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Questions and Answers
Which group of individuals should be monitored for potential diabetes complications due to their BMI?
Which group of individuals should be monitored for potential diabetes complications due to their BMI?
- Individuals aged 18–24 years with a BMI ≥35 kg/m2
- Adults aged 25–59 years with a BMI <35 kg/m2
- Individuals aged 60 years and older with a BMI ≥30 kg/m2
- Adults aged 25–59 years with a BMI ≥35 kg/m2 (correct)
For individuals undergoing metformin therapy, which parameter should be monitored periodically?
For individuals undergoing metformin therapy, which parameter should be monitored periodically?
- Hemoglobin levels
- Vitamin B12 levels (correct)
- Creatinine clearance
- Calcium levels
What is the recommended frequency for monitoring A1C in individuals with preclinical type 1 diabetes?
What is the recommended frequency for monitoring A1C in individuals with preclinical type 1 diabetes?
- Approximately every 6 months (correct)
- Annually, without exceptions
- Every 3 months
- Every month
Which medication is suggested to delay the onset of symptomatic type 1 diabetes?
Which medication is suggested to delay the onset of symptomatic type 1 diabetes?
What fasting plasma glucose level is considered elevated and requires monitoring?
What fasting plasma glucose level is considered elevated and requires monitoring?
What A1C percentage range is classified as prediabetes?
What A1C percentage range is classified as prediabetes?
What is the fasting plasma glucose value that indicates diabetes?
What is the fasting plasma glucose value that indicates diabetes?
What two-hour glucose value during an oral glucose tolerance test indicates prediabetes?
What two-hour glucose value during an oral glucose tolerance test indicates prediabetes?
Which statement is true regarding random glucose testing for diagnosing diabetes?
Which statement is true regarding random glucose testing for diagnosing diabetes?
What A1C percentage is indicative of diabetes?
What A1C percentage is indicative of diabetes?
Which group of individuals should have their kidney function monitored more frequently?
Which group of individuals should have their kidney function monitored more frequently?
What is insufficient evidence regarding continuous glucose monitoring?
What is insufficient evidence regarding continuous glucose monitoring?
What fasting plasma glucose range indicates prediabetes?
What fasting plasma glucose range indicates prediabetes?
What is a recommended counseling focus for individuals with diabetes?
What is a recommended counseling focus for individuals with diabetes?
Which measurement is NOT used to classify diabetes?
Which measurement is NOT used to classify diabetes?
What service is critical for helping individuals with diabetes achieve health goals?
What service is critical for helping individuals with diabetes achieve health goals?
At which level is a 2-hour glucose value during an oral glucose tolerance test classified as diabetes?
At which level is a 2-hour glucose value during an oral glucose tolerance test classified as diabetes?
How often should DSMES be referred to an individual with diabetes?
How often should DSMES be referred to an individual with diabetes?
What is one of the proven outcomes of effective diabetes management?
What is one of the proven outcomes of effective diabetes management?
What random glucose level can be indicative of classic hyperglycemia symptoms?
What random glucose level can be indicative of classic hyperglycemia symptoms?
Which factor is emphasized for diabetes self-management education?
Which factor is emphasized for diabetes self-management education?
In what settings can diabetes self-management education be conducted?
In what settings can diabetes self-management education be conducted?
Support with which aspect can significantly enhance the management of diabetes?
Support with which aspect can significantly enhance the management of diabetes?
What is NOT a benefit of effective diabetes self-management?
What is NOT a benefit of effective diabetes self-management?
Which recommendation supports routine physical activity for individuals with diabetes?
Which recommendation supports routine physical activity for individuals with diabetes?
What is the minimum recommended amount of vigorous-intensity activity per week?
What is the minimum recommended amount of vigorous-intensity activity per week?
How many days per week should vigorous-intensity activity be spread over?
How many days per week should vigorous-intensity activity be spread over?
What is the benefit of breaking up prolonged sitting with as little as 30 minutes of moderate activity?
What is the benefit of breaking up prolonged sitting with as little as 30 minutes of moderate activity?
What is the daily step increase associated with a reduced risk of cardiovascular morbidity and mortality?
What is the daily step increase associated with a reduced risk of cardiovascular morbidity and mortality?
What additional types of sessions are recommended alongside vigorous-intensity activity?
What additional types of sessions are recommended alongside vigorous-intensity activity?
What is one key consideration for interventions in the treatment of diabetes?
