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CDCES > SOC 6: Glycemic targets > Flashcards

SOC 6: Glycemic targets Flashcards

1
Q

What are 2 alternatives to A1c test?

A

Fructosamine & 1,5 andhydroglucitol

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2
Q

African Americans have what % point reduction in A1c if they have these variants?

A

Hbs- 0.3

G6PD- 0.8

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3
Q

What is the legacy effect? What studies did it emerge from?

A

DCCT & UKPDS studies. Early intense BG MGMT is beneficial decades later even after tight control has ceased

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4
Q

How to prevent DKA?

A

Ensure adequate fluids & kcals

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5
Q

What poorly effects endothelial function?

A

Post prandial hyperglycemia

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6
Q

When is it appropriate to have pt monitor post prandial values?

A

When pre-meal is within target but A1c is elevated

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7
Q

What usually prompts an episode of DKA?

A

Stress, illness, trauma, mediation (steroids)

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8
Q

What should be encouraged immediately after HYPO episode?

A

Meal or snack

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9
Q

For whom should glucagon be prescribed?

A

Those @ risk for level 2 hypo

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10
Q

What is hypo associated autonomic failure?

A

hypo unawareness

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11
Q

Who is especially at risk for hypo unawareness?

A

Older individuals, African Americans, children

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12
Q

What is neuroendocrine response to hypo?

A

BG <70, adrenergic s/s like shakiness, sweating

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13
Q

What is neuroglycopenic response to hypo?

A

BG <54, brain cells deprived of glucose

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14
Q

Hypo is associated with what 3 conditions in the elderly?

A

Cognitive decline, dementia, mortality

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15
Q

Why should a CHO containing fat NOT be used to treat hypo?

A

Fat retards and prolongs BG recovery

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16
Q

Why should PRO containing CHO not be used to treat hypo?

A

PRO causes insulin response without BG recovery

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17
Q

What are two outcomes of interest in CGM studies?

A
  • decrease A1c 0.3-0.6%

- decrease time spent in type 1 hypo <70 >54

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18
Q

TIR from CGM is associated with what?

A

Reduced risk of complications (particularly microvascular)

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19
Q

What 7 things should be considered when individualizing glycemic targets (hint: 2 modifiable, 5 non-modifiable)

A

2 modifiable: patient preference, patient support system/resources
5 non-modifiable: risk of hypo, DM duration, life expectancy, vascular complications, other important co-morbidities

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20
Q

What are the standard CGM recommendations?

A 
TIR: 70-180 >70% time
>180: <25% time
>250: <5% time
>70: <4% time
>54: <1% time
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21
Q

What is the standard % coefficient target for CGM? When may a lower % be warranted?

A

standard: = 36%
lower: <33% if on sulfonylurea or insulin to protect against hypo

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22
Q

How many days should CGM be worn?

A

14 days

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23
Q

What % time CGM device is active is recommended?

A

> 70%

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24
Q

TIR of 70% = what A1c?

A

7%

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25
Q

When should a lower TIR (>60% time) be recommended? What does that correlate to in A1c?

A

In those <25 years old.

~7.5%

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26
Q

How many BG points is 1% in A1c?

A

~29 points

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27
Q

How to calculate BG from A1c?

A

A1c x 28.7- 46.7

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28
Q

What is level 1 hypo?

A

<70 but >/= 54

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29
Q

What is level 2 hypo?

A

<54

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30
Q

What is level 3 hypo?

A

no # but individual has AMS or APS and needs assistance from other to treat

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31
Q

What are the FBG, A1c, 1 H PP and 2 H PP goals for GDM?

A

FPG- <95
A1c- 6-6.5%
1 H PP- <140
2 H PP-<120

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32
Q

What is BP target in GDM?

A

120-135/80-85

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33
Q

What is BG goal in hospitalized pts?

A

140-180

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34
Q

When do you start insulin on hospitalized pt?

A

BG >180

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35
Q

What is the BP goal in an older adult who is relatively healthy?

A

<140/90

36
Q

What is the BP goal for an older adult who is in poor health?

A

<150/90

37
Q

What is the general peds A1c goal?

A

<7%; <6.5 if at low risk for hypo

38
Q

What is BP goal in peds?

A

<120/80

39
Q

When can you start statin in peds?

A

> /= age 10

LDL >160 or LDL >130 + 1 or more CVD risk factor

40
Q

What is the LDL goal in peds?

A

<100

41
Q

When to start statin in adult?

A

LDL >130

42
Q

BP goal in healthy adult w/ pre-DM or DM?

