PC3 Exam3 Test Blueprint

PC3 Exam3 Test Blueprint Endocrine (Diabetes) [10 -12 Questions] Review the textbook readings (Dunphy & Papadakis) on Type 1 & Type 2 Diabetes, Insulin Resistance as well as PowerPoint lectures & assigned supplemental readings on Diabetes. Expect to apply the current guidelines (ADA Standards) for dx & mgmt of Diabetes to specific pt scenarios. Review Goals & Benchmarks for eval & tx & mgmt of patients w/ Diabetes. DM-2019 -Summary of Revisions -ADA Guidelines • Classification and Dx of DM o Base d on new data, the criteria for the diagnosis of diabetes were changed to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from the same sample). • Prevention of DM o Weight loss if overweight or obese o Stop smoking o A recommendation was added to include the 10 -year atherosclerotic cardiovascular disease (ASCVD) risk as part of overall risk assessment. • Meal Planning and Physical Activity o There is not a one -size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized o A recommendation was modified to encourage people with diabetes to decrease consumption of both sugar sweetened and nonnutritive -sweetened beverages and use other alternatives with an emphasis on water intake. o The sod ium consumption recommendation was modified to eliminate the further restriction that was potentially indicated for those with both diabetes and hypertension. o Additional discussion was added to the physical activity section to include the benefit of a vari ety of leisure -time physical activities and flexibility and balance exercises. • Medication and Management A recommendation that, for most patients who need the greater efficacy of an injectable medication glucagon -like peptide 1 receptor agonist should be t he first choice , ahead of insulin. ▪ Dulaglutide (Trulicity) taken by injection weekly. ▪ Exenatide extended release (Bydureon) taken by injection weekly. ▪ Exenatide (Byetta) taken by injection twice daily. ▪ Semaglutide (Ozempic) taken by injection weekly. o For alignment with the ADA -EASD consensus report, two recommendations were added for the use of medications that have proven cardiovascular benefit in people with ASCVD, with and without heart failure. o Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. o The gastroparesis section includes a discussion of a few additional treatment modalities. o The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone. o Greater emphasis has been placed on the use of insulin as the preferred medication for treating hyperglycemia in gestational diabetes mellitus as it does not cross the placenta to a measurable extent . o Metformin and Glyburide should not be used as first -line agents as both cross the placenta to the fetus. DM-Population Health.2019 -ADA.Guidelines • Population health is defined as “the health outcomes of a group of individuals, including the distribution of health outcomes within the group” • These outcomes can be measured in terms of health outcomes (mortality, morbidity, health, and functional status), disease burden (incidence and prevalence), and behavioral and metabolic factors (exercise, diet, A1C, etc.) Recommendations • 1.5 Providers should assess social context, including potential food insecuri ty, housing stability, and financial barriers, and apply that information to treatment decisions → A • 1.6 Refer patients to local community resources when available → B • 1.7 Provide patients with self -management support from lay health coaches, navigators, o r • community health workers when available → A DM-Older.Adults.2019 -ADA.Guidelines Fig. 12.1 —Algorithm to simplify insulin regimen for older patients with type 2 diabetes. Basal insulins: glargine U -100 and U -300, detemir, degludec, and human NP H. Mealtime insulins: short -acting (regular human insulin) or rapid -acting (lispro, aspart, and glulisine). Premixed insulins: 70/30, 75/25, and 50/50 products.