Diabetes Risk Factors and Screening

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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?

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?

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?

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?

To help maintain behaviors that prevent or delay type 2 diabetes. Signup and view all the answers

What is the suggested coverage for diabetes prevention intervention programs?

They should be covered by third-party payers. Signup and view all the answers

What is the BMI threshold for considering testing in adults with obesity?

25 kg/m2 Signup and view all the answers

What is one risk factor that would necessitate diabetes testing in individuals with a BMI of 25 kg/m2 or greater?

Having a first-degree relative with diabetes Signup and view all the answers

How often should patients with prediabetes be tested?

Every year Signup and view all the answers

What is the recommended age to begin testing for diabetes in individuals without risk factors?

Age 45 Signup and view all the answers

How frequently should normal test results be followed up with further testing?

At a minimum of 3-year intervals Signup and view all the answers

Which assessment tool is mentioned for guiding testing for prediabetes and undiagnosed type 2 diabetes?

ADA risk test Signup and view all the answers

What condition results in women needing lifelong diabetes testing every three years?

Gestational diabetes mellitus Signup and view all the answers

Which of the following is NOT a condition associated with insulin resistance that warrants consideration for testing?

Sleep apnea Signup and view all the answers

What is the minimum percentage of weight loss that can improve glycemic control in patients with type 2 diabetes?

3-5% Signup and view all the answers

How often should long-term weight maintenance programs provide contact to be effective?

Monthly Signup and view all the answers

Which intervention can help achieve a weight loss of 5% for carefully selected patients?

Very low-calorie diets Signup and view all the answers

What is the recommended amount of physical activity per week for optimal weight management?

200-300 minutes Signup and view all the answers

For patients with comorbid heart failure, how frequently should weight monitoring occur?

More frequently than annual visits Signup and view all the answers

Which of the following is NOT a recommended self-monitoring strategy for weight maintenance?

Limiting caloric intake to 600 kcal daily Signup and view all the answers

What is a key benefit of treating obesity in patients at risk of type 2 diabetes?

Delays progression from prediabetes Signup and view all the answers

What aspect of weight maintenance programs is critical to their effectiveness?

Offering long-term counseling Signup and view all the answers

What is primarily characterized by persistent albuminuria and low eGFR?

Chronic Kidney Disease (CKD) Signup and view all the answers

Which class of medications has been proven effective in reducing albuminuria and preventing CKD progression?

SGLT2 inhibitors Signup and view all the answers

What risk is markedly increased among people with diabetes and CKD?

Cardiovascular disease (CVD) Signup and view all the answers

What combination of medications should be avoided due to no benefit and higher rates of adverse events?

ACE inhibitors and ARBs Signup and view all the answers

Which adverse events are associated with the combination of ACE inhibitors and ARBs?

Hyperkalemia and acute kidney injury Signup and view all the answers

What is the recommended patient care for managing diabetic retinopathy?

Referral to an experienced ophthalmologist Signup and view all the answers

Which of the following statements about Metformin in patients with CKD is true?

Metformin should be avoided if eGFR is below 30 mL/min/1.73 m² Signup and view all the answers

What is albuminuria associated with in CKD patients?

Increased risks of CVD and mortality Signup and view all the answers

What is recommended for patients treated with an ACE inhibitor, ARB, or diuretic?

Check serum Cr/estimated glomerular filtration rate annually. Signup and view all the answers

What should be done for patients with hypertension who are not reaching blood pressure targets on three classes of antihypertensive medications?

Consider mineralocorticoid receptor antagonist therapy. Signup and view all the answers

Who should receive moderate-intensity statin therapy in addition to lifestyle therapy?

Patients with diabetes aged 40-75 years without ASCVD. Signup and view all the answers

When is it reasonable to initiate statin therapy for patients aged 20-39 years with diabetes?

Only if they have additional ASCVD risk factors. Signup and view all the answers

What condition must be excluded before diagnosing resistant hypertension?

Medication nonadherence. Signup and view all the answers

For patients at higher risk for ASCVD, what type of statin therapy is reasonable to use?

High-intensity statin therapy. Signup and view all the answers

How often should a lipid profile be obtained after starting statins or changing doses?

4–12 weeks after starting or changing dose, then annually. Signup and view all the answers

Which medication class should be included in therapy for patients not meeting blood pressure targets on three antihypertensives?

Mineralocorticoid receptor antagonists. Signup and view all the answers

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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Description

This quiz focuses on the criteria for diabetes testing in adults with overweight or obesity. It examines the significant risk factors such as family history, ethnicity, cardiovascular disease, and metabolic health indicators. Test your understanding of when screening is recommended and the implications for health management.