A

<130/80

43
Q

BP goal in healthy adult w/o DM

A

<120/80

44
Q

Dx criteria for DM

A

FBG: >/= 126
2 H: >/= 200
A1c: >/=6.5%

45
Q

Dx criteria pre-DM

A

FBG: 100-125
2 H: 140-199
A1c: 5.7-6.4%

46
Q

Normal glycemic values

A

FBG: <100
2 H: <140
A1c: <5.7%

47
Q

Exercise targets in T1DM

A

90-250 to start, 15 g CHO prior, 0.5-1 g CHO/kg/hr

48
Q

When is exercise inappropriate in T1DM?

A

> 240 w/ ketones or s/s

never if >350, B-OHB >1.5 mmol/L

49
Q

Exercise targets in T2DM- when to avoid

A

> 300 & ketones or s/s

50
Q

If pre-exercise BG is <90- what to do

A

15-30 g CHO

51
Q

If pre-exercise BG is 90-150

A

may need 15 g CHO depending on type of exercise

52
Q

What should peds BG be before exercise?

A

90-250

53
Q

What is peds fasting goal and HS goal?

A

Fasting- 90-130

HS- 90-150

54
Q

How often should A1c be tested if pt is stable, tx goals met?

A

2x/year

55
Q

How often should A1c be tested if tx has changed or not meeting goals?

A

quarterly

56
Q

What are limitations of A1c?

A
  • does not reflect hypo or glycemic variability
57
Q

Why is CGM helpful?

A
  • can guide MNT
  • prevent hypo/recognize it earlier
  • provide info that guides changing meds
  • tells you hyper, hypo, glycemic variability, time in range
58
Q

Based on DCCT trial, intense BG tx (A1c 7% vs. 9%) reduced microvascular complications by what %

A

50-75%

59
Q

Who benefits from less strict A1c targets?

A
  • those w/ severe hypo
  • older/frail
  • advanced atherosclerosis
  • history of hypo
60
Q

Target PP BG

A

<180 1-2 H after meal

61
Q

What is preferred tx for hypo?

A

Glucose 15-20 g

Glucose grams rather than CHO grams

62
Q

Who is @ risk for level 3 hypo?

A
  • insulin users
  • poor glycemic control
  • albuminuria
  • poor cognitive function
  • older African Americans
  • > 60 years old
63
Q

Why is level 3 hypo dangerous?

A

Seizure, coma, death, loss of consciousness, falls, MVA

64
Q

How can the risk for hypo be reduced?

A
  • Bed time snack
  • individualize BG targets
  • exercise MGMT
  • medication MGMT
  • Glu monitoring
  • pt ed
65
Q

T1 DM + level 3 hypo may benefit from what?

A

human islet transplant

66
Q

What increases risk for situational hypo?

A
  • fasting for test
  • delayed meals
  • during/after ETOH
  • during/after intense exercise
  • during sleep
67
Q

For what conditions would using A1c not be appropriate for?

A

G6PD deficiency
2nd, 3rd trimester pregnancy
recent blood loss, blood transfusion
ESRD/HD

68
Q

When should assay interference be considered w/ A1c?

A

When A1c is vastly different/does not correlate from SMBG

69
Q

Most assays in the US are accurate in people with ______ for most common variants

A

heterozygous

70
Q

TIR is associated with decreased risk of ______ complications

A

microvascular

71
Q

Better glycemic control is associated with ______ reduction in microvascular conditions? (DCCT)
Which microvascular conditions?

A

50-75%

DKD, neuropathy, retinopathy

72
Q

Achieving A1c of

A

<7%

73
Q

Greatest # of complications reduced when A1c goes from ______ to _____ control

A

Poor –> fair/good

74
Q

What is the ACCORD trial and why was it stopped early?

A

Tried to get A1c <6% in T2DM

Increased mortality rate & CVD deah

75
Q

Severe hypoglycemia is associated with _____ and _______

A

CVD events and mortality

76
Q

What are s/s of hypo?

A 
Shaky
Sweaty
Irritable
Confused
Hungry
Tachycardia
77
Q

Why did ADA change low end of fasting goal from 70 to 80?

A

Higher glycemic target corresponded to A1c goals and provided safety net against hypo

78
Q

What is a breakthough s/s of hypo for someone on B-blocker?

A

Sweaty

79
Q

What % of pts meet A1c, BP, lipid + non-smoking target?

A

15%

80
Q

What % of pts do not meet targets for A1c, BP, or lipids?

A

33-50%

81
Q

When someone is dx with DM what % of pancreas is functioning?

A

20%

82
Q

When someone is dx with pre-DM what % of pancreas is functioning?

A

50%

83
Q

What are peds A1c goals?

A

<7 for most
<7.5 if they can’t articulate s/s hypo
<6.5% if they can do it safely

84
Q

What are the A1c and fasting BG recommendations for a older healthy adult versus an older adult with complications and risk for hypo?

A

<7.5/90-130 versus <8/90-150

85
Q

What are A1c and fasting BG recommendations for an older adult who is chronically ill and in poor health?

A

<8.5, 100-180

CDCES (13 decks)

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