Diabetes Risk Management Quiz

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Questions and Answers

Which dietary pattern is NOT recommended for adults at risk for type 2 diabetes?

High-sugar diet (correct)

Mediterranean-style

Low-carbohydrate

Vegetarian or plant-based

How much physical activity is recommended per week for adults at risk for type 2 diabetes?

30 minutes of high-intensity exercise

20 minutes of intense running

150 minutes of moderate-intensity activity (correct)

60 minutes of low-intensity yoga

What is one of the primary goals of the Diabetes Prevention Program (DPP) intervention?

Increase portion sizes of meals

Achieve and maintain ≥7% weight loss (correct)

Eliminate all carbohydrates from the diet

Achieve a daily sugar intake of less than 25 grams

Which food group should be emphasized in the diet of someone at risk for type 2 diabetes?

Whole grains Signup and view all the answers

Which of the following is NOT a suggested dietary pattern for managing diabetes risk?

Ketogenic diet with zero carbs Signup and view all the answers

In order to reduce sedentary time, what action is suggested?

Take short breaks to move periodically Signup and view all the answers

What is one outcome the DPP study demonstrated regarding lifestyle intervention?

It could reduce type 2 diabetes risk by 58% Signup and view all the answers

How many minutes per week of resistance or strength training is included in the recommendations?

No specific recommendation is given Signup and view all the answers

Under what condition should posttransplantation diabetes mellitus be diagnosed?

When the individual is stable on immunosuppressive therapy and free of infections Signup and view all the answers

In which scenario should monogenic diabetes be suspected?

In children and young adults with atypical characteristics and a family history of diabetes Signup and view all the answers

What should be done for people on medications known to increase diabetes risk?

Consider screening for prediabetes or diabetes. Signup and view all the answers

What is the recommended frequency for monitoring individuals with prediabetes?

At least annually Signup and view all the answers

Which of the following correctly describes the characteristics of an informal assessment for screening?

It involves assessing risk factors for diabetes. Signup and view all the answers

Why is lab testing for diabetes screening considered safe and cost-effective?

It provides reliable results without significant risks. Signup and view all the answers

Which group should specifically be assessed for risk factors annually?

Individuals with prediabetes Signup and view all the answers

What is a common characteristic of therapies that increase diabetes risk?

They include glucocorticoids and second-generation antipsychotics. Signup and view all the answers

Which diagnostic criterion is associated with Stage 2 of type 1 diabetes?

2-h PG of 140–199 mg/dl Signup and view all the answers

What is the primary characteristic of Stage 3 type 1 diabetes?

Symptomatic presentation Signup and view all the answers

Which of the following conditions is NOT characteristic of Stage 1 type 1 diabetes?

Dysglycemia Signup and view all the answers

What distinguishes Stage 2 from Stage 1 type 1 diabetes?

Dysglycemia evaluated via fasting plasma glucose Signup and view all the answers

At what fasting plasma glucose level is Stage 2 type 1 diabetes diagnosed?

FPG 100–125 mg/dl Signup and view all the answers

Which statement is true regarding autoantibodies in Stage 3 type 1 diabetes?

They may become absent. Signup and view all the answers

What characterizes the presymptomatic phase of Stage 1 type 1 diabetes?

Multiple islet autoantibodies without IGT or IFG Signup and view all the answers

Which of these findings is considered a diagnostic criterion for Stage 2 type 1 diabetes?

2-h PG level of 140–199 mg/dl Signup and view all the answers

What is diabetes distress primarily linked to?

Ongoing demands of diabetes self-care Signup and view all the answers

Which of the following factors can significantly affect medication-taking behavior in individuals with diabetes?

High levels of diabetes distress Signup and view all the answers

Which characteristic is essential for a successful Medical Nutrition Therapy (MNT) program?

Sustainability and realism Signup and view all the answers

What type of professional should provide Medical Nutrition Therapy for diabetes?

Registered dietitian nutritionist Signup and view all the answers

Which food group should be minimized according to the key nutrition principles for diabetes management?

Sugar-sweetened beverages Signup and view all the answers

Which of the following is NOT included in the key nutrition principles for diabetes management?

Ultra-processed foods Signup and view all the answers

What should successful Medical Nutrition Therapy (MNT) programs screen for?

Food insecurity Signup and view all the answers

What do data suggest about the distribution of macronutrients in managing diabetes?

There is no supported specific distribution Signup and view all the answers

What is the recommended therapy for weight management in individuals at high risk for liver fibrosis?

Intensive lifestyle therapy and/or metabolic surgery Signup and view all the answers

In the absence of decompensated cirrhosis, which agents are preferred for treating hyperglycemia in adults with type 2 diabetes and NASH?

Glucagon-like peptide 1 receptor agonists and pioglitazone Signup and view all the answers

What should be done for individuals identified as low risk for liver fibrosis?