What is one key consideration for interventions in the treatment of diabetes?
Why is it important to screen both people with diabetes and their caregivers annually?
Why is it important to screen both people with diabetes and their caregivers annually?
What successful outcome can increased utilization of primary care and preventive services lead to?
What successful outcome can increased utilization of primary care and preventive services lead to?
Which mental health aspect should be prioritized for people with diabetes?
Which mental health aspect should be prioritized for people with diabetes?
Who should ideally be referred to for psychosocial support in diabetes care?
Who should ideally be referred to for psychosocial support in diabetes care?
What is one resource and tool available for health care professionals to support mental health in diabetes?
What is one resource and tool available for health care professionals to support mental health in diabetes?
What role does psychosocial screening play in the care for people with diabetes?
What role does psychosocial screening play in the care for people with diabetes?
What can be a significant factor affecting self-management in people with diabetes?
What can be a significant factor affecting self-management in people with diabetes?
What is one of the social determinants of health that should be assessed?
What is one of the social determinants of health that should be assessed?
Which physical examination is specifically related to assessing foot health?
Which physical examination is specifically related to assessing foot health?
When should serum creatinine and estimated glomerular filtration rate be evaluated for patients?
When should serum creatinine and estimated glomerular filtration rate be evaluated for patients?
Which examination screens for peripheral arterial disease (PAD)?
Which examination screens for peripheral arterial disease (PAD)?
What test is suggested if the A1C results are not available within the past 3 months?
What test is suggested if the A1C results are not available within the past 3 months?
What condition should a thyroid-stimulating hormone test specifically be considered for?
What condition should a thyroid-stimulating hormone test specifically be considered for?
Which psychological factors need to be screened in the evaluation?
Which psychological factors need to be screened in the evaluation?
What routine measurement assesses the patient's growth in children and adolescents?
What routine measurement assesses the patient's growth in children and adolescents?
Which laboratory evaluation is necessary for patients taking metformin?
Which laboratory evaluation is necessary for patients taking metformin?
What should be evaluated regarding a patient's insulin pump settings?
What should be evaluated regarding a patient's insulin pump settings?
Which laboratory test evaluates liver function in patients?
Which laboratory test evaluates liver function in patients?
What screening test involves a 10-g monofilament exam?
What screening test involves a 10-g monofilament exam?
What is one potential indication for the assessment of cognitive performance?
What is one potential indication for the assessment of cognitive performance?
What type of information is necessary when identifying a surrogate decision maker?
What type of information is necessary when identifying a surrogate decision maker?
Flashcards
A1C test
A1C test
A blood test that measures average blood sugar levels over the past 2-3 months.
Prediabetes
Prediabetes
A condition where blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes.
Fasting plasma glucose test
Fasting plasma glucose test
A blood test that measures blood sugar levels after fasting for at least 8 hours.
2-hour glucose tolerance test
2-hour glucose tolerance test
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Random glucose test
Random glucose test
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Diabetes
Diabetes
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Prediabetes fasting plasma glucose level
Prediabetes fasting plasma glucose level
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Diabetes fasting plasma glucose level
Diabetes fasting plasma glucose level
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Prediabetes blood sugar level during 2-hour glucose tolerance test
Prediabetes blood sugar level during 2-hour glucose tolerance test
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Diabetes blood sugar level during 2-hour glucose tolerance test
Diabetes blood sugar level during 2-hour glucose tolerance test
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What BMI indicates obesity in adults?
What BMI indicates obesity in adults?
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What A1C level can be a sign of pre-diabetes?
What A1C level can be a sign of pre-diabetes?
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Who is at increased risk for type 2 diabetes?
Who is at increased risk for type 2 diabetes?
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Why is vitamin B12 monitoring essential for patients on metformin?
Why is vitamin B12 monitoring essential for patients on metformin?
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What fasting blood sugar level indicates increased risk for type 2 diabetes?
What fasting blood sugar level indicates increased risk for type 2 diabetes?
