Diabetes Monitoring Guidelines Quiz

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Questions and Answers

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?

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?

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?

Teplizumab-mzwv infusion Signup and view all the answers

What fasting plasma glucose level is considered elevated and requires monitoring?

≥110 mg/dL Signup and view all the answers

What A1C percentage range is classified as prediabetes?

5.7–6.4% Signup and view all the answers

What is the fasting plasma glucose value that indicates diabetes?

≥126 mg/dL Signup and view all the answers

What two-hour glucose value during an oral glucose tolerance test indicates prediabetes?

140–199 mg/dL Signup and view all the answers

Which statement is true regarding random glucose testing for diagnosing diabetes?

It confirms diabetes if value is ≥200 mg/dL. Signup and view all the answers

What A1C percentage is indicative of diabetes?

≥6.5% Signup and view all the answers

Which group of individuals should have their kidney function monitored more frequently?

People with diabetes and chronic kidney disease Signup and view all the answers

What is insufficient evidence regarding continuous glucose monitoring?

It cannot be used for diagnosing diabetes or prediabetes. Signup and view all the answers

What fasting plasma glucose range indicates prediabetes?

100–125 mg/dL Signup and view all the answers

What is a recommended counseling focus for individuals with diabetes?

Cessation of tobacco products Signup and view all the answers

Which measurement is NOT used to classify diabetes?

Cholesterol levels Signup and view all the answers

What service is critical for helping individuals with diabetes achieve health goals?

Diabetes self-management education and support (DSMES) Signup and view all the answers

At which level is a 2-hour glucose value during an oral glucose tolerance test classified as diabetes?

≥200 mg/dL Signup and view all the answers

How often should DSMES be referred to an individual with diabetes?

Annually and when not meeting treatment goals Signup and view all the answers

What is one of the proven outcomes of effective diabetes management?

Reduced all-cause mortality risk Signup and view all the answers

What random glucose level can be indicative of classic hyperglycemia symptoms?

≥200 mg/dL Signup and view all the answers

Which factor is emphasized for diabetes self-management education?

Culturally appropriate content Signup and view all the answers

In what settings can diabetes self-management education be conducted?

Group or individual visits, in-person or remotely Signup and view all the answers

Support with which aspect can significantly enhance the management of diabetes?

Behavioral health professionals Signup and view all the answers

What is NOT a benefit of effective diabetes self-management?

Increased confusion about health goals Signup and view all the answers

Which recommendation supports routine physical activity for individuals with diabetes?

Counsel on routine physical activity Signup and view all the answers

What is the minimum recommended amount of vigorous-intensity activity per week?

75 minutes Signup and view all the answers

How many days per week should vigorous-intensity activity be spread over?

At least 3 days Signup and view all the answers

What is the benefit of breaking up prolonged sitting with as little as 30 minutes of moderate activity?

Improves metabolic profiles Signup and view all the answers

What is the daily step increase associated with a reduced risk of cardiovascular morbidity and mortality?

500 steps Signup and view all the answers

What additional types of sessions are recommended alongside vigorous-intensity activity?

Resistance, flexibility, and balance sessions Signup and view all the answers

What is one key consideration for interventions in the treatment of diabetes?

They should be collaborative and culturally informed. Signup and view all the answers

Why is it important to screen both people with diabetes and their caregivers annually?

To address changes in disease, treatment, or life circumstances. Signup and view all the answers

What successful outcome can increased utilization of primary care and preventive services lead to?

Lower health care costs and improved health equity. Signup and view all the answers

Which mental health aspect should be prioritized for people with diabetes?

Addressing both clinical and subclinical psychological symptoms. Signup and view all the answers

Who should ideally be referred to for psychosocial support in diabetes care?

Behavioral health professionals with diabetes training. Signup and view all the answers

What is one resource and tool available for health care professionals to support mental health in diabetes?

Behavioral health toolkit. Signup and view all the answers

What role does psychosocial screening play in the care for people with diabetes?

It assesses psychological symptoms related to diabetes management. Signup and view all the answers

What can be a significant factor affecting self-management in people with diabetes?

Social and family support. Signup and view all the answers

What is one of the social determinants of health that should be assessed?

Food security Signup and view all the answers

Which physical examination is specifically related to assessing foot health?

Comprehensive foot examination Signup and view all the answers

When should serum creatinine and estimated glomerular filtration rate be evaluated for patients?

Every annual visit Signup and view all the answers

Which examination screens for peripheral arterial disease (PAD)?

Pedal pulses Signup and view all the answers

What test is suggested if the A1C results are not available within the past 3 months?

A1C test Signup and view all the answers

What condition should a thyroid-stimulating hormone test specifically be considered for?

Type 1 diabetes Signup and view all the answers

Which psychological factors need to be screened in the evaluation?

Depression and anxiety Signup and view all the answers

What routine measurement assesses the patient's growth in children and adolescents?

Height, weight, and BMI Signup and view all the answers

Which laboratory evaluation is necessary for patients taking metformin?

Vitamin B12 level Signup and view all the answers

What should be evaluated regarding a patient's insulin pump settings?

Connected pen and glucose data Signup and view all the answers

Which laboratory test evaluates liver function in patients?

Liver function tests Signup and view all the answers

What screening test involves a 10-g monofilament exam?

For neuropathy Signup and view all the answers

What is one potential indication for the assessment of cognitive performance?

Age and neurological symptoms Signup and view all the answers

What type of information is necessary when identifying a surrogate decision maker?

Legal documentation Signup and view all the answers

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.