric surgery

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8
Q

Why is physical activity important for peds and adults?

A

Improves insulin sensitivity

reduces abdominal fat

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9
Q

Interrupted periods of prolonged sitting may benefit _______

A

post prandial BG

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10
Q

In the immediate years after quitting smoking the risk of DM is higher or lower?

A

higher

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11
Q

CDC diabetes prevention recognition program

A

certifies technology assisted DPP modalities

  • approved curriculums
  • interaction w/ coach
  • active participation
  • physical activity reporting
  • weight loss outcomes reported
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12
Q

How can delivery of DPP programs be reduced in cost?

A
  • community settings vs. primary care offices
  • group vs individual
  • use lay health workers
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13
Q

National DPP

A
  • in community settings (not medical settings)

- eligibility: overweight BMI, preDM labs w/in last year

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14
Q

Who should be offered Metformin?

A
  • hx GDM
  • BMI >/= 35
  • <60 years old
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15
Q

Who should be considered for MEtformin?

A

All preDM

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16
Q

What is more effective metformin or ILI

A

ILI

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17
Q

Who should be offered DSMES?

A

All PWD

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18
Q

4 critical times for DSMES

A

@ dx
annually to assess ed, NTR, emotional factors
when complications arise
when transition in care occurs

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19
Q

what does DSMES do

A

provides knowledge, support, decision making and skill development

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20
Q

objectives of DSMES

A
  • support informed decision making
  • self-care behavior
  • problem solving
  • collaboration w/ care team
  • must be cost effective
  • patient centered
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21
Q

Inclusive language

instead of diabetic, control, test

A

PWD
Manage
Check

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22
Q

When will medicare reimburse DSMES?

A
  • meets national standards

- recognized by ADA or other approving body

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23
Q

When is DSMES covered by insurance?

A
  • when it’s done in person

- may not be covered virtual or over the phone

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24
Q

MNT may be covered by medicare part B

A

3 hours initial during 1st consult year, 2 hours of follow-up in subsequent years

