Treatment Overview: ADA, AACE, DCCT, UKPDS Flashcards
An A1c test measure average plasma glucose over the previous ___ to ___ months.
2-3
How often should an A1c be tested in a patient with good glycemic control?
twice yearly
How often should a patient have an A1c test done if their therapy has recently been changed or who are not meeting treatment goals?
once every quarter
What are the ADA goals for preprandial glucose and postprandial glucose?
- Preprandial: 70-130 mg/dL
- Postprandial: <180 mg/dL
What are the ADA targets for blood pressure?
<130/80 mmHg
What is the ADA targets for lipids? (LDL, triglycerides, HDL)
- LDL: <100 mg/dL
- Triglycerides: <150 mg/dL
- HDL: >40 mg/DL (men), >50 mg/dL (women)
What are the AACE goals for preprandial and postprandial glucose?
- Preprandial: <110 mg/dL
- Postprandial: <140 mg/dL
What was DCCT stand for?
Diabetes Control and Complications Trial
What patient population did the DCCT study?
type 1 patients
What did the DCCT compare?
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)
What was a key finding of the DCCT?
Any reduction in A1c is helpful in preventing or reducing the complications of type 1 diabetes.
What was the potential adverse effect(s) associated with intensive insulin therapy according to the DCCT?
- intensive therapy had a 2-3 fold greater incidence of severe hypglycemia.
- weight gain
According to the ADA, what should the treatment regimen be in every newly diagnosed type 2 patient?
lifestyle changes and metformin
What does UKPDS stand for?
United Kingdom Prospective Diabetes Study
What group of patients did UKPDS study?
type 2 patients
How many patients were in the UKPDS?
3,867
How long were patients in the UKPDS followed?
10 years
What was the purpose of the UKPDS?
to compare patients who were randomized to conventional therapy (diet alone) or intensive therapy (managment with 1 or more pharmacologic agents, including insulin)
What was the median A1c at the end of the trial for patients in the conventional arm versus the intensive arm?
7.9% for conventional, 7.0% for intensive
Compared to conventional therapy, intensive therapy reduced microvascular complications (retinopathy, nephropathy, neuropathy) by _____%.
25%
According to UKPDS, for every ____% decrease in A1c achieved there was a _____% decrease in the risk of microvascular complications.
1% decrease, 35% decrease
In UKPDS, there was a nonsignificant trend toward a reduced risk of ________________ with intensive therapy.
myocardial infarction
True or False: UKPDS found that strict blood pressure control produced even greater benefits than glycemic control.
True.
What is the primary limiting factor in intensive regimens?
hypoglycemia
What did the DAWN study report?
there were low levels of compliance with self-management behaviors
What does MNT stand for?
Medical Nutrition Therapy
What is the average minimum requirement of carbohydrates per day for most people?
130 g
According to proper MNT, saturated fats should be limited to <____% of total calories.
7%
Dietary cholesterol should be limited to <_____ mg/day.
<200 mg per day
The protein recommendation for patients with normal renal function is __% - __% of total calories, which is the same recommendation for the general population.
15%-20%
For patients in the early stages of chronic kidney disease, what should their level of protein intake be?
0.8-1.0 g/kg of body weight per day
True or False: Protein can increase insulin sensitivity in patients with type 2 diabetes without increasing plasma glucose.
True. Therefore, protein should not be used to prevent or treat nocturnal hypoglycemia.
How much exercise does the ADA recommend each week?
- 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
What are the symptoms of hypoglycemia?
- shakiness
- weakness
- confusion
- fatigue
- irritability
- rapid pulse rate
What did DECODE study show regarding correlation between age and hyperglycemia?
postmeal hyperglycemia increases with age
Diabetes increases the risk for adverse coronary events ___fold in women and ___fold in men.
twofold (women), fourfold (men)
Hypertension in type 1 patients is often due to underlying _________________.
nephropathy
Hypertension in type 2 patients is often part of _____________ and ____________.
hyperglycemia, dyslipidemia
What are the blood pressure treatment goals for adults with diabetes?
<130mmHg / <80mmHg
Patients with more severe hypertension should receive pharmacologic therapy. When should therapy be initiated?
=>140 mmHg / =>90 mmHg
What is the first-line agents for BP lowering in diabetes patients? Why?
ACE inhibitors and ARBs because they have been shown to slow the development of nephropathy
What are the lipid abnormalities associated with type 2 diabetes?
- high triglycerides
- low HDL
- high LDL
How often should lipid panels be done in adult patients?
at least every year unless part of a low-risk group (then every 2 years)
In individuals without overt CVD, what is the primary goal of lipid control?
reduce LDL levels (goal is <100 mg/dL)
In individuals with overt CVD, what is the LDL goal?
<70 mg/dL
What is the secondary goal of lipids management?
- lower triglycerides to <150 mg/dL
- raise HDL to >40 mg/dL (men) and >50 mg/dL (women)
What is the most frequent cause of new blindness among adults ages 20-74?
diabetic retinopathy
True or False: nearly all type 1 patients develop retinopathy during the first 2 decades of diabetes.
True.
According to the ADA, how often should type 1 patients aged 10 years or older received a dilated and comprehensive eye exam?
within 2-5 years of diagnosis and annual exams thereafter
All women with diabetes who plan on becoming pregnant should have an eye exam when?
before conception and within the first trimester and for 1 year postpartum
What percentage of new ESRD is attributed to diabetes?
40%
About __% to __% of patients with diabetes develop nephropathy.
20%-40%
How is nephropathy usually first detected?
as small amounts of protein in the urine (microalbuminuria)
How often should urine be screened for albumin?
- at the time of diagnosis for type 2 patients
- 5 years after diagnosis for type 1 patients
- subsequent screening should occur annually
How many abnormal tests are required to designate a patient as having microalbuminuria?
2 out of 3 over a 3-6 month period
