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Screening for Diabetes Mellitus (DM)
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Screening for Diabetes Mellitus (DM)

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Questions and Answers

What is the recommended age for screening asymptomatic patients for T2D?

  • 35 years or older (correct)
  • 30 years or older
  • 25 years or older
  • 40 years or older

    • What is the primary reason for measuring islet autoantibodies in first-degree relatives of T1D patients?

  • To diagnose T1D
  • To monitor glucose levels
  • To identify symptoms of hyperglycemia
  • To assess risk of T1D (correct)

    • What is the BMI threshold for screening asymptomatic patients for T2D?

  • 30 kg/m2 or greater
  • 35 kg/m2 or greater
  • 25 kg/m2 or greater (correct)
  • 20 kg/m2 or greater

    • What is the recommended time for screening for gestational DM?

    <p>At 24–28 weeks' gestation</p> Signup and view all the answers

    What is the recommended frequency for screening patients who have had gestational DM for T2D?

    <p>Every 3 years</p> Signup and view all the answers

    What is the diagnostic criterion for T2D in nonpregnant patients?

    <p>FPG ≥ 126 mg/dL</p> Signup and view all the answers

    What is the primary goal of counseling patients who screen positive for islet autoantibodies?

    <p>To counsel on symptoms of hyperglycemia and risk of DM</p> Signup and view all the answers

    What is the recommended course of action for patients who have had gestational DM?

    <p>Screen for T2D 4–12 weeks after delivery</p> Signup and view all the answers

    What is the recommended gestational age for gestational diabetes diagnosis?

    <p>24-28 weeks</p> Signup and view all the answers

    What is the fasting plasma glucose criterion for diagnosing gestational diabetes?

    <p>92 mg/dL or greater</p> Signup and view all the answers

    What is the next step if the 1-hour plasma glucose after the 50-g OGTT is 140 mg/dL or greater?

    <p>Perform a 100-g OGTT to confirm the diagnosis</p> Signup and view all the answers

    What is the definition of impaired fasting glucose?

    <p>FPG 100-125 mg/dL</p> Signup and view all the answers

    What is the primary goal of diabetes management in nonpregnant adults?

    <p>Prevent the onset of acute or chronic complications</p> Signup and view all the answers

    What is the current A1C level of the 56-year-old man with T2D?

    <p>6.9%</p> Signup and view all the answers

    What is the most potential agent to reduce both microvascular and macrovascular complications in the 56-year-old man with T2D?

    <p>Insulin glargine</p> Signup and view all the answers

    What is the recommended screening interval for T2D if the patient is positive for prediabetes?

    <p>Yearly</p> Signup and view all the answers

    What is the patient's current heart condition?

    <p>Class III, ejection fraction 33%</p> Signup and view all the answers

    What is the primary mechanism of action of GLP-1 analogs?

    <p>Glucose-dependent insulin secretion</p> Signup and view all the answers

    What is the initial dosage of exenatide in the twice-daily formulation?

    <p>5 mcg subcutaneously twice daily</p> Signup and view all the answers

    What is the maximal daily dosage of liraglutide?

    <p>1.8 mg subcutaneously once daily</p> Signup and view all the answers

    How often is lixisenatide administered?

    <p>Once daily</p> Signup and view all the answers

    What is a side effect of GLP-1 analogs?

    <p>Reduced gastric emptying</p> Signup and view all the answers

    How is the exenatide once-weekly formulation administered?

    <p>Injected subcutaneously once weekly</p> Signup and view all the answers

    What is the dosage titration schedule for exenatide?

    <p>From 5 to 10 mcg twice daily after 1 month</p> Signup and view all the answers

    What is the primary mechanism of action of SGLT-2 inhibitors?

    <p>Blocking normal reabsorption in the proximal convoluted tubule</p> Signup and view all the answers

    What is the maximal daily dosage of canagliflozin?

    <p>300 mg</p> Signup and view all the answers

    What is the recommended dosage adjustment for canagliflozin in patients with an eGFR of 30-59 mL/minute/1.73 m²?

    <p>Reduce the dosage to 100 mg</p> Signup and view all the answers

    What is a common adverse effect of SGLT-2 inhibitors?

    <p>Increased urination</p> Signup and view all the answers

    What is a rare but serious adverse effect of SGLT-2 inhibitors?

    <p>Euglycemic DKA</p> Signup and view all the answers

    What is a specific consideration for canagliflozin that is not shared with other SGLT-2 inhibitors?

    <p>Possible increased bone fracture risk</p> Signup and view all the answers

    What is the recommended dosage of dapagliflozin?

    <p>5 mg once daily</p> Signup and view all the answers

    What is the contraindication for initiating or continuing SGLT-2 inhibitors in patients with renal impairment?

