Screening for Type 2 Diabetes in Adults

Type 2 diabetes is often asymptomatic and can cause microvascular and macrovascular damage before symptoms appear, and early detection and interventions can delay or prevent the onset of type 2 diabetes.

Lifestyle interventions and medications.

It may prevent or reduce the progression of microvascular disease and macrovascular cardiovascular disease (CVD).

<p>The American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF).</p> Signup and view all the answers

<p>No, screening for type 1 diabetes in the general population is not yet recommended.</p> Signup and view all the answers

<p>To detect presymptomatic type 1 diabetes and potentially delay clinical diabetes development with therapy.</p> Signup and view all the answers

<p>Hemoglobin A1c, fasting plasma glucose, and oral glucose tolerance test (OGTT)</p> Signup and view all the answers

<p>Destruction of insulin-producing β cells in the pancreas</p> Signup and view all the answers

<p>5% to 10%</p> Signup and view all the answers

<p>Glutamic acid decarboxylase (GAD65), tyrosine phosphatases IA-2 and IA-2β, islet cells, insulin, and zinc transporter</p> Signup and view all the answers

<p>It indicates little to no insulin secretion</p> Signup and view all the answers

<p>It decreases toxicity associated with extreme hyperglycemia, allowing the β cells to regain some ability to produce insulin</p> Signup and view all the answers

<p>Autoantibody development leading to β-cell destruction and ultimately to insulin deficiency</p> Signup and view all the answers

<p>Measuring autoantibodies glutamic acid decarboxylase and tyrosine phosphatase IA-2 at initial diagnosis</p> Signup and view all the answers

<p>Variable insulin deficiency due to β-cell destruction in the absence of autoantibodies</p> Signup and view all the answers

<p>It is diagnostic of diabetes and does not require further confirmatory testing</p> Signup and view all the answers

<p>7% over 6 months</p> Signup and view all the answers

<p>Diet rich in monounsaturated fat, whole grains, vegetables, whole fruits, and nuts</p> Signup and view all the answers

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

<p>Persons with prediabetes, particularly those aged 25 to 59 years with a BMI of 35 or greater, higher fasting plasma glucose (≥110 mg/dL [6.11 mmol/L]), and hemoglobin A1c values of 6% or greater</p> Signup and view all the answers

<p>A type of diabetes that presents with episodic diabetic ketoacidosis (DKA) resulting from insulin deficiency, but has variable periods of insulin dependence and independence</p> Signup and view all the answers

<p>To resolve DKA and allow β cells to produce sufficient amounts of insulin to suppress lipolysis</p> Signup and view all the answers

<p>Autoantibody status and β-cell function</p> Signup and view all the answers

<p>Hyperglycemia during the second or third trimester in patients without a prepregnancy diagnosis of type 1 or type 2 diabetes</p> Signup and view all the answers

<p>To identify women at risk for adverse maternal and neonatal outcomes related to diabetes</p> Signup and view all the answers

<p>To identify women with preexisting and undiagnosed diabetes that is first noticed during pregnancy</p> Signup and view all the answers

<p>Ineffective use of insulin by the peripheral cells to process glucose and fatty acids</p> Signup and view all the answers

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

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

<p>A constellation of risk factors for development of type 2 diabetes and CVD</p> Signup and view all the answers

<p>To identify patients at high risk of developing CVD</p> Signup and view all the answers

<p>Multifactorial, with influence from both genetic and environmental factors</p> Signup and view all the answers

<p>Adults, although the incidence is increasing among children and adolescents</p> Signup and view all the answers

<p>Typically associated with insulin resistance</p> Signup and view all the answers

<p>Weight loss and reduction of insulin resistance, as well as mitigation of cardiovascular risk factors</p> Signup and view all the answers

<p>58%</p> Signup and view all the answers

<p>Patient circumstances, preferences, and treatment</p> Signup and view all the answers

<p>To identify undetected hyperglycemia when preprandial blood glucose values are at the target goal but hemoglobin A1c is above goal</p> Signup and view all the answers

<p>To measure treatment efficacy</p> Signup and view all the answers

<p>When altering nutrition plans, exercise, and/or medications</p> Signup and view all the answers

<p>To improve diabetes care by lowering hemoglobin A1c and avoiding hypoglycemia</p> Signup and view all the answers

<p>50%</p> Signup and view all the answers

<p>As close to daily as possible</p> Signup and view all the answers

<p>10 to 20 grams of carbohydrates</p> Signup and view all the answers

<p>Because they are more likely to have serious morbidity and mortality from COVID-19</p> Signup and view all the answers

<p>To cover meal-time glucose excursions</p> Signup and view all the answers

<p>Diet and physical activity</p> Signup and view all the answers

<p>Before 15 weeks of gestation</p> Signup and view all the answers

<p>Individualized diabetes-specific education to promote healthy diet choices and reductions in hemoglobin A1c</p> Signup and view all the answers

<p>1 unit of regular or analogue insulin for every 50 mg/dL above the target glucose value</p> Signup and view all the answers

<p>Hyperglycemia identified during the first trimester is classified as type 2 diabetes, while hyperglycemia identified later is classified as gestational diabetes.</p> Signup and view all the answers

<p>Improved glycemic control</p> Signup and view all the answers

<p>Combination of intermediate- or long-acting basal insulin and rapid- or short-acting insulin in fixed concentrations</p> Signup and view all the answers

<p>One-step OGTT involving blood glucose measurements at baseline, 1 hour, and 2 hours after a 75-g oral glucose load.</p> Signup and view all the answers

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

<p>To confirm resolution of hyperglycemia after pregnancy.</p> Signup and view all the answers

<p>Autosomal dominant monogenetic defect on different chromosomal loci with at least 14 known gene mutations.</p> Signup and view all the answers

