Treatment Overview: ADA, AACE, DCCT, UKPDS

Question 1

An A1c test measure average plasma glucose over the previous ___ to ___ months.

Answer 1

2-3

Question 2

How often should an A1c be tested in a patient with good glycemic control?

Answer 2

twice yearly

Question 3

How often should a patient have an A1c test done if their therapy has recently been changed or who are not meeting treatment goals?

Answer 3

once every quarter

Question 4

What are the ADA goals for preprandial glucose and postprandial glucose?

Answer 4

• Preprandial: 70-130 mg/dL
• Postprandial: <180 mg/dL

Question 5

What are the ADA targets for blood pressure?

Answer 5

<130/80 mmHg

Question 6

What is the ADA targets for lipids? (LDL, triglycerides, HDL)

Answer 6

• LDL: <100 mg/dL
• Triglycerides: <150 mg/dL
• HDL: >40 mg/DL (men), >50 mg/dL (women)

Question 7

What are the AACE goals for preprandial and postprandial glucose?

Answer 7

• Preprandial: <110 mg/dL
• Postprandial: <140 mg/dL

Question 8

What was DCCT stand for?

Answer 8

Diabetes Control and Complications Trial

Question 9

What patient population did the DCCT study?

Answer 9

type 1 patients

Question 10

What did the DCCT compare?

Answer 10

type 1 patients who were either managed with intensive insulin therapy (3 or more injections per day) or with a more conventional regimen (1-2 insulin injections per day)

Question 11

What was a key finding of the DCCT?

Answer 11

Any reduction in A1c is helpful in preventing or reducing the complications of type 1 diabetes.

Question 12

What was the potential adverse effect(s) associated with intensive insulin therapy according to the DCCT?

Answer 12

• intensive therapy had a 2-3 fold greater incidence of severe hypglycemia.
• weight gain

Question 13

According to the ADA, what should the treatment regimen be in every newly diagnosed type 2 patient?

Answer 13

lifestyle changes and metformin

Question 14

What does UKPDS stand for?

Answer 14

United Kingdom Prospective Diabetes Study

Question 15

What group of patients did UKPDS study?

Answer 15

type 2 patients

Question 16

How many patients were in the UKPDS?

Answer 16

3,867

Question 17

How long were patients in the UKPDS followed?

Answer 17

10 years

Question 18

What was the purpose of the UKPDS?

Answer 18

to compare patients who were randomized to conventional therapy (diet alone) or intensive therapy (managment with 1 or more pharmacologic agents, including insulin)

Question 19

What was the median A1c at the end of the trial for patients in the conventional arm versus the intensive arm?

Answer 19

7.9% for conventional, 7.0% for intensive

Question 20

Compared to conventional therapy, intensive therapy reduced microvascular complications (retinopathy, nephropathy, neuropathy) by _____%.

Answer 20

25%

Question 21

According to UKPDS, for every ____% decrease in A1c achieved there was a _____% decrease in the risk of microvascular complications.

Answer 21

1% decrease, 35% decrease

Question 22

In UKPDS, there was a nonsignificant trend toward a reduced risk of ________________ with intensive therapy.

Answer 22

myocardial infarction

Question 23

True or False: UKPDS found that strict blood pressure control produced even greater benefits than glycemic control.

Answer 23

True.

Question 24

What is the primary limiting factor in intensive regimens?

Answer 24

hypoglycemia

Question 25

What did the DAWN study report?

Answer 25

there were low levels of compliance with self-management behaviors

Question 26

What does MNT stand for?

Answer 26

Medical Nutrition Therapy

Question 27

What is the average minimum requirement of carbohydrates per day for most people?

Answer 27

130 g

Question 28

According to proper MNT, saturated fats should be limited to \<\_\_\_\_% of total calories.

Answer 28

7%

Question 29

Dietary cholesterol should be limited to \<\_\_\_\_\_ mg/day.