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Vigorous Activity Recommendation
Vigorous Activity Recommendation
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Supplementary Exercise Recommendation
Supplementary Exercise Recommendation
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Moderate Activity Benefits
Moderate Activity Benefits
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Benefits of Increased Steps
Benefits of Increased Steps
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Frailty Phenotype
Frailty Phenotype
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Social Support Network Assessment
Social Support Network Assessment
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Surrogate Decision Maker Identification
Surrogate Decision Maker Identification
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Advanced Care Plan
Advanced Care Plan
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Social Determinants of Health Assessment
Social Determinants of Health Assessment
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Daily Routine and Environment Assessment
Daily Routine and Environment Assessment
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Height, Weight, and BMI Assessment
Height, Weight, and BMI Assessment
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Blood Pressure Measurement
Blood Pressure Measurement
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Orthostatic Blood Pressure Measurement
Orthostatic Blood Pressure Measurement
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Fundoscopic Examination
Fundoscopic Examination
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Thyroid Palpation
Thyroid Palpation
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Skin Examination for Diabetes
Skin Examination for Diabetes
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Comprehensive Foot Examination
Comprehensive Foot Examination
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Mental Health Assessment
Mental Health Assessment
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Cognitive Performance Assessment
Cognitive Performance Assessment
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Functional Performance Assessment
Functional Performance Assessment
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What is diabetes distress?
What is diabetes distress?
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Why is screening for mental health important in people with diabetes?
Why is screening for mental health important in people with diabetes?
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How should mental health interventions for diabetes be approached?
How should mental health interventions for diabetes be approached?
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What is the role of a behavioral health professional in caring for someone with diabetes?
What is the role of a behavioral health professional in caring for someone with diabetes?
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What is the importance of addressing subclinical psychological symptoms?
What is the importance of addressing subclinical psychological symptoms?
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How does mental health play a role in diabetes care?
How does mental health play a role in diabetes care?
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How often should mental health screening happen for those with diabetes?
How often should mental health screening happen for those with diabetes?
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What are important factors to consider when developing treatment plans for mental health in diabetes?
What are important factors to consider when developing treatment plans for mental health in diabetes?
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Why are kidney function tests important in older adults with diabetes?
Why are kidney function tests important in older adults with diabetes?
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When else are kidney function tests important in people with diabetes?
When else are kidney function tests important in people with diabetes?
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Who needs more frequent kidney function tests in diabetes?
Who needs more frequent kidney function tests in diabetes?
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What is DSMES?
What is DSMES?
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Why is DSMES important?
Why is DSMES important?
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Who can benefit from DSMES?
Who can benefit from DSMES?
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When should DSMES be offered?
When should DSMES be offered?
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What makes a DSMES program effective?
What makes a DSMES program effective?
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What is MNT?
What is MNT?
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Why is MNT important?
Why is MNT important?
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Study Notes
Improving Care and Promoting Health in Populations
- A multifaceted approach encompassing patient-level, system-level, and policy-level interventions is crucial for enhancing population health in the context of diabetes.
- Patient-Level: Minimize therapeutic inertia, align with evidence-based treatment guidelines, address social determinants of health, and foster shared decision-making considering individual preferences, prognoses, comorbidities, and financial factors.
- System-Level: Foster a quality-oriented culture, leverage patient registries and electronic health records for quality enhancement, use collaborative, multidisciplinary health care teams, incorporate telehealth alongside in-person visits to expand access to quality diabetes care, ensure access to diabetes self-management education and support, evaluate socioeconomic and linguistic barriers to diabetes management and care, and facilitate referrals to local community resources.
- Policy-Level: Ensure access to health insurance with adequate coverage for diabetes management, including medications, supplies/equipment, technology, and medical care; ensure access to healthcare professionals with expertise in diabetes management.
Diagnosis and Classification of Diabetes
- There is insufficient evidence to support the use of continuous glucose monitoring for screening or diagnosing prediabetes or diabetes.
- In the absence of unequivocal hyperglycemia, type 2 diabetes diagnosis requires confirmatory testing.
- Marked discordance between A1C and repeated blood glucose measurements may indicate a problem with either test.
- Type 1 diabetes involves idiopathic or autoimmune β-cell destruction.
- Type 2 diabetes is characterized by progressive loss of adequate β-cell insulin secretion frequently on the background of insulin resistance and metabolic syndrome.
- Gestational diabetes mellitus (GDM) is diagnosed in individuals without previously identified diabetes or high-risk glucose metabolism between 24-28 weeks of gestation.
Screening Criteria for Prediabetes and Type 2 Diabetes
- Screening for prediabetes and type 2 diabetes should be performed in asymptomatic adults with an informal assessment of risk factors or a validated risk calculator.