<p>A patient-centered approach with individualized goals and treatment plans compatible with patient preferences, lifestyle requirements, comorbidities, safety, and social determinants of health.</p> Signup and view all the answers

<p>The knowledge and skills for patients to perform diabetes-related self-care and develop effective problem-solving strategies.</p> Signup and view all the answers

<p>At the time of diagnosis, annually, when treatment targets are unmet, when complicating circumstances develop, and at times of life and care transitions.</p> Signup and view all the answers

<p>Improved outcomes such as hemoglobin A1c and quality of life, as well as reduced costs by decreasing use of acute care and inpatient facilities for diabetes management.</p> Signup and view all the answers

<p>Digital coaching and digital self-management.</p> Signup and view all the answers

<p>Nutrient-dense carbohydrate sources that are high in fiber (≥14 g fiber/1000 kcal) and minimally processed</p> Signup and view all the answers

<p>At least 5% weight loss</p> Signup and view all the answers

<p>Moderate- to vigorous-intensity aerobic activity for 150 minutes/week, vigorous-intensity aerobic activity for 75 minutes/week, or a combination of both</p> Signup and view all the answers

<p>Two to three times per week</p> Signup and view all the answers

<p>Interrupting sedentary behavior with light activity or standing at 30-minute intervals</p> Signup and view all the answers

<p>In patients with BMI of 40 or greater (≥37.5 in Asian Americans) and in patients with BMI of 35.0 to 39.9 (32.5-37.4 in Asian Americans) for whom medical interventions are unsuccessful</p> Signup and view all the answers

<p>Smoking is a significant risk factor for cardiovascular disease and other complications in patients with diabetes</p> Signup and view all the answers

<p>Age, health status, weight, pathophysiology of hyperglycemia, specific risks and benefits of a potential therapeutic agent, medication cost, lifestyle, and personal treatment goals</p> Signup and view all the answers

<p>Between 7% and 8%</p> Signup and view all the answers

<p>Based on individualized goals and the potential for harms to outweigh benefits in this population</p> Signup and view all the answers

<p>Significantly reduces the incidence and progression of microvascular complications.</p> Signup and view all the answers

<p>A significant reduction in CVD and mortality.</p> Signup and view all the answers

<p>No change in cardiovascular or overall mortality.</p> Signup and view all the answers

<p>Reduces the composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, and hospitalization for heart failure.</p> Signup and view all the answers

<p>Favorable outcomes, including decreased risk of kidney disease progression and mortality.</p> Signup and view all the answers

<p>Reduces the primary composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, and all-cause mortality.</p> Signup and view all the answers

<p>Life-long insulin therapy with an intensive insulin regimen, including multiple daily doses of insulin to mimic the physiologic action of the pancreas.</p> Signup and view all the answers

<p>To maintain glycemic control while fasting and between meals.</p> Signup and view all the answers

<p>Reduces major adverse cardiovascular events, all-cause mortality, hospitalization for heart failure, and a composite of various kidney outcomes.</p> Signup and view all the answers

<p>Most clinical practice guidelines recommend target hemoglobin A1c thresholds.</p> Signup and view all the answers

<p>Type 2 diabetes is often preceded by a prolonged asymptomatic hyperglycemic period, lifestyle interventions and medications can delay or prevent onset, and early intensive glucose control can prevent or reduce microvascular and macrovascular disease.</p> Signup and view all the answers

<p>It allows for referral to a specialized center for consideration of therapy to potentially delay clinical diabetes development.</p> Signup and view all the answers

<p>To prevent or reduce the progression of microvascular and macrovascular disease.</p> Signup and view all the answers

<p>It may delay the onset of symptomatic type 1 diabetes.</p> Signup and view all the answers

<p>It is not yet recommended because it is not yet indicated.</p> Signup and view all the answers

<p>The American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF).</p> Signup and view all the answers

<p>Hemoglobin A1c, fasting plasma glucose, and oral glucose tolerance test (OGTT)</p> Signup and view all the answers

<p>5% to 10%</p> Signup and view all the answers

<p>Glutamic acid decarboxylase (GAD65), tyrosine phosphatases IA-2 and IA-2β, islet cells, insulin, and zinc transporter</p> Signup and view all the answers

<p>It indicates little to no insulin secretion.</p> Signup and view all the answers

<p>Autoantibody development leading to β-cell destruction and ultimately to insulin deficiency.</p> Signup and view all the answers

<p>Measuring autoantibodies glutamic acid decarboxylase and tyrosine phosphatase IA-2 at initial diagnosis.</p> Signup and view all the answers

<p>Variable insulin deficiency because of β-cell destruction in the absence of autoantibodies.</p> Signup and view all the answers

<p>It is diagnostic of diabetes and does not require further confirmatory testing.</p> Signup and view all the answers

<p>It decreases toxicity associated with extreme hyperglycemia, allowing the β cells to regain some ability to produce insulin.</p> Signup and view all the answers

<p>GAD65 and IA-2 autoantibodies</p> Signup and view all the answers

<p>Effective diabetes management is best achieved through a patient-centered approach with patients and their caregivers developing individualized goals and treatment plans compatible with patient preferences, lifestyle requirements, comorbidities, safety, and social determinants of health.</p> Signup and view all the answers

<p>β-Cell destruction may occur from diseases affecting the pancreas or from the effect of drugs or infections.</p> Signup and view all the answers

<p>The two types of OGTT methods are the 'one-step' OGTT and the 'two-step' OGTT.</p> Signup and view all the answers

<p>The ineffective use of insulin by the peripheral cells to process glucose and fatty acids.</p> Signup and view all the answers

<p>MODY is characterized as an autosomal dominant monogenetic defect on different chromosomal loci, with at least 14 known gene mutations.</p> Signup and view all the answers

