Podcast
Questions and Answers
What impact did the DPP trial find an intensive lifestyle intervention had on the incidence of type 2 diabetes over 3 years?
What impact did the DPP trial find an intensive lifestyle intervention had on the incidence of type 2 diabetes over 3 years?
- It increased the incidence by 58%.
- It reduced the incidence by 58%. (correct)
- It had no effect on the incidence.
- It slightly decreased the incidence by 20%.
Which study showed a 39% reduction in the conversion rate to type 2 diabetes after 30 years?
Which study showed a 39% reduction in the conversion rate to type 2 diabetes after 30 years?
- American Diabetes Association Study.
- Da Qing Diabetes Prevention Study. (correct)
- DPP trial.
- Finnish Diabetes Prevention Study.
What is recommended for the treatment of modifiable risk factors associated with prediabetes?
What is recommended for the treatment of modifiable risk factors associated with prediabetes?
- Screening and treatment recommendations. (correct)
- No specific recommendations available.
- Lifestyle changes only.
- Surgical interventions.
What is the purpose of Diabetes Self-Management Education and Support (DSMES) programs?
What is the purpose of Diabetes Self-Management Education and Support (DSMES) programs?
What is the suggested coverage for diabetes prevention intervention programs?
What is the suggested coverage for diabetes prevention intervention programs?
What is the BMI threshold for considering testing in adults with obesity?
What is the BMI threshold for considering testing in adults with obesity?
What is one risk factor that would necessitate diabetes testing in individuals with a BMI of 25 kg/m2 or greater?
What is one risk factor that would necessitate diabetes testing in individuals with a BMI of 25 kg/m2 or greater?
How often should patients with prediabetes be tested?
How often should patients with prediabetes be tested?
What is the recommended age to begin testing for diabetes in individuals without risk factors?
What is the recommended age to begin testing for diabetes in individuals without risk factors?
How frequently should normal test results be followed up with further testing?
How frequently should normal test results be followed up with further testing?
Which assessment tool is mentioned for guiding testing for prediabetes and undiagnosed type 2 diabetes?
Which assessment tool is mentioned for guiding testing for prediabetes and undiagnosed type 2 diabetes?
What condition results in women needing lifelong diabetes testing every three years?
What condition results in women needing lifelong diabetes testing every three years?
Which of the following is NOT a condition associated with insulin resistance that warrants consideration for testing?
Which of the following is NOT a condition associated with insulin resistance that warrants consideration for testing?
What is the minimum percentage of weight loss that can improve glycemic control in patients with type 2 diabetes?
What is the minimum percentage of weight loss that can improve glycemic control in patients with type 2 diabetes?
How often should long-term weight maintenance programs provide contact to be effective?
How often should long-term weight maintenance programs provide contact to be effective?
Which intervention can help achieve a weight loss of 5% for carefully selected patients?
Which intervention can help achieve a weight loss of 5% for carefully selected patients?
What is the recommended amount of physical activity per week for optimal weight management?
What is the recommended amount of physical activity per week for optimal weight management?
For patients with comorbid heart failure, how frequently should weight monitoring occur?
For patients with comorbid heart failure, how frequently should weight monitoring occur?
Which of the following is NOT a recommended self-monitoring strategy for weight maintenance?
Which of the following is NOT a recommended self-monitoring strategy for weight maintenance?
What is a key benefit of treating obesity in patients at risk of type 2 diabetes?
What is a key benefit of treating obesity in patients at risk of type 2 diabetes?
What aspect of weight maintenance programs is critical to their effectiveness?
What aspect of weight maintenance programs is critical to their effectiveness?
What is primarily characterized by persistent albuminuria and low eGFR?
What is primarily characterized by persistent albuminuria and low eGFR?
Which class of medications has been proven effective in reducing albuminuria and preventing CKD progression?
Which class of medications has been proven effective in reducing albuminuria and preventing CKD progression?
What risk is markedly increased among people with diabetes and CKD?
What risk is markedly increased among people with diabetes and CKD?
What combination of medications should be avoided due to no benefit and higher rates of adverse events?
What combination of medications should be avoided due to no benefit and higher rates of adverse events?
Which adverse events are associated with the combination of ACE inhibitors and ARBs?
Which adverse events are associated with the combination of ACE inhibitors and ARBs?