Repeat testing in 2–3 years Signup and view all the answers

How should individuals with type 2 diabetes and decompensated cirrhosis be treated?

Insulin therapy is recommended Signup and view all the answers

What is noted about statin therapy in the context of NAFLD?

Safe to use but requires caution and monitoring Signup and view all the answers

For individuals at indeterminate risk for liver fibrosis, what is the recommendation for follow-up testing?

Repeat testing in 2–3 years Signup and view all the answers

What are the goals of intensive lifestyle therapy for high-risk individuals?

To create sustainable behavior changes for weight loss Signup and view all the answers

Which of the following statements is true regarding the treatment of hyperglycemia in individuals with liver conditions?

Treatment options vary significantly based on the presence of liver disease Signup and view all the answers

What is assessed during the initial visit regarding the patient's diabetes history?

Frequency and cause of past hospitalizations Signup and view all the answers

Which component is considered in the follow-up visit related to personal history?

Eating patterns and weight history Signup and view all the answers

Which of the following is NOT typically assessed during an annual diabetes medical evaluation?

Current job-related stress Signup and view all the answers

What should be checked regarding medication during the follow-up visit?

Current medication plan and dosage Signup and view all the answers

What details regarding family history should be recorded during the initial diabetes evaluation?

Family history of diabetes Signup and view all the answers

During the initial diabetes visit, which comorbidity related to personal history is reviewed?

Obstructive sleep apnea (OSA) Signup and view all the answers

Which behavioral factor is monitored during the follow-up visit?

Physical activity levels Signup and view all the answers

What aspect related to vaccination is assessed in the annual evaluation?

Vaccination history and needs Signup and view all the answers

How is hypoglycemia monitored during diabetes consultations?

Awareness and frequency of episodes Signup and view all the answers

Which aspect of medical history is reviewed during both initial and follow-up visits?

Changes in medical/family history Signup and view all the answers

What type of assessment related to lifestyle factors is included in the initial diabetes evaluation?

Physical activity and sleep behaviors Signup and view all the answers

Which aspect regarding tobacco and substance use is reviewed during follow-up visits?

Current substance use and frequency Signup and view all the answers

What type of additional medicine use is evaluated at both the initial and follow-up visits?

Use of herbal remedies Signup and view all the answers

What is the significance of assessing assistive devices during diabetes evaluations?

To understand patient mobility and its impact on health Signup and view all the answers

Signup and view all the answers

Study Notes

Section 1: 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 in diagnosis and treatment. Align with evidence-based treatment guidelines. Address social determinants of health. Foster shared decision-making that considers individual preferences, prognoses, comorbidities, and financial factors.
System-Level: Foster a quality-oriented culture to improve safety, timeliness, effectiveness, equity, and person-centeredness through system-based approaches. Leverage patient registries and electronic health records for quality enhancement in diabetes care. Use collaborative, multidisciplinary health care teams for diabetes care delivery. Incorporate telehealth alongside in-person visits to expand access to quality diabetes care. Ensure access to diabetes self-management education and support, using both professional and community-based resources. Evaluate socioeconomic and linguistic barriers to diabetes management and care, and facilitate referrals to local community resources when needed.
Policy-Level: Ensure access to health insurance with adequate coverage for all aspects of diabetes management, including medications, supplies/equipment, technology, and medical care. Ensure access to health care professionals with expertise in diabetes management.

Section 2: 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 (e.g., hyperglycemic crisis), diagnosis of type 2 diabetes requires confirmatory testing.
Classification of diabetes type is not always straightforward at presentation, and misdiagnosis is common.
Diagnostic criteria and tests for different types of diabetes (A1C, fasting plasma glucose, 2-hour glucose tolerance test) are included.

Section 3: Prevention or Delay of Diabetes and Associated Comorbidities

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.
Informal risk factor assessment includes factors like age, history of prediabetes, history of GDM, overweight/obesity (BMI ≥25/23 in Asians, respective), first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension, polycystic ovary syndrome, HDL cholesterol <35 mg/dL, triglycerides >250 mg/dL, physical inactivity, or other conditions associated with insulin resistance.
Screening criteria for prediabetes and type 2 diabetes in children and adolescents include overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and one or more risk factors.
Screening should be repeated at least annually for those with prediabetes; or every 3 years (annually for those with prediabetes) if results are normal, or sooner with symptoms or changes in risk.

Section 4: Comprehensive Medical Evaluation and Assessment of Comorbidities

People with type 1 diabetes should be screened soon after diagnosis and periodically thereafter for autoimmune thyroid disease, celiac disease, autoimmune liver disease, collagen vascular diseases, pernicious anemia, primary adrenal insufficiency, and/or myasthenia gravis.
People with type 1 or type 2 diabetes have a higher fracture risk than those without diabetes.
Optimizing bone health in people with diabetes includes screening older adults (>65 years of age) and high-risk young adults with Dual-energy X-ray absorptiometry every 2-3 years. Nutritional counseling (calcium and vitamin D, aerobic and weight-bearing physical activity, fall precautions) and pharmacotherapy (glucose-lowering medications safe for bone health) are also recommended where appropriate.