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

<p>Before 15 weeks of gestation and considering testing all patients at the initial prenatal visit.</p> Signup and view all the answers

<p>A constellation of risk factors for development of type 2 diabetes and CVD.</p> Signup and view all the answers

<p>DSMES provides the knowledge and skills for patients to perform diabetes-related self-care and develop effective problem-solving strategies.</p> Signup and view all the answers

<p>To confirm resolution of hyperglycemia.</p> Signup and view all the answers

<p>Multifactorial, with influence from both genetic and environmental factors.</p> Signup and view all the answers

<p>Gradual onset, with most affected persons remaining asymptomatic for several years.</p> Signup and view all the answers

<p>Patient education has been shown to improve outcomes, such as hemoglobin A1c and quality of life, and reduce costs by decreasing use of acute care and inpatient facilities for diabetes management.</p> Signup and view all the answers

<p>Acanthosis nigricans is typically associated with insulin resistance.</p> Signup and view all the answers

<p>Most patients with gestational diabetes have glucose normalization after pregnancy, but they are at an increased risk for development of recurrent gestational diabetes and type 2 diabetes.</p> Signup and view all the answers

<p>Weight loss and the reduction of insulin resistance.</p> Signup and view all the answers

<p>Genetic counseling and testing are recommended to identify the specific gene mutation and guide treatment.</p> Signup and view all the answers

<p>Lifestyle modifications reduced the incidence of type 2 diabetes in persons with prediabetes by 58%.</p> Signup and view all the answers

<p>At least every 3 years.</p> Signup and view all the answers

<p>Acquired β-cell destruction may occur from diseases affecting the pancreas or from the effect of drugs or infections.</p> Signup and view all the answers

<p>A constellation of risk factors for development of type 2 diabetes and CVD.</p> Signup and view all the answers

<p>To identify undetected hyperglycemia in patients with target preprandial blood glucose values but high hemoglobin A1c levels.</p> Signup and view all the answers

<p>To measure treatment efficacy and correlate average 3-month blood glucose levels with hemoglobin A1c levels.</p> Signup and view all the answers

<p>When altering nutrition plans, exercise, and/or medications.</p> Signup and view all the answers

<p>To improve diabetes care by lowering hemoglobin A1c and avoiding hypoglycemia.</p> Signup and view all the answers

<p>To maximize the benefit of CGM in improving glycemic control and avoiding hypoglycemia.</p> Signup and view all the answers

<p>To provide individualized diabetes-specific education to promote healthy diet choices and achieve glycemic and weight management goals.</p> Signup and view all the answers

<p>Because patients with diabetes are more likely to have serious morbidity and mortality from COVID-19.</p> Signup and view all the answers

<p>Diet and physical activity, which should be individualized to promote healthy choices and achieve glycemic and weight management goals.</p> Signup and view all the answers

<p>Hemoglobin A1c generally correlates with average 3-month blood glucose levels.</p> Signup and view all the answers

<p>Patient circumstances, preferences, and treatment, including insulin regimen and individualized monitoring needs.</p> Signup and view all the answers

<p>Nutrient-dense carbohydrate sources that are high in fiber (≥14 g fiber/1000 kcal) and minimally processed, such as nonstarchy vegetables, fruits, and whole grains.</p> Signup and view all the answers

<p>At least 5% weight loss, although weight loss of 10% or more may be necessary to achieve the desired results.</p> Signup and view all the answers

<p>Moderate- to vigorous-intensity aerobic activity for 150 minutes/week, vigorous-intensity aerobic activity for 75 minutes/week, or a combination of both.</p> Signup and view all the answers

<p>Two or more times per week.</p> Signup and view all the answers

<p>Individualized based on the patient's age, health status, weight, pathophysiology of hyperglycemia, specific risks and benefits of a potential therapeutic agent, medication cost, lifestyle, and personal treatment goals.</p> Signup and view all the answers

<p>Between 7% and 8%.</p> Signup and view all the answers

<p>Assessment and management.</p> Signup and view all the answers

<p>Interrupting prolonged sedentary behavior at 30-minute intervals with light activity or standing.</p> Signup and view all the answers

<p>Considering metabolic surgery in patients with BMI of 40 or greater, and in patients with BMI of 35.0 to 39.9 who have not achieved weight loss goals and improvement in comorbidities with medical interventions.</p> Signup and view all the answers

<p>One of the most important aspects of treatment.</p> Signup and view all the answers

<p>Weight loss of at least 7% and moderate-intensity exercise of at least 150 minutes per week</p> Signup and view all the answers

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

<p>variable periods of insulin dependence and independence</p> Signup and view all the answers

<p>Hyperglycemia during the second or third trimester in patients without a prepregnancy diagnosis of type 1 or type 2 diabetes</p> Signup and view all the answers

<p>Reduces the risk of diabetes complications</p> Signup and view all the answers

<p>To identify women at risk for GDM and prevent adverse maternal and neonatal outcomes</p> Signup and view all the answers

<p>At least 7% weight loss over 6 months</p> Signup and view all the answers

<p>A diet rich in monounsaturated fat, whole grains, vegetables, whole fruits, and nuts</p> Signup and view all the answers

<p>Persons with prediabetes, particularly those aged 25 to 59 years with a BMI of 35 or greater, higher fasting plasma glucose (≥110 mg/dL [6.11 mmol/L]), and hemoglobin A1c values of 6% or greater, as well as patients with a history of gestational diabetes</p> Signup and view all the answers

<p>Reduces the incidence of type 2 diabetes mellitus in persons with prediabetes</p> Signup and view all the answers