Answer 29

\<200 mg per day

Question 30

The protein recommendation for patients with normal renal function is \_\_% - \_\_% of total calories, which is the same recommendation for the general population.

Answer 30

15%-20%

Question 31

For patients in the early stages of chronic kidney disease, what should their level of protein intake be?

Answer 31

0.8-1.0 g/kg of body weight per day

Question 32

True or False: Protein can increase insulin sensitivity in patients with type 2 diabetes without increasing plasma glucose.

Answer 32

True. Therefore, protein should not be used to prevent or treat nocturnal hypoglycemia.

Question 33

How much exercise does the ADA recommend each week?

Answer 33

* at least 150 minutes of moderate-intensity aerobic exercise per week spread out over at least 3 days per week iwth no more than 2 consecutive days without exercise. * resistance exercise at least twice per week

Question 34

What are the symptoms of hypoglycemia?

Answer 34

* shakiness * weakness * confusion * fatigue * irritability * rapid pulse rate

Question 35

What did DECODE study show regarding correlation between age and hyperglycemia?

Answer 35

postmeal hyperglycemia increases with age

Question 36

Diabetes increases the risk for adverse coronary events \_\_\_fold in women and \_\_\_fold in men.

Answer 36

twofold (women), fourfold (men)

Question 37

Hypertension in type 1 patients is often due to underlying \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 37

nephropathy

Question 38

Hypertension in type 2 patients is often part of _____________ and \_\_\_\_\_\_\_\_\_\_\_\_.

Answer 38

hyperglycemia, dyslipidemia

Question 39

What are the blood pressure treatment goals for adults with diabetes?

Answer 39

\<130mmHg / \<80mmHg

Question 40

Patients with more severe hypertension should receive pharmacologic therapy. When should therapy be initiated?

Answer 40

=\>140 mmHg / =\>90 mmHg

Question 41

What is the first-line agents for BP lowering in diabetes patients? Why?

Answer 41

ACE inhibitors and ARBs because they have been shown to slow the development of nephropathy

Question 42

What are the lipid abnormalities associated with type 2 diabetes?

Answer 42

1. high triglycerides 2. low HDL 3. high LDL

Question 43

How often should lipid panels be done in adult patients?

Answer 43

at least every year unless part of a low-risk group (then every 2 years)

Question 44

In individuals without overt CVD, what is the primary goal of lipid control?

Answer 44

reduce LDL levels (goal is \<100 mg/dL)

Question 45

In individuals with overt CVD, what is the LDL goal?

Answer 45

\<70 mg/dL

Question 46

What is the secondary goal of lipids management?

Answer 46

* lower triglycerides to \<150 mg/dL * raise HDL to \>40 mg/dL (men) and \>50 mg/dL (women)

Question 47

What is the most frequent cause of new blindness among adults ages 20-74?

Answer 47

diabetic retinopathy

Question 48

True or False: nearly all type 1 patients develop retinopathy during the first 2 decades of diabetes.

Answer 48

True.

Question 49

According to the ADA, how often should type 1 patients aged 10 years or older received a dilated and comprehensive eye exam?

Answer 49

within 2-5 years of diagnosis and annual exams thereafter

Question 50

All women with diabetes who plan on becoming pregnant should have an eye exam when?

Answer 50

before conception and within the first trimester and for 1 year postpartum

Question 51

What percentage of new ESRD is attributed to diabetes?

Answer 51

40%

Question 52

About \_\_% to \_\_% of patients with diabetes develop nephropathy.

Answer 52

20%-40%

Question 53

How is nephropathy usually first detected?

Answer 53

as small amounts of protein in the urine (microalbuminuria)

Question 54

How often should urine be screened for albumin?

Answer 54

* at the time of diagnosis for type 2 patients * 5 years after diagnosis for type 1 patients * subsequent screening should occur annually

Question 55

How many abnormal tests are required to designate a patient as having microalbuminuria?

Answer 55

2 out of 3 over a 3-6 month period