Metformin Therapy for Type 2 Diabetes Prevention

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Questions and Answers

Who should be considered for metformin therapy for prevention of type 2 diabetes?

Individuals with an A1C of 4.5–5.6%

Individuals with an A1C of 5.7–6.4% (correct)

Individuals with a BMI below 30 kg/m2

Individuals aged 60 years or older

What is the primary recommendation for individuals at high risk for type 2 diabetes?

To initiate metformin therapy immediately

To undergo regular blood testing every week

To participate in an intensive behavioral lifestyle intervention program (correct)

To engage in intensive dietary restrictions

What is the target A1C level for many nonpregnant adults with diabetes?

≤8.0%

≤7.0% (correct)

≤7.5%

≤6.5%

Which of the following is NOT a characteristic of ideal candidates for diabetes prevention efforts?

A1C level of 6.5% or higher Signup and view all the answers

What is the preprandial capillary plasma glucose target range for adults with diabetes?

80–130 mg/dL Signup and view all the answers

How much moderate-intensity physical activity is recommended for diabetes prevention?

At least 150 minutes per week Signup and view all the answers

Which of the following factors should be considered when individualizing glycemic goals?

Comorbid conditions Signup and view all the answers

Which of the following statements about metformin is true?

It has a stronger evidence base compared to other pharmacologic therapies. Signup and view all the answers

What is the peak postprandial capillary plasma glucose target for many adults with diabetes?

≤180 mg/dL Signup and view all the answers

What measure is considered when evaluating other pharmacologic agents for diabetes prevention?

Cost, side effects, and durable efficacy Signup and view all the answers

What should be evaluated for individuals at risk of hypoglycemia?

Symptomatic and asymptomatic hypoglycemia Signup and view all the answers

In patients taking medication that can lead to hypoglycemia, what is crucial to assess?

Risk for unrecognized hypoglycemia Signup and view all the answers

Which eating pattern is considered acceptable for individuals with prediabetes?

Any variety of eating patterns Signup and view all the answers

Why might postprandial glucose be targeted in certain patients?

If A1C goals are not met despite preprandial goals Signup and view all the answers

Which group of individuals is prioritized for diabetes prevention efforts?

Individuals with impaired fasting glucose Signup and view all the answers

Which of the following factors does NOT influence the individualization of glycemic targets?

Dietary restrictions Signup and view all the answers

Which type of medication is classified as a dipeptidyl peptidase 4 inhibitor?

DPP-4 inhibitor Signup and view all the answers

Which of the following medications has been investigated for its effects on renal and cardiovascular outcomes in diabetic nephropathy?

SGLT2 inhibitor Signup and view all the answers

What factor is important to consider when selecting antihyperglycemic treatment?

Drug-specific dosing recommendations Signup and view all the answers

Which of the following statements is true about injectable therapies for type 2 diabetes?

They can be combined with oral medications. Signup and view all the answers

What is a common effect of SGLT2 inhibitors in the treatment of type 2 diabetes?

Weight loss Signup and view all the answers

Which therapy is most appropriate for a patient experiencing high fasting plasma glucose levels?

Insulin Signup and view all the answers

What does the acronym CVOT stand for in the context of diabetes treatment studies?

Cardiovascular Outcome Trials Signup and view all the answers

Which of the following is a possible benefit of thiazolidinediones in diabetes management?

Improved insulin sensitivity Signup and view all the answers

What is the preferred initial pharmacologic agent for the treatment of type 2 diabetes?

Metformin Signup and view all the answers

At what BMI range is metabolic surgery considered for adults with type 2 diabetes?

30.0–34.9 kg/m2 Signup and view all the answers

What should be included in the long-term postoperative management after metabolic surgery?

Routine monitoring of micronutrient and nutritional status Signup and view all the answers

Which factors may lead to the early introduction of insulin in diabetes treatment?

Evidence of ongoing catabolism or symptoms of hyperglycemia Signup and view all the answers

Metformin should be continued as long as it is:

Tolerated and not contraindicated Signup and view all the answers

In which type of center should metabolic surgery be performed?