Section 5: Facilitating Positive Health Behaviors and Well-Being to Improve Health Outcomes

Building positive health behaviors and maintaining psychological well-being is critical for effective diabetes management.
Essential tasks include referral for diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), counseling on routine physical activity, and support cessation of tobacco and products.
Psychosocial care is essential for all people with diabetes; this often includes screening, interventions, and referral to behavioral health professionals or other trained healthcare professionals. Includes assessing life circumstances, and social and family support resources.

Section 6: Glycemic Goals and Hypoglycemia

A1C, continuous glucose monitoring (CGM), and glucose management indicator (GMI) are key tools for assessing glycemic status.
Glycemic goals are individualized based on characteristics of the person with diabetes, like age and disease duration. Also factors like comorbidities, preferences and resources/support.
Common general guidelines include an A1C goal less than 7.0% (<53 mmol/mol) in many non-pregnant adults without significant hypoglycemia.

Section 7: Diabetes Technology

Technology available includes insulin pumps, connected insulin pens, continuous glucose monitors (CGM), and automated insulin delivery (AID) systems; diabetes self-management support software.
Diabetes devices should be offered to people with diabetes, with individualized type(s) and selection of devices based on needs, preferences, and skills.

Section 8: Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes

Weight management is crucial for people with type 2 diabetes and overweight or obesity, as it delays progression, improves glycemia, reduces cardiovascular risks, and reduces other obesity-related health risks.
Person-centered treatment options for overweight and obesity in type 2 diabetes generally include intensive behavioral counseling, obesity pharmacotherapy, and/or metabolic surgery. The appropriate choice is based on individual BMI, and other relevant factors assessed individually.

Section 9: Pharmacologic Approaches to Glycemic Treatment

Strategies, to address barrier to treatment and empower patients to optimize diabetes care via individualization of care and use of appropriate glucose lowering medications.
When to initiate injectable therapies (GLP-1 agonists or dual GIP/GLP-1 receptor agonists) in type 2 diabetes in relation to factors such as A1C, glucose, and/or ketosis.

Section 10: Cardiovascular Disease and Risk Management

Atherosclerosis is the primary cause of morbidity and mortality in individuals with diabetes.
Recommendations for treating hypertension in nonpregnant people with diabetes include lifestyle management, and initiating one or two medications based on blood pressure and albuminuria (albuminuria is a protein in urine).
Screening and treatment for asymptomatic cardiovascular disease based on patient risk. This includes coronary artery disease, heart failure and peripheral artery disease.

Section 11: Chronic Kidney Disease and Risk Management

Screening for chronic kidney disease (CKD) in people with type 1 or type 2 diabetes includes annually assessing urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).
Monitoring and classifying CKD is based on cause, GFR and/or albuminuria values.

Section 12: Retinopathy, Neuropathy, and Foot Care

Optimizing the management of glycemia, blood pressure, and lipids can reduce or slow the progression of microvascular complications of diabetes.
Routine eye exams, with dilated comprehensive eye exam or retinal photography for people with type 1 or type 2 diabetes are recommended (specific frequencies based on individual factors/complications/treatments).
Screening for neuropathy (at diagnosis and annually thereafter for type 1 and 2 diabetes), treatment with various medications and/or behavioral interventions; as well as foot care (daily inspection, appropriate footwear).

Section 13: Older Adults

Individualization of treatment goals and medication plans is critical for older adults with diabetes, considering factors like health status, comorbidities, and functional capabilities, and risks.
Treatment plans for older adults should be designed with consideration for the individual's capacity for managing medications and/or complex regimens; or use simpler regimens with an emphasis on preventing serious side effects (i.e., hypoglycemia), and avoiding polypharmacy.

Section 14: Children and Adolescents

Address diabetes self-management education and support of youth.
Screening and diagnosis (type 2) in youth and adolescents, as well as comprehensive treatment and monitoring.

Section 15: Management of Diabetes in Pregnancy

Preconception and preconception counseling with family planning.
Glycemic goals in pregnancy: Optimize glucose levels; ideally A1c <6% , or goal can be <7% .
Recommendations for management of gestational diabetes mellitus (GDM); and post-partum care.

Section 16: Diabetes Care in the Hospital

Carefully managing people with diabetes during hospitalization is important to prevent hyperglycemia, hypoglycemia, or extreme glucose variability.
Instituting specific care standards and protocols for managing blood glucose levels.
Transitioning from hospital care to outpatient care; ensuring appropriate care continuity, including arranging follow-up visits.

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Description

Test your knowledge on dietary patterns and physical activity recommendations for adults at risk for type 2 diabetes. This quiz covers essential strategies from the Diabetes Prevention Program, including nutritional guidelines and exercise tips to help manage diabetes risk effectively.