<p>50%</p> Signup and view all the answers

<p>Give an additional 1 unit of regular or analogue insulin at the time of the premeal measurement for every 50 mg/dL (2.8 mmol/L) above the target glucose value.</p> Signup and view all the answers

<p>1 unit of insulin covers 10 to 20 g of carbohydrates consumed</p> Signup and view all the answers

<p>Adjust the dose by 50% based on the portion of food consumed</p> Signup and view all the answers

<p>To cover the remaining 50% of the total daily dose of insulin not covered by basal insulin</p> Signup and view all the answers

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

<p>Significant reduction in the incidence and progression of microvascular complications</p> Signup and view all the answers

<p>Significant reduction in CVD and mortality</p> Signup and view all the answers

<p>Reduction in the composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, as well as hospitalization for heart failure, and all-cause mortality</p> Signup and view all the answers

<p>Significant reduction in the primary composite outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, as well as all-cause mortality</p> Signup and view all the answers

<p>The target hemoglobin A1c threshold should be based on a patient's health status</p> Signup and view all the answers

<p>To mimic the physiologic action of the pancreas</p> Signup and view all the answers

<p>To maintain glycemic control while fasting and between meals</p> Signup and view all the answers

<p>Favorable outcomes for kidney function, including decreased risk of kidney disease progression and incidence of end-stage kidney disease</p> Signup and view all the answers

<p>Improvement in nonglycemic effects such as weight loss, especially visceral fat, and reduction in triglycerides</p> Signup and view all the answers

<p>To achieve tight glycemic control and reduce the risk of long-term complications</p> Signup and view all the answers

<p>Glycemic control</p> Signup and view all the answers

<p>Metformin, due to its known effectiveness and inability to cause hypoglycemia</p> Signup and view all the answers

<p>Comorbidities such as atherosclerotic CVD, ASCVD risk factors, established kidney disease, heart failure, and overweight and obesity, as well as hypoglycemia risk, adverse effects, cost, and patient preference</p> Signup and view all the answers

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

<p>To consider individual patient needs, preferences, and comorbidities</p> Signup and view all the answers

<p>Weight management, physical activity, and smoking cessation, when applicable</p> Signup and view all the answers

<p>Intravenous insulin therapy</p> Signup and view all the answers

<p>To maintain a glucose level between 140 and 180 mg/dL (7.8-10.0 mmol/L) for most patients</p> Signup and view all the answers

<p>Because it is a reactive, nonphysiologic approach that leads to large glucose fluctuations</p> Signup and view all the answers

<p>Basal insulin and prandial insulin therapy</p> Signup and view all the answers

<p>Greater than 45 mL/min/1.73 m2</p> Signup and view all the answers

<p>In noncritically ill hospitalized adults with insulin-treated diabetes who are at high risk for hypoglycemia, if CGM is available</p> Signup and view all the answers

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

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

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

<p>To detect undetected hypoglycemia</p> Signup and view all the answers

<p>Continuation of outpatient CSII therapy may be appropriate for noncritically ill patients who have an intact level of consciousness and can appropriately adjust pump settings in hospitals with personnel who have expertise in insulin pump therapy</p> Signup and view all the answers

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

<p>SGLT2 inhibitors and/or GLP-1 RAs</p> Signup and view all the answers

<p>Because organ function has returned to baseline</p> Signup and view all the answers

<p>Monitoring for glucose abnormalities</p> Signup and view all the answers

<p>SGLT2 inhibitors</p> Signup and view all the answers

<p>SGLT2 inhibitors (preferred) and/or GLP-1 RAs</p> Signup and view all the answers

<p>In patients with symptomatic hyperglycemia, ongoing catabolism, hemoglobin A1c &gt; 10%, or glucose level &gt; 300 mg/dL (16.7 mmol/L)</p> Signup and view all the answers

<p>Insulin with a GLP-1 RA</p> Signup and view all the answers

<p>To achieve glycemic targets and reduce the risk of cardiovascular complications</p> Signup and view all the answers

<p>Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF).</p> Signup and view all the answers

<p>Monthly injections for at least 12 months followed by intermittent injections.</p> Signup and view all the answers

<p>Measurement of eGFR and screening for the presence of albuminuria, as well as urinary albumin excretion determined from a random urine collection as the urine albumin-to-creatinine ratio (UACR).</p> Signup and view all the answers

<p>An eGFR less than 30 mL/min/1.73 m2.</p> Signup and view all the answers

<p>Uncontrolled hypertension and hyperglycemia.</p> Signup and view all the answers

<p>An ACE inhibitor or an ARB.</p> Signup and view all the answers

<p>It is indicative of glucose abnormalities before hospitalization, and these patients require follow-up for diagnosis of possible diabetes.</p> Signup and view all the answers

<p>Infection, myocardial infarction, nonadherence to diabetes therapy, stress, trauma, and confounding medications (e.g., atypical antipsychotics, glucocorticoids, and SGLT2 inhibitors).</p> Signup and view all the answers

<p>DKA typically occurs in individuals with type 1 diabetes younger than 65 years, while HHS typically occurs in individuals with type 2 diabetes who are older than 65 years.</p> Signup and view all the answers

<p>DKA is a relative or absolute insulin deficiency state resulting in unsuppressed lipolysis, whereas HHS is a partial insulin deficiency that is able to suppress lipolysis and prevent ketone body production.</p> Signup and view all the answers

<p>Symptoms may include abdominal pain, nausea, vomiting, polyuria, polydipsia, weight loss, or shortness of breath, and typically occur within 24 hours of onset in DKA, whereas symptoms from HHS may not appear for several days.</p> Signup and view all the answers

<p>DKA is characterized by an increased anion gap metabolic acidosis, while HHS typically does not develop significant ketoacidosis.</p> Signup and view all the answers