- Adults ≥18 years with overweight or obesity (BMI ≥25 kg/m² or ≥23 kg/m² for Asian Americans) with one or more of the following risk factors should be screened: first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension (≥130/80 mmHg), polycystic ovary syndrome, HDL cholesterol <35 mg/dL (<0.9 mmol/L) and/or triglycerides >250 mg/dL (>2.8 mmol/L), physical inactivity, and other clinical conditions associated with insulin resistance.
- Screening for prediabetes or type 2 diabetes should be considered in obese children and adolescents (BMI ≥95th percentile) or overweight adolescents (BMI ≥85th percentile) with one or more risk factors after puberty or age 10.
- Screening of those with a history of GDM or HIV, exposure to high-risk medicines, or history of pancreatitis should be done frequently.
Additional Screening Guidelines
- A mismatch between A1C and glycemia can result from several factors, including some hemoglobin variants, pregnancy, glucose-6-phosphate dehydrogenase deficiency, HIV, hemodialysis, recent blood loss, transfusion, anemia, or erythropoietin therapy.
- Individuals with cystic fibrosis should undergo annual screening for hyperglycemia beginning at age 10 years.
- Post-transplantation diabetes mellitus should be screened when the individual is stable on immunosuppressive therapy and free from acute infections.
- Screen people for prediabetes or diabetes if they are using glucocorticoids, statins, thiazide diuretics, some HIV medications, or second-generation antipsychotic medications.
Prevention or Delay of Diabetes and Associated Comorbidities
- Lab testing is a safe and cost-effective way to screen for diabetes.
- Screening assists with addressing cardiovascular risk factors such as hypertension and dyslipidemia.
- People with prediabetes should be monitored annually.
- Others should be screened every three years, or sooner if risk factors change.
- Screen children and adolescents (overweight or obese) with one or more risk factors starting at age 10 or puberty.
Where to Refer
- Refer adults with overweight or obesity at high risk for type 2 diabetes to a recognized diabetes prevention lifestyle change program.
Person-Centered Care Goals for Individuals at Risk of Type 2 Diabetes
- It is important to weight the individual risks and benefits of interventions.
- Facilitate weight management in those with overweight/obesity.
- Minimize progression of hyperglycemia.
- Reduce cardiovascular risk.
- Consider more intensive approaches for individuals at high risk of progression to diabetes.
What Medications Can Be Prescribed to Prevent Type 2 Diabetes?
- Metformin has the strongest evidence base for prevention.
Who Should Be Considered for Metformin Therapy To Prevent Type 2 Diabetes?
- Adults aged 25-59 years with BMI ≥35 kg/m² or with higher fasting plasma glucose (e.g., ≥110 mg/dL [≥ 6 mmol/L]), higher A1C (e.g., ≥6.0% [≥42 mmol/mol]), or a history of gestational diabetes mellitus.
Vitamin B12 Screening and Type 1 Diabetes
- Vitamin B12 should be measured periodically, especially in those with anemia or peripheral neuropathy.
- Screening for type 1 diabetes in those with preclinical type 1 diabetes involves monitoring A1C and a 75-g oral glucose tolerance test (fasting and 2-h plasma glucose).
Staging of Type 1 Diabetes
- Stages (1-3) are based on the presence of autoimmunity, normoglycemia/dysglycemia, and symptoms.
How Does Diabetes Affect Bone Health?
- People with type 1 or type 2 diabetes have a higher fracture risk than those without diabetes.
- This risk escalates with longer diabetes duration and poor glycemic control.
Are People With Diabetes at Increased Risk for Cancer?
- Diabetes is associated with a higher risk of certain cancers (liver, pancreas, endometrium, colon/rectum, breast, and bladder).
What Medications Can Be Prescribed to Adults to Prevent Type 2 Diabetes?
- The U.S. Food and Drug Administration has not approved any drugs for diabetes prevention.
- Metformin has the strongest evidence base for prevention.
How Prevalent is Nonalcoholic Fatty Liver Disease (NAFLD)?
- Approximately 70% of people with type 2 diabetes have NAFLD.
Comprehensive Medical Evaluation and Assessment of Comorbidities
- People with type 1 diabetes require screening for autoimmune conditions soon after diagnosis and periodically thereafter.
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Description
Test your knowledge on the key monitoring guidelines for diabetes, including important measurements like A1C and fasting plasma glucose levels. This quiz covers essential aspects such as medication effects, BMI considerations, and the frequency of health checks for individuals at risk of diabetes complications.
