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CDCES > SOC 3 > Flashcards

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
Q

DSME coverage by medicare

A
  • 1 hour individual assessment
  • 9 hour group (1x in lifetime)
  • 2 hour follow-up annually
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26
Q

MNT effectiveness for T1DM

A

1-1.9% reduction A1c

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27
Q

MNT effectiveness for T2DM

A

0.3-2% T2DM

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28
Q

Goals of MNT for adults:

A
  • achieve and maintain healthy BW
  • attain individualized BP, BG, lipid goals
  • delay or prevent onset of DM complications
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29
Q

Things RD should assess

A
  • 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
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30
Q

Weight loss for T2DM

A
  • improve A1c
  • reduce CVD risk factors
  • encourage reduced kcals, physical activity
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31
Q

modest weight loss benefits

A
  • delay progression of pre-DM to T2DM

- benefit MGMT/tx T2DM

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32
Q

pre-DM WL goal

A

7-10%

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33
Q

T2DM WL goal

A

5% however 10-15% may be appropriate

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34
Q

Weight loss maintenance

A

kept it off for 5 years;associated w/ improved A1c and lipids

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35
Q

various plans work for weight loss

A

Structured low kcal meal plan
mediterranean style
low CHO

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36
Q

instead of diet rx

A

individualized meal plans

nutrient dense food

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37
Q

Who should not be on low CHO diet?

A

pregnant or lactating women
kids
PW renal dz
those with disordered eating

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38
Q

Dietary recommendations for CHO

A
  • choose veggies, legumes, fruit, dairy, whole grains

- discourage SSB, processed foods/refined grains/added sugars

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39
Q

Dietary recommendations for those on insulin

A

insulin:CHO ratio for meal planning, modify insulin from meal to meal to improve glycemic management

40
Q

protein recommendation for CKD

A

0.8-1 g/kg

41
Q

Fat recommendations

A

avoid trans fats
quality>quantity
limit SFA

42
Q

omega3 supplement

A
  • did not improve glycemic mgmt in DM

- not recommended for prevention of CVD

43
Q

What are naturally occurring omega-3 foods?

A

salmon, tuna, mackerel, herring, chia, flax, walnuts, canola oil, soybean oil

44
Q

sodium

A

<2,300 mg in DM

<1,500 not recommended

45
Q

Considerations for sodium

A
  • palatability
  • availability
  • affordability
  • difficulty meeting low sodium guidelines
46
Q

Metformin and B12

A

consider periodic testing in those taking it LT

47
Q

supplements not advised

A

cinnamon, curcumin, vitamin D, aloe vera, chromium, Vits E/C/carotene

48
Q

Who needs a MVI?

A
  • pregnant or lactating women
  • older adults
  • vegetarians
  • low kcal or low CHO diet
49
Q

What are the risks of alcohol?

A

weight gain
hypo and delayed hypo
hyper

50
Q

what should you tell a PWD who wants to drink

A

risks, monitor BG after drinking to prevent or ID low

51
Q

what are the alcohol recommendations?

A

women- 1/day or less
men- 2/day or less
5 ounce wine, 12 ounce beer, 1.5 ounce distill spirits

52
Q

artificial sweeteners

A
  • do not appear to affect BG management
53
Q

best beverage choice

A

water; reduce intake of sugar sweetened and non-nutritive sweetened beverages

54
Q

What did the Finnish prevention program find?

A

45% decreased transmission to DM x 7 years

55
Q

Da Quinn DPP findings

A

40% decrease conversion to T2D x 30 years

Decrease all cause mortality;CVD mortality; micro vascular complications

56
Q

Name 3 DPP programs

A

US DPP ,Finnish, Da Qing

57
Q

Why is PA important for women planning pregnancy or already pregnant

A

May prevent GDM

58
Q

Met firm in may be cost saving over what year period

A

10

59
Q

Women with previous GDM given metformin in or ILI had what reduction in DM and for how many years

A

50%, 10 years

60
Q

When BMI is >= 35, what is more effective metformin or ILI

A

Equally effective if under 60

61
Q

What score on ADA DM risk test warrants testing

A

5 or higher

62
Q

What questions are on ADA risk test

A 
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
Q

Why should third party payers cover DPP

A

Cost effective

Improve Outcomes

64
Q

Maximal prevention of T2DM in those with preDM

A

10% weight loss

65
Q

Why is reducing prolonged periods of sedentary time important

A

May reduce post prandial BG

66
Q

When did Medicare reimbursement expand for DPP

A

2018

67
Q

For whom was metformin most effective after 15 years

A

Hx GDM and with higher FPG > 110

68
Q

Who should receive DSMES

A

All PWD

69
Q

What % PWD on Medicare get DSMES

A

5-7%

70
Q

What are 4 critical times for DSMES

A

when not meeting targets
When complicating factors arise
Transition in life and care

71
Q

DSMES should be

A

Pt centered
Group or individual
May use technology
Should be communicated with whole care team

72
Q

What does DSMES do

A

Improve knowledge skills decision making
Self care behavior
Problem solving
Collaboration with HC team

73
Q

Outcomes of DSMES

A 
Improve dm knowledge
Improve self care behaviors
Lower self reported weight
Improve QOL
Reduce all cause mortality risk
Healthy coping
Reduce HC costs
74
Q

Gold star dsmes

A 
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
Q

Technology based DSMES gold star

A

2 way communication
Individualized feedback
Education
Pt generated health data used

76
Q

Outcomes of DSMES

A

Reduce mortality

Reduce A1C by 0.57%

77
Q

When will Medicare reimburse DSMES

A

Meets national standards
Recognized by ADA or ADCES
When done in person

78
Q

When may low or very low cho diet be appropriate

A

Not meeting glycemic targets.
Pt declines meds
May be most effective for 6 months
<26% energy from cho

79
Q

Most PWD report cho intake of

A

45%

80
Q

Fiber associated with

A

Lower all cause mortality in pwd

Reduced risk of T2DM

81
Q

Delayed hyper can occur when with HF or high PRO meals

A

3 H after eating

May need increase meal time bonus insulin

82
Q

pRo of what % may increase satiety

A

20-30%

83
Q

Do not replace saturated fat with

A

Refined CHO

84
Q

Reduce it trial

A

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
Q

Risk for delayed hypo after alcohol

A

Insulin or insulin secretgogues

86
Q

Who meets PA guidelines

A

45% W/c and B/AA

65% H/L

87
Q

Risk of PA with autonomic neuropathy

A

Decrease cardiac responsiveness
Postural hypotension
Impaired thermoregulation
Hypo risk

88
Q

Prediabetic neuropathy

A

Improve outcomes with 150 minutes of MI PA

89
Q

Reduce risk of feet ulcers or reulceration by

A

Wearing proper footwear
Moderate intensity PA
Examine feet daily

90
Q

Foot injury or open sore

A

Non weight bearing exercise only

91
Q

Does weight gain after smoking cessation undo CVD benefit

A

No

92
Q

How does smoking cessation benefit pwd

A

Reduce BP reduce albuminuria

93
Q

Psychosocial tx effect on A1C

A

Decrease 0,3%

94
Q

How common is depression in pwd

A

1/4

More common in women

95
Q

What med can help bulimic symptoms

A

GLP1 reduces hunger

96
Q

When to monitor A1C after starting second generation atypical anti psychotics

A

4 months after starting then at least annually

CDCES (13 decks)

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