<p>Early recognition and treatment are crucial to prevent life-threatening consequences from dehydration and electrolyte abnormalities.</p> Signup and view all the answers

<p>Euglycemic DKA is a condition described in patients taking SGLT2 inhibitors, and requires a high level of suspicion during initial evaluation.</p> Signup and view all the answers

<p>They are initiated as a consequence of severe hyperglycemia and impair efficient glucose use.</p> Signup and view all the answers

<p>HHS is associated with a higher mortality rate compared with DKA, and is typically seen in older individuals with type 2 diabetes.</p> Signup and view all the answers

<p>DKA and HHS are life-threatening conditions that require early recognition and aggressive treatment to avoid severe consequences.</p> Signup and view all the answers

<p>A basal-bolus insulin regimen with prandial insulin before two or more meals.</p> Signup and view all the answers

<p>A prolonged action profile (&gt;24 hours), peakless insulin delivery, and decreased variability in action between and within individuals.</p> Signup and view all the answers

<p>Patients with type 2 diabetes not at glycemic goal despite adherence to glucose monitoring and multiple treatment modalities.</p> Signup and view all the answers

<p>Patient-centered considerations, including comorbidities such as atherosclerotic cardiovascular disease and associated risk factors, kidney disease, heart failure, and overweight or obesity.</p> Signup and view all the answers

<p>130/80 mm Hg or lower</p> Signup and view all the answers

<p>Metformin.</p> Signup and view all the answers

<p>Glucagon-like peptide 1 receptor agonists and/or sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy.</p> Signup and view all the answers

<p>Moderate-intensity statin</p> Signup and view all the answers

<p>In DKA, pH is profoundly low, whereas in HHS, it is typically greater than 7.3.</p> Signup and view all the answers

<p>Aspirin (75-162 mg/d)</p> Signup and view all the answers

<p>Every 3 months with subsequent adjustments to therapeutic agents until the glycemic target is achieved, and every 6 months if at goal.</p> Signup and view all the answers

<p>Diabetic Retinopathy</p> Signup and view all the answers

<p>It indicates severe dehydration.</p> Signup and view all the answers

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

<p>To both monitor and modify insulin delivery via sensor-augmented, algorithm-derived insulin delivery.</p> Signup and view all the answers

<p>Neovascularization caused by chronic ischemia</p> Signup and view all the answers

<p>To identify potential depletion of body stores and avoid cardiac arrhythmias.</p> Signup and view all the answers

<p>To correct hyperglycemia, replete electrolytes, and identify and treat inciting factors.</p> Signup and view all the answers

<p>Complications from severe hypoglycemia and hyperglycemia, such as electrolyte abnormalities and dehydration.</p> Signup and view all the answers

<p>To treat high-risk proliferative diabetic retinopathy and severe nonproliferative retinopathy</p> Signup and view all the answers

<p>75-162 mg/d</p> Signup and view all the answers

<p>Cardiovascular disease (CVD).</p> Signup and view all the answers

<p>Below 130/80 mm Hg, if possible to achieve safely.</p> Signup and view all the answers

<p>To prevent and delay the progression of retinopathy</p> Signup and view all the answers

<p>Reduced risk of adverse cardiovascular and kidney events.</p> Signup and view all the answers

<p>130/80 mm Hg or lower</p> Signup and view all the answers

<p>To allow for treatment interventions to prevent vision loss</p> Signup and view all the answers

<p>To prevent recurrence and improve patient outcomes.</p> Signup and view all the answers

<p>To guide repletion and adjust insulin therapy.</p> Signup and view all the answers

<p>Due to the complexity of care required.</p> Signup and view all the answers

<p>An eGFR greater than 45 mL/min/1.73 m2</p> Signup and view all the answers

<p>Comprehensive lifestyle modification, including weight management, physical activity, and smoking cessation, is first-line therapy. Clinicians should also consider comorbidities, hypoglycemia risk, adverse effects, cost, and patient preference when selecting medications.</p> Signup and view all the answers

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

<p>Metformin is the recommended first-line oral agent. Gastrointestinal adverse effects are common, which can be reduced by slow titration of doses, administration with food, or use of an extended-release formulation.</p> Signup and view all the answers

<p>Up to 30%</p> Signup and view all the answers

<p>Clinicians should consider comorbidities such as atherosclerotic CVD, ASCVD risk factors, established kidney disease, heart failure, and overweight and obesity, as well as hypoglycemia risk, adverse effects, cost, and patient preference.</p> Signup and view all the answers

<p>Every 6 months</p> Signup and view all the answers

<p>Comprehensive lifestyle modification, including weight management, physical activity, and smoking cessation, is an essential part of managing type 2 diabetes and can help obtain glycemic control.</p> Signup and view all the answers

<p>Pharmacotherapy should be started at the time of type 2 diabetes diagnosis unless contraindications are present, and may be combined with lifestyle modifications to obtain glycemic control.</p> Signup and view all the answers

<p>SGLT2 inhibitors and/or GLP-1 RAs</p> Signup and view all the answers

<p>SGLT2 inhibitors (preferred) and/or GLP-1 RAs with proven benefit in this population</p> Signup and view all the answers

<p>A basal-bolus insulin regimen with prandial insulin before two or more meals.</p> Signup and view all the answers

<p>Clinicians should consider comorbidities, hypoglycemia risk, adverse effects, cost, and patient preference when selecting medications for patients with type 2 diabetes.</p> Signup and view all the answers

<p>Ultralong-acting basal analogue insulins have a prolonged action profile (&gt;24 hours), peakless insulin delivery, and decreased variability in action between and within individuals.</p> Signup and view all the answers

<p>A stepwise approach, considering the clinical characteristics of the patient</p> Signup and view all the answers

<p>When glycemic targets are not met, and other agents are not effective or tolerated</p> Signup and view all the answers