What is the recommended patient care for managing diabetic retinopathy?
What is the recommended patient care for managing diabetic retinopathy?
Which of the following statements about Metformin in patients with CKD is true?
Which of the following statements about Metformin in patients with CKD is true?
What is albuminuria associated with in CKD patients?
What is albuminuria associated with in CKD patients?
What is recommended for patients treated with an ACE inhibitor, ARB, or diuretic?
What is recommended for patients treated with an ACE inhibitor, ARB, or diuretic?
What should be done for patients with hypertension who are not reaching blood pressure targets on three classes of antihypertensive medications?
What should be done for patients with hypertension who are not reaching blood pressure targets on three classes of antihypertensive medications?
Who should receive moderate-intensity statin therapy in addition to lifestyle therapy?
Who should receive moderate-intensity statin therapy in addition to lifestyle therapy?
When is it reasonable to initiate statin therapy for patients aged 20-39 years with diabetes?
When is it reasonable to initiate statin therapy for patients aged 20-39 years with diabetes?
What condition must be excluded before diagnosing resistant hypertension?
What condition must be excluded before diagnosing resistant hypertension?
For patients at higher risk for ASCVD, what type of statin therapy is reasonable to use?
For patients at higher risk for ASCVD, what type of statin therapy is reasonable to use?
How often should a lipid profile be obtained after starting statins or changing doses?
How often should a lipid profile be obtained after starting statins or changing doses?
Which medication class should be included in therapy for patients not meeting blood pressure targets on three antihypertensives?
Which medication class should be included in therapy for patients not meeting blood pressure targets on three antihypertensives?
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Study Notes
Diabetes Risk Assessment and Testing
- Testing recommended for adults with overweight or obesity (BMI ≥25 kg/m², or ≥23 kg/m² for Asian Americans) who have risk factors such as:
- First-degree relative with diabetes
- High-risk ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
- Cardiovascular disease (CVD) history
- Hypertension (≥140/90 mmHg or receiving therapy)
- Low HDL (<35 mg/dL) or high triglycerides (≥250 mg/dL)
- Polycystic ovary syndrome in women
- Physical inactivity
- Other insulin-resistance-related conditions
- Patients with prediabetes (A1C ≥5.7%, impaired glucose tolerance, impaired fasting glucose) should be tested annually.
- Women with a history of gestational diabetes mellitus (GDM) require lifelong testing every 3 years.
- General population testing begins at age 45.
- Normal test results mandate retesting every 3 years; more frequent tests may be needed based on risk factors.
Diabetes Prevention Strategies
- Informal risk factor assessments and tools (e.g., ADA risk test) recommended to decide on diagnostic testing.
- Evidence shows pharmacologic interventions (e.g. SGLT2 and GLP-1 receptor agonists) are effective in reducing albuminuria and diabetes progression.
- Intensive lifestyle interventions can reduce type 2 diabetes incidence by 58% over 3 years.
- Long-term studies indicate sustained reductions in diabetes conversion rates through lifestyle changes, with Da Qing and Finnish studies reporting reductions of 39% and 43%, respectively.
Chronic Kidney Disease (CKD) Management
- CKD characterized by persistent albuminuria, low estimated glomerular filtration rate (eGFR), and kidney damage.
- Severity of albuminuria correlates with CKD progression, CVD risk, and mortality rates.
- Patients with diabetes face heightened CVD risks associated with CKD.
Glucose-Lowering Medications for CKD
- Metformin contraindicated in patients with eGFR <30 mL/min/1.73 m².
- Co-administration of ACE inhibitors and ARBs found ineffective for CVD benefits; may increase adverse events.
Diabetes Management Recommendations
- DSMES (Diabetes Self-Management Education and Support) programs beneficial for high-risk individuals.
- Treatment of obesity shown to delay progression from prediabetes to type 2 diabetes and improve glycemic control.
- Sustained weight loss (≥3-5%) can enhance health outcomes and lower medication needs.
- Weight management programs should encourage regular monitoring and contact to maintain long-term changes.
Resistant Hypertension Guidelines
- Patients not meeting blood pressure targets on three antihypertensives should consider mineralocorticoid receptor antagonists.
- Exclude conditions like medication nonadherence and secondary hypertension before diagnosing resistant hypertension.
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