    <p>eGFR &lt; 30 mL/minute/1.73 m²</p> Signup and view all the answers

    What is a potential benefit of an Amylin agonist?

    <p>Modest weight loss</p> Signup and view all the answers

    What is a potential side effect of insulin therapy?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is a potential benefit of basal insulin?

    <p>Flexibility in dosing strategies and titration</p> Signup and view all the answers

    What is a potential side effect of an Amylin agonist?

    <p>GI adverse effects</p> Signup and view all the answers

    What is a potential benefit of bolus insulin?

    <p>Efficacy on postprandial glucose</p> Signup and view all the answers

    What is a potential side effect of insulin therapy?

    <p>Injection-site effects</p> Signup and view all the answers

    What is a potential benefit of an Amylin agonist?

    <p>Possible heart failure benefit</p> Signup and view all the answers

    What is a characteristic of insulin therapy?

    <p>Frequent injections</p> Signup and view all the answers

    Study Notes

    Screening for Diabetes Mellitus (DM)

    • Screening for T1D:
      • Symptomatic patients
      • Asymptomatic patients at higher risk (first-degree relatives with T1D)
      • Measure islet autoantibodies to assess risk of T1D
    • Screening for T2D:
      • Age 35 or older, repeat every 3 years if normal
      • Screen regardless of age if BMI is 25 kg/m2 or greater (23 kg/m2 or greater in Asian Americans) and at least one of the following risk factors:
        • History of cardiovascular disease
        • A1C is 5.7% or greater, impaired glucose tolerance, or impaired fasting glucose in previous testing
        • History of PCOS
        • HDL less than 35 mg/dL or TG greater than 250 mg/dL
        • Hypertension
        • High-risk ethnicity: African American, Latino, Native American, Asian American, Pacific Islander
        • First-degree relative with T2D
        • Physical inactivity
        • Insulin resistance conditions (e.g., severe obesity, acanthosis nigricans)
    • Screening for Gestational DM:
      • Screen at first prenatal visit for undiagnosed T2D in all patients with T2D risk factors present
      • Screen at 24–28 weeks’ gestation using OGTT
      • If a diagnosis of gestational DM is made, screen for diabetes 4–12 weeks after delivery
      • Continue to screen patients who have had gestational DM every 3 years for T2D for life

    DM Diagnosis

    • Glycemic values in nonpregnant patients:
      • FPG ≥ 126 mg/dL
      • OGTT ≥ 200 mg/dL
    • Gestational diabetes diagnosis:
      • Glycemic values in pregnancy:
        • One-step approach: 75-g OGTT at 24–28 weeks’ gestation Fasting: ≥ 92 mg/dL 1 hour after OGTT: ≥ 180 mg/dL 2 hours after OGTT: ≥ 153 mg/dL
        • Two-step approach: 50-g OGTT (nonfasting) at 24–28 weeks’ gestation If 1 hour after 50-g OGTT is < 140 mg/dL, no further workup If ≥ 140 mg/dL, do additional fasting OGTT using 100 g

    Goals of Diabetes Management in Nonpregnant Adults

    • Primary goal: Prevent the onset of acute or chronic complications
    • Acute complications:
      • Hypoglycemia
      • Diabetic ketoacidosis (DKA)
      • Hyperglycemic hyperosmolar non-ketotic syndrome
    • Chronic complications:
      • Mechanism of action: Increases urinary glucose excretion by blocking normal reabsorption in the proximal convoluted tubule; has some effect on delaying GI glucose absorption
      • Dosing:
        • Canagliflozin: 100 mg once daily before the first meal of the day, max 300 mg
        • Dapagliflozin: 5 mg once daily in the morning (with or without food), max 10 mg
        • Empagliflozin: 10 mg once daily in the morning (with or without food), max 25 mg
        • Ertugliflozin: 5 mg once daily in the morning (with or without food), max 15 mg

    GLP-1 Analogs

    • Mechanism of action: Synthetic analog of human GLP-1 that binds to GLP-1 receptors, resulting in glucose-dependent insulin secretion, reduction in glucagon secretion, and reduced gastric emptying; promotes satiety
    • Approved agents: Exenatide, liraglutide, dulaglutide, lixisenatide, and semaglutide
    • Dosing:
      • Exenatide:
        • Twice-daily formulation (pen): 5 mcg subcutaneously twice daily, max 10 mcg twice daily
        • Once-weekly formulation (single-dose tray or pen): 2 mg subcutaneously once weekly
      • Liraglutide (pen):
        • 0.6 mg subcutaneously once daily for 1 week, max 1.8 mg/day
      • Lixisenatide (pen):
        • Initial dose: 10 mcg once daily for 14 days, maintenance dose: 20 mcg once daily

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    Description

    This quiz covers the guidelines for screening for Diabetes Mellitus (DM) using glycemic diagnostic criteria, including T1D and T2D.

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