<p>Glucagon-like peptide 1 receptor agonists and/or sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy.</p> Signup and view all the answers

<p>Combination therapy with a GLP-1 RA</p> Signup and view all the answers

<p>Every 3 months with subsequent adjustments to therapeutic agents until the glycemic target is achieved, and every 6 months if at goal.</p> Signup and view all the answers

<p>Insulin therapy.</p> Signup and view all the answers

<p>Combination injectable therapy initially, with a basal insulin dose and prandial insulin added before the largest meal if hyperglycemia persists</p> Signup and view all the answers

<p>They both monitor and modify insulin delivery via sensor-augmented, algorithm-derived insulin delivery.</p> Signup and view all the answers

<p>Blood glucose levels.</p> Signup and view all the answers

<p>To avoid complications from severe hypoglycemia and hyperglycemia, such as electrolyte abnormalities and dehydration.</p> Signup and view all the answers

<p>A hemoglobin A1c test should be performed if not done within the past 3 months.</p> Signup and view all the answers

<p>Altered mental status, fasting (expected or unexpected), illness, insulin–meal timing mismatch, poor oral intake, and alterations in hyperglycemia-inducing therapies.</p> Signup and view all the answers

<p>Between 140 and 180 mg/dL (7.8-10.0 mmol/L)</p> Signup and view all the answers

<p>Critically ill patients with type 1 and type 2 diabetes</p> Signup and view all the answers

<p>To avoid development of DKA (diabetic ketoacidosis)</p> Signup and view all the answers

<p>Because it is a reactive, nonphysiologic approach that leads to large glucose fluctuations</p> Signup and view all the answers

<p>Noncritically ill hospitalized adults with insulin-treated diabetes who are at high risk for hypoglycemia</p> Signup and view all the answers

<p>Basal-bolus regimen with prandial coverage and correction boluses for premeal hyperglycemia</p> Signup and view all the answers

<p>To detect undetected hypoglycemia</p> Signup and view all the answers

<p>Continuous insulin therapy with basal insulin and prandial insulin coverage</p> Signup and view all the answers

<p>To provide coverage for premeal hyperglycemia</p> Signup and view all the answers

<p>Because it provides a continuous supply of insulin and can be adjusted in response to changing glucose levels</p> Signup and view all the answers

<p>Insufficient insulin levels coupled with an increase in counterregulatory hormones, which impairs efficient glucose use and initiates glycogenolysis and gluconeogenesis.</p> Signup and view all the answers

<p>DKA is a relative or absolute insulin deficiency state, whereas HHS is a partial insulin deficiency that can suppress lipolysis but cannot correct hyperglycemia or prevent dehydration and electrolyte abnormalities.</p> Signup and view all the answers

<p>Infection, myocardial infarction, nonadherence to diabetes therapy, stress, trauma, and confounding medications such as atypical antipsychotics, glucocorticoids, and SGLT2 inhibitors.</p> Signup and view all the answers

<p>A high level of suspicion is necessary during initial evaluation, as patients may present with normal or near-normal blood glucose levels.</p> Signup and view all the answers

<p>Abdominal pain, nausea, vomiting, polyuria, polydipsia, weight loss, or shortness of breath, which can progress to lethargy, obtundation, and death if left untreated.</p> Signup and view all the answers

<p>Measurement of serum glucose level, serum electrolytes, serum ketones, blood urea nitrogen, serum creatinine, plasma osmolality, complete blood count, arterial blood gases, urinalysis, and urine ketones, as well as an ECG and cultures of blood, sputum, and urine if an infection is suspected.</p> Signup and view all the answers

<p>An increased anion gap metabolic acidosis secondary to the production of acetoacetic acid and β-hydroxybutyrate.</p> Signup and view all the answers

<p>DKA typically presents with a moderate to severe reduction in serum bicarbonate levels, whereas HHS may have normal or mildly reduced levels (&gt;20 mEq/L).</p> Signup and view all the answers

<p>DKA or HHS may be the initial presentation of a person with undiagnosed diabetes, and prompt recognition can lead to timely diagnosis and treatment.</p> Signup and view all the answers

<p>To avoid life-threatening consequences from dehydration and electrolyte abnormalities, as well as to reduce mortality rates.</p> Signup and view all the answers

<p>Anti-VEGF intravitreal injections</p> Signup and view all the answers

<p>For early detection of kidney disease</p> Signup and view all the answers

<p>An ACE inhibitor or an ARB</p> Signup and view all the answers

<p>It warrants a referral to a nephrologist</p> Signup and view all the answers

<p>To decrease the risk of vision loss</p> Signup and view all the answers

<p>Annual measurements, with more frequent assessments as necessary</p> Signup and view all the answers

<p>Typically, the serum pH is less than 7.3 in DKA, but greater than 7.3 in HHS. Hypertonic hyponatremia occurs due to extreme hyperglycemia and osmotic shifts of water from intracellular to extracellular compartments.</p> Signup and view all the answers

<p>Key components include intravenous hydration, electrolyte repletion, and correction of hyperglycemia with insulin. Frequent electrolyte measurements are necessary to guide repletion as hydration and insulin therapy continue.</p> Signup and view all the answers

<p>Cardiovascular disease (CVD) is a major cause of morbidity and mortality. Simultaneous management of CVD risk factors, including hypertension, dyslipidemia, and albuminuria, is recommended to decrease morbidity and mortality.</p> Signup and view all the answers

<p>The recommended target is below 130/80 mm Hg, if possible to achieve safely. The American Diabetes Association (ADA), American Association of Clinical Endocrinology/American College of Endocrinology, and the American College of Cardiology/American Heart Association advocate for this target.</p> Signup and view all the answers