High-volume centers with multidisciplinary teams Signup and view all the answers

What combination therapy can be considered at treatment initiation for some patients?

Metformin with other agents like insulin Signup and view all the answers

For Asian Americans, what BMI threshold is indicated for considering metabolic surgery?

27.5–32.4 kg/m2 Signup and view all the answers

What does the green color in the GFR and albuminuria grid indicate?

Normal eGFR and UACR with other kidney damage markers Signup and view all the answers

How frequently should follow-up measurements be conducted for patients in the yellow category?

At least once per year Signup and view all the answers

What color indicates the need for measurements three times per year?

Red Signup and view all the answers

In the context of the GFR and albuminuria grid, which condition would primarily require dark red category monitoring?

Severe kidney impairment Signup and view all the answers

Which of the following represents a condition marked by the orange category?

Moderate kidney damage requiring biannual assessments Signup and view all the answers

Which of the following is NOT a characteristic of the yellow category in the GFR and albuminuria grid?

Necessitates monthly check-ups Signup and view all the answers

What is the significance of identifying other markers of kidney damage when interpreting a green category?

It provides a clearer assessment of kidney health status Signup and view all the answers

What is the primary meaning of the colors in the GFR and albuminuria grid?

They reflect varying levels of risk concerning disease progression Signup and view all the answers

Study Notes

Metformin and Diabetes Prevention

Metformin therapy is recommended for high-risk individuals, especially those with an A1C of 5.7–6.4%, impaired glucose tolerance, or prediabetes.
Candidates for prevention efforts are often those with a BMI ≥35 kg/m², individuals under 60 years old, and women with a history of gestational diabetes (GDM).
Although no medications are FDA-approved specifically for diabetes prevention, many have yielded promising results in studies, with metformin presenting the strongest evidence for long-term safety and efficacy.

Lifestyle Intervention Recommendations

Intensive behavioral lifestyle programs modelled after the Diabetes Prevention Program (DPP) are crucial for patients with prediabetes.
Goals include a 7% weight loss of initial body weight and at least 150 minutes of moderate-intensity physical activity per week.

Glucose Monitoring

Self-monitoring of blood glucose (SMBG) is essential for achieving glycemic targets in diabetes management.
Regular monitoring facilitates better control and management of overall treatment efficacy.

Glycemic Recommendations

Target A1C for many adults with diabetes is less than 7.0% (53 mmol/mol).
Preprandial plasma glucose goals are set between 80-130 mg/dL (4.4-7.2 mmol/L).
Peak postprandial plasma glucose should ideally be less than 180 mg/dL (10.0 mmol/L).

Hypoglycemia Awareness

Individuals at risk of hypoglycemia should be routinely screened for symptoms at each medical encounter.
Special emphasis should be placed on managing those taking medications that may induce hypoglycemia.

Pharmacologic Therapy for Type 2 Diabetes

Metformin is the preferred first-line pharmacological agent for type 2 diabetes.
It should be continued as tolerated. Additional medications may be added if needed to optimize blood sugar control.
Consider early combination therapy to prolong glucose control effectiveness.
In cases of significant hyperglycemia (A1C levels >10% or blood glucose ≥300 mg/dL), early insulin therapy might be warranted.

Metabolic Surgery Considerations

Metabolic surgery is an option for adults with BMI 30.0–34.9 kg/m² who have not had success with other weight loss methods.
Care should be taken to perform surgery in accredited centers with interdisciplinary teams experienced in managing diabetes.

Long-term Management

Post-surgery, patients require ongoing lifestyle support and monitoring of nutritional status.
Assessments for micronutrient deficiencies should follow guidelines from diabetes and surgical professional societies.

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Description

This quiz focuses on the considerations and implications of Metformin therapy in individuals at high risk for type 2 diabetes. It covers criteria such as A1C levels and underlying conditions like prediabetes that may necessitate such treatment. Test your knowledge on this important aspect of diabetes management!