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25
DSME coverage by medicare
- 1 hour individual assessment - 9 hour group (1x in lifetime) - 2 hour follow-up annually
26
MNT effectiveness for T1DM
1-1.9% reduction A1c
27
MNT effectiveness for T2DM
0.3-2% T2DM
28
Goals of MNT for adults:
- achieve and maintain healthy BW - attain individualized BP, BG, lipid goals - delay or prevent onset of DM complications
29
Things RD should assess
- take into consideration pt preference, cultural background, health literacy - healthcare access - willingness and ability to make changes - addressing barriers to change - maintain pleasure of eating - develop healthy eating pattern
30
Weight loss for T2DM
- improve A1c - reduce CVD risk factors - encourage reduced kcals, physical activity
31
modest weight loss benefits
- delay progression of pre-DM to T2DM | - benefit MGMT/tx T2DM
32
pre-DM WL goal
7-10%
33
T2DM WL goal
5% however 10-15% may be appropriate
34
Weight loss maintenance
kept it off for 5 years;associated w/ improved A1c and lipids
35
various plans work for weight loss
Structured low kcal meal plan mediterranean style low CHO
36
instead of diet rx
individualized meal plans | nutrient dense food
37
Who should not be on low CHO diet?
pregnant or lactating women kids PW renal dz those with disordered eating
38
Dietary recommendations for CHO
- choose veggies, legumes, fruit, dairy, whole grains | - discourage SSB, processed foods/refined grains/added sugars
39
Dietary recommendations for those on insulin
insulin:CHO ratio for meal planning, modify insulin from meal to meal to improve glycemic management
40
protein recommendation for CKD
0.8-1 g/kg
41
Fat recommendations
avoid trans fats quality>quantity limit SFA
42
omega3 supplement
- did not improve glycemic mgmt in DM | - not recommended for prevention of CVD
43
What are naturally occurring omega-3 foods?
salmon, tuna, mackerel, herring, chia, flax, walnuts, canola oil, soybean oil
44
sodium
<2,300 mg in DM | <1,500 not recommended
45
Considerations for sodium
- palatability - availability - affordability - difficulty meeting low sodium guidelines
46
Metformin and B12
consider periodic testing in those taking it LT
47
supplements not advised
cinnamon, curcumin, vitamin D, aloe vera, chromium, Vits E/C/carotene
48
Who needs a MVI?
- pregnant or lactating women - older adults - vegetarians - low kcal or low CHO diet
49
What are the risks of alcohol?
weight gain hypo and delayed hypo hyper
50
what should you tell a PWD who wants to drink
risks, monitor BG after drinking to prevent or ID low
51
what are the alcohol recommendations?
women- 1/day or less men- 2/day or less 5 ounce wine, 12 ounce beer, 1.5 ounce distill spirits
52
artificial sweeteners
- do not appear to affect BG management
53
best beverage choice
water; reduce intake of sugar sweetened and non-nutritive sweetened beverages
54
What did the Finnish prevention program find?
45% decreased transmission to DM x 7 years
55
Da Quinn DPP findings
40% decrease conversion to T2D x 30 years | Decrease all cause mortality;CVD mortality; micro vascular complications
56
Name 3 DPP programs
US DPP ,Finnish, Da Qing
57
Why is PA important for women planning pregnancy or already pregnant
May prevent GDM
58
Met firm in may be cost saving over what year period
10
59
Women with previous GDM given metformin in or ILI had what reduction in DM and for how many years
50%, 10 years
60
When BMI is >= 35, what is more effective metformin or ILI
Equally effective if under 60
61
What score on ADA DM risk test warrants testing
5 or higher
62
What questions are on ADA risk test
``` Age- up to 3 points Gender Hx GDM 1st degree relative with DM HTN Physical activity or lack of Weight status- up to 3 points ```
63
Why should third party payers cover DPP
Cost effective | Improve Outcomes
64
Maximal prevention of T2DM in those with preDM
10% weight loss
65
Why is reducing prolonged periods of sedentary time important
May reduce post prandial BG
66
When did Medicare reimbursement expand for DPP
2018
67
For whom was metformin most effective after 15 years
Hx GDM and with higher FPG > 110
68
Who should receive DSMES
All PWD
69
What % PWD on Medicare get DSMES
5-7%
70
What are 4 critical times for DSMES
when not meeting targets When complicating factors arise Transition in life and care
71
DSMES should be
Pt centered Group or individual May use technology Should be communicated with whole care team
72
What does DSMES do
Improve knowledge skills decision making Self care behavior Problem solving Collaboration with HC team
73
Outcomes of DSMES
``` Improve dm knowledge Improve self care behaviors Lower self reported weight Improve QOL Reduce all cause mortality risk Healthy coping Reduce HC costs ```
74
Gold star dsmes
``` 6-10 H over 6-12 months Ongoing support Culturally and age appropriate Tailed to individual needs Behavioral strategies Address psychosocial issues Group or individual ```
75
Technology based DSMES gold star
2 way communication Individualized feedback Education Pt generated health data used
76
Outcomes of DSMES
Reduce mortality | Reduce A1C by 0.57%
77
When will Medicare reimburse DSMES
Meets national standards Recognized by ADA or ADCES When done in person
78
When may low or very low cho diet be appropriate
Not meeting glycemic targets. Pt declines meds May be most effective for 6 months <26% energy from cho
79
Most PWD report cho intake of
45%
80
Fiber associated with
Lower all cause mortality in pwd | Reduced risk of T2DM
81
Delayed hyper can occur when with HF or high PRO meals
3 H after eating | May need increase meal time bonus insulin
82
pRo of what % may increase satiety
20-30%
83
Do not replace saturated fat with
Refined CHO
84
Reduce it trial
4 g pure EPA reduce risk of averse CV event | 5% reduction in those with ASCVD already on statin but still with high TG
85
Risk for delayed hypo after alcohol
Insulin or insulin secretgogues
86
Who meets PA guidelines
45% W/c and B/AA | 65% H/L
87
Risk of PA with autonomic neuropathy
Decrease cardiac responsiveness Postural hypotension Impaired thermoregulation Hypo risk
88
Prediabetic neuropathy
Improve outcomes with 150 minutes of MI PA
89
Reduce risk of feet ulcers or reulceration by
Wearing proper footwear Moderate intensity PA Examine feet daily
90
Foot injury or open sore
Non weight bearing exercise only
91
Does weight gain after smoking cessation undo CVD benefit
No
92
How does smoking cessation benefit pwd
Reduce BP reduce albuminuria
93
Psychosocial tx effect on A1C
Decrease 0,3%
94
How common is depression in pwd
1/4 | More common in women
95
What med can help bulimic symptoms
GLP1 reduces hunger
96
When to monitor A1C after starting second generation atypical anti psychotics
4 months after starting then at least annually

CDCES (13 decks)

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