<p>SGLT2 inhibitors and/or GLP-1 RAs with proven CVD benefit are recommended to decrease morbidity and mortality.</p> Signup and view all the answers

<p>Combined therapy can provide additive reduction of the risk for adverse cardiovascular and kidney events.</p> Signup and view all the answers

<p>The ADA recommends receiving an SGLT2 inhibitor with proven cardiovascular benefit to reduce the risk for worsening heart failure, heart failure hospitalizations, and cardiovascular death.</p> Signup and view all the answers

<p>Inciting factors, such as infection and myocardial infarction, must be identified and treated to prevent recurrence and improve outcomes.</p> Signup and view all the answers

<p>Correcting hyperglycemia, preferably with intravenous insulin, is essential to prevent life-threatening consequences from dehydration and electrolyte abnormalities.</p> Signup and view all the answers

<p>Repletion of electrolyte deficits, particularly potassium, is necessary to prevent cardiac arrhythmias and other complications.</p> Signup and view all the answers

<p>130/80 mm Hg or lower</p> Signup and view all the answers

<p>Moderate-intensity statin, with high-intensity statin reasonable if one or more atherosclerotic cardiovascular disease risk factors are present</p> Signup and view all the answers

<p>Nonproliferative (occurs within the retina) or proliferative (occurs in the vitreous or retinal inner surface)</p> Signup and view all the answers

<p>To treat high-risk proliferative diabetic retinopathy and severe nonproliferative retinopathy</p> Signup and view all the answers

<p>Aspirin (75-162 mg/day)</p> Signup and view all the answers

<p>Diabetic retinopathy</p> Signup and view all the answers

<p>Duration of diabetes, degree of hyperglycemia, hypertension, albuminuria, and dyslipidemia</p> Signup and view all the answers

<p>To allow for early detection of asymptomatic abnormalities and treatment interventions to prevent vision loss</p> Signup and view all the answers

<p>To prevent and delay the progression of retinopathy</p> Signup and view all the answers

<p>Not universally recommended; individualized decision-making is recommended</p> Signup and view all the answers

<p>Type 2 diabetes is often preceded by a prolonged asymptomatic hyperglycemic period, lifestyle interventions and medications can delay or prevent its onset, and early intensive glucose control can prevent or reduce microvascular and macrovascular disease.</p> Signup and view all the answers

<p>To identify individuals at high risk and prevent or delay the onset of type 2 diabetes and its associated complications.</p> Signup and view all the answers

<p>It can identify individuals with presymptomatic type 1 diabetes who may benefit from therapy to delay clinical diabetes development.</p> Signup and view all the answers

<p>It can prevent or reduce the progression of microvascular disease and macrovascular cardiovascular disease.</p> Signup and view all the answers

<p>There is no effective therapy to prevent or delay the onset of type 1 diabetes in the general population.</p> Signup and view all the answers

<p>It can delay the onset of symptomatic type 1 diabetes in selected individuals.</p> Signup and view all the answers

<p>The presence of autoantibodies in type 1A diabetes, whereas type 1B diabetes is characterized by variable insulin deficiency in the absence of autoantibodies.</p> Signup and view all the answers

<p>In the setting of symptomatic hyperglycemia, a single random plasma glucose value of 200 mg/dL or greater is diagnostic of diabetes.</p> Signup and view all the answers

<p>GAD65 autoantibodies have a high prevalence (70%) at the time of diagnosis and may remain detectable for years.</p> Signup and view all the answers

<p>Initiating insulin at the time of diagnosis may decrease toxicity associated with extreme hyperglycemia, allowing the β cells to regain some ability to produce insulin.</p> Signup and view all the answers

<p>Latent autoimmune diabetes in adults is characterized by autoantibody development leading to β-cell destruction and ultimately to insulin deficiency, typically without initial insulin dependence.</p> Signup and view all the answers

<p>The result is a state of insulin deficiency, which is characteristic of type 1 diabetes.</p> Signup and view all the answers

<p>A low or undetectable serum C-peptide level is evidence of little to no insulin secretion, indicating a complete destruction of the insulin-producing β cells.</p> Signup and view all the answers

<p>Patients with type 1A diabetes have an increased risk for other autoimmune disorders, including celiac disease, thyroid disorders, vitiligo, and autoimmune primary adrenal gland failure.</p> Signup and view all the answers

<p>GAD65 and IA-2 autoantibodies are recommended as initial testing for type 1A diabetes in newly diagnosed disease.</p> Signup and view all the answers

<p>The goal of insulin therapy is to replace the missing insulin and maintain near-normal blood glucose levels, reducing the risk of long-term complications.</p> Signup and view all the answers

<p>Type 1B diabetes is characterized by β-cell destruction, which may occur from diseases affecting the pancreas or from the effect of drugs or infections, and has a strong family history of type 2 diabetes.</p> Signup and view all the answers

<p>Insulin resistance leads to normal blood glucose levels as long as the β cells can increase insulin production, whereas insulin deficiency results in hyperglycemia.</p> Signup and view all the answers

<p>Metabolic syndrome is a constellation of risk factors for the development of type 2 diabetes and cardiovascular disease.</p> Signup and view all the answers

<p>The extent of β-cell dysfunction determines the degree of hyperglycemia, which may worsen over time with progressive decrease in insulin production.</p> Signup and view all the answers

<p>The recommended screening interval is every 3 years, and the parameters to be measured include fasting plasma glucose, fasting lipid panel, blood pressure, and waist circumference.</p> Signup and view all the answers

<p>A diet rich in monounsaturated fat, whole grains, vegetables, whole fruits, and nuts, and achieving at least 150 min/week of moderate-intensity exercise, with a goal of 7% weight loss over 6 months.</p> Signup and view all the answers

<p>Acanthosis nigricans is typically associated with insulin resistance, and its presence should prompt screening for diabetes and, if of acute onset, screening for malignancy.</p> Signup and view all the answers

<p>The goal is weight loss and the reduction of insulin resistance, with mitigation of cardiovascular risk factors.</p> Signup and view all the answers

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

<p>The DPP showed that lifestyle modifications reduced the incidence of type 2 diabetes in persons with prediabetes by 58%.</p> Signup and view all the answers

<p>Episodic diabetic ketoacidosis (DKA) resulting from insulin deficiency, with variable periods of insulin dependence and independence.</p> Signup and view all the answers

<p>Type 2 diabetes typically presents in adults, with a gradual onset, and most affected persons remain asymptomatic for several years.</p> Signup and view all the answers

<p>Individuals with preserved β-cell function (A+β+ and A−β+) are more likely to discontinue insulin, whereas those without β-cell reserve (A+β− and A−β−) are more likely to have poor glycemic control and develop long-term insulin dependence.</p> Signup and view all the answers

<p>Macrosomia, labor and delivery complications, preeclampsia, neonatal hypoglycemia, spontaneous abortion, and intrauterine fetal demise.</p> Signup and view all the answers

<p>The pathogenesis of type 2 diabetes is multifactorial, with influence from both genetic and environmental factors.</p> Signup and view all the answers

<p>Universal screening for all women between 24 and 28 weeks of gestation, or earlier if risk factors are present.</p> Signup and view all the answers

<p>Reducing the risk of long-term complications, such as cardiovascular disease and microvascular disease.</p> Signup and view all the answers

<p>They are effective tools for delivering DPP-based interventions and improving patient outcomes.</p> Signup and view all the answers

<p>Values of 6% or greater are associated with an increased risk of developing type 2 diabetes.</p> Signup and view all the answers

<p>To reduce the incidence of type 2 diabetes in high-risk individuals.</p> Signup and view all the answers

<p>before 15 weeks of gestation</p> Signup and view all the answers

<p>type 2 diabetes</p> Signup and view all the answers

<p>at 24 weeks or after</p> Signup and view all the answers

<p>to diagnose gestational diabetes</p> Signup and view all the answers

<p>an autosomal dominant monogenetic defect on different chromosomal loci</p> Signup and view all the answers

<p>at least every 3 years</p> Signup and view all the answers

<p>to provide the knowledge and skills for patients to perform diabetes-related self-care and develop effective problem-solving strategies</p> Signup and view all the answers

<p>Patient circumstances, preferences, and treatment.</p> Signup and view all the answers

<p>improved outcomes, such as hemoglobin A1c and quality of life</p> Signup and view all the answers

<p>at the time of diagnosis, annually and/or when treatment targets are unmet, when complicating circumstances develop, and at times of life and care transitions</p> Signup and view all the answers

<p>When altering nutrition plans, exercise, and/or medications.</p> Signup and view all the answers

<p>To measure treatment efficacy.</p> Signup and view all the answers

<p>4 to 12 weeks postpartum</p> Signup and view all the answers

<p>To improve diabetes care by lowering hemoglobin A1c and avoiding hypoglycemia.</p> Signup and view all the answers

<p>As close to daily as possible.</p> Signup and view all the answers

<p>Because patients with diabetes are more likely to have serious morbidity and mortality from COVID-19.</p> Signup and view all the answers

<p>To provide individualized diabetes-specific education to promote healthy diet choices.</p> Signup and view all the answers

<p>Diet and physical activity.</p> Signup and view all the answers

<p>To identify undetected hyperglycemia.</p> Signup and view all the answers

<p>Reductions in hemoglobin A1c.</p> Signup and view all the answers

<p>Tight glycemic control significantly reduces the incidence and progression of microvascular complications.</p> Signup and view all the answers

<p>It reduces the risk of CVD and mortality, particularly in patients early in the course of diabetes.</p> Signup and view all the answers

<p>They reduce the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, and hospitalization for heart failure.</p> Signup and view all the answers

<p>They reduce the risk of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, and all-cause mortality.</p> Signup and view all the answers

<p>The target threshold should be based on a patient's health status.</p> Signup and view all the answers

<p>An intensive insulin regimen that includes multiple daily doses of insulin to mimic the physiologic action of the pancreas.</p> Signup and view all the answers

<p>To provide continuous subcutaneous insulin infusions (CSII) for basal coverage and prandial coverage.</p> Signup and view all the answers

<p>They decrease the risk of kidney disease progression, incidence of end-stage kidney disease, and mortality in patients with chronic kidney disease.</p> Signup and view all the answers

<p>They improve weight loss, especially visceral fat, and reduce triglycerides.</p> Signup and view all the answers

<p>To mimic the physiologic action of the pancreas and provide basal coverage, prandial coverage, and supplemental insulin for correction of hyperglycemia.</p> Signup and view all the answers

<p>≥14 g fiber/1000 kcal</p> Signup and view all the answers

<p>at least 5% weight loss</p> Signup and view all the answers

<p>150 minutes/week of moderate- to vigorous-intensity aerobic activity</p> Signup and view all the answers

<p>two or more times per week</p> Signup and view all the answers

<p>interrupting prolonged sedentary behavior at 30-minute intervals with light activity or standing</p> Signup and view all the answers

<p>BMI of 40 or greater (≥37.5 in Asian Americans)</p> Signup and view all the answers

<p>smoking discontinuation</p> Signup and view all the answers

<p>between 7% and 8%</p> Signup and view all the answers

<p>based on individualized goals</p> Signup and view all the answers

<p>based on the patient's age, health status, weight, pathophysiology of hyperglycemia, specific risks and benefits of a potential therapeutic agent, medication cost, lifestyle, and personal treatment goals</p> Signup and view all the answers