Diabetes PNN
Based on the ADA 2019 guidelines, what are the recommendations for comprehensive
care of diabetic patients? - ✔️✔️1. Aspirin is no longer recommended for primary
prevention. It should continue for secondary prevention in pts with ASCVD
2. Cholesterol control
- patients with ASCVD or ASCVD risk >20% should receive high intensity statin
- pts >= 40 years old moderate intensity
- pts < 40 years and ASCVD risk factors moderate intensity
3. BP goal
- for most pts is < 140/90 mmHg
- pts with ASCVD or ASCVD risk > 15%, a goal of < 130/80 is appropriate
How often should diabetic patients be evaluated for kidney disease? - ✔️✔️Annually
- measure urine albumin excretion
What is the diagnostic criteria for pre-diabetes? - ✔️✔️FPG 100-125 mg/dl
or
2 hr post plasma glucose 140-199 mg/dl after a 75 g oral glucose tolerance test
or
A1C 5.7-6.4%
What is the diagnostic criteria for diabetes? - ✔️✔️Classic symptoms of hyperglycemia
or hyperglycemic crisis AND a random plasma glucose > 200
or
FPG > 126 mg/dl (no caloric intake for at least 8 hrs)
or
2 hr plasma glucose > 200 mg/dl after a 75 g OGTT
or
A1C > 6.5%
How frequently should normal BG test results be repeated? - ✔️✔️every 3 years
What is non-drug treatment for diabetes? - ✔️✔️Weight loss (decrease weekly calorie
intake by 3500 kcal, weight circumference < 35 women, <40 men)
Nutrition
Physical activity (move every 30 min, moderate intensity aerobic exercise X 150
min/wk)
How much is one carbohydrate serving? What are some examples? - ✔️✔️15 g
one small piece of fruit, 1 slice of bread, 1/3 cup of cookied rice/pasta and 1/2 cup
oatmeal
What test can be done to determine if a patient is still producing insulin? - ✔️✔️C-
peptide test
, What are risk factors of T2DM? - ✔️✔️BMI > 25 kg/m2 or > 23 kg/m2 in Asian
Americans
Physical inactivity
A1C > 5.7%, impaired glucose tolerance or impaired fasting glucose on previous testing
History of CVD
BP > 140/90 or taking medications for HTN
HDL < 35 and/or TG > 250 mg/dL
Women with polycystic ovary syndrome
High risk race/ethnicity (African American, Asian, Latino, Native, Pacific Islander)
First degree relative with diabetes
Hx of gestational DM
Other clinical conditions associated with insulin resistance (severe obesity, acanthosis
nigricans)
For prediabetes, metformin can be used to help improve BG, especially in these
patients - ✔️✔️BMI >= 35
< 60 years old
Hx of gestational DM
What are the goals for diabetes in pregnancy? - ✔️✔️Fasting =< 95 mg/dl
1 hr post meal: =< 140 mg/dl
2 hr post meal: =< 120 mg/dl
If BG is high in pregnant women, the baby can develop - ✔️✔️macrosomia (large baby)
be at risk for hypoglycemiat at birth
will have a high risk for childhood obesity and T2DM
What medications can be used for glycemic control in diabetes in pregnancy? -
✔️✔️1st line: insulin
Alt. Metformin or glyburide (long-term safety is not known; glyburide is associated with
higher rates of neonatal hypoglycemia and macrosomia)
When should an ACE/ARB be initiated in a diabetic patient? - ✔️✔️Urinary albumin
excretion > 30 mg/24 hrs (or urine albumin to creatinine ratio > 30 mg/g)
Pts can have HTN or not to receive ARB/ACEi for kidney protection
What medications can be used in a patient without albuminuria, but who has HTN? -
✔️✔️Any drug for the 4 classes of first-line BP medications (thiazide, ACEi, ARB, CCB)
When should diabetic patients be screened for neuropathy? - ✔️✔️Annually
Based on the ADA 2019 guidelines, what are the recommendations for comprehensive
care of diabetic patients? - ✔️✔️1. Aspirin is no longer recommended for primary
prevention. It should continue for secondary prevention in pts with ASCVD
2. Cholesterol control
- patients with ASCVD or ASCVD risk >20% should receive high intensity statin
- pts >= 40 years old moderate intensity
- pts < 40 years and ASCVD risk factors moderate intensity
3. BP goal
- for most pts is < 140/90 mmHg
- pts with ASCVD or ASCVD risk > 15%, a goal of < 130/80 is appropriate
How often should diabetic patients be evaluated for kidney disease? - ✔️✔️Annually
- measure urine albumin excretion
What is the diagnostic criteria for pre-diabetes? - ✔️✔️FPG 100-125 mg/dl
or
2 hr post plasma glucose 140-199 mg/dl after a 75 g oral glucose tolerance test
or
A1C 5.7-6.4%
What is the diagnostic criteria for diabetes? - ✔️✔️Classic symptoms of hyperglycemia
or hyperglycemic crisis AND a random plasma glucose > 200
or
FPG > 126 mg/dl (no caloric intake for at least 8 hrs)
or
2 hr plasma glucose > 200 mg/dl after a 75 g OGTT
or
A1C > 6.5%
How frequently should normal BG test results be repeated? - ✔️✔️every 3 years
What is non-drug treatment for diabetes? - ✔️✔️Weight loss (decrease weekly calorie
intake by 3500 kcal, weight circumference < 35 women, <40 men)
Nutrition
Physical activity (move every 30 min, moderate intensity aerobic exercise X 150
min/wk)
How much is one carbohydrate serving? What are some examples? - ✔️✔️15 g
one small piece of fruit, 1 slice of bread, 1/3 cup of cookied rice/pasta and 1/2 cup
oatmeal
What test can be done to determine if a patient is still producing insulin? - ✔️✔️C-
peptide test
, What are risk factors of T2DM? - ✔️✔️BMI > 25 kg/m2 or > 23 kg/m2 in Asian
Americans
Physical inactivity
A1C > 5.7%, impaired glucose tolerance or impaired fasting glucose on previous testing
History of CVD
BP > 140/90 or taking medications for HTN
HDL < 35 and/or TG > 250 mg/dL
Women with polycystic ovary syndrome
High risk race/ethnicity (African American, Asian, Latino, Native, Pacific Islander)
First degree relative with diabetes
Hx of gestational DM
Other clinical conditions associated with insulin resistance (severe obesity, acanthosis
nigricans)
For prediabetes, metformin can be used to help improve BG, especially in these
patients - ✔️✔️BMI >= 35
< 60 years old
Hx of gestational DM
What are the goals for diabetes in pregnancy? - ✔️✔️Fasting =< 95 mg/dl
1 hr post meal: =< 140 mg/dl
2 hr post meal: =< 120 mg/dl
If BG is high in pregnant women, the baby can develop - ✔️✔️macrosomia (large baby)
be at risk for hypoglycemiat at birth
will have a high risk for childhood obesity and T2DM
What medications can be used for glycemic control in diabetes in pregnancy? -
✔️✔️1st line: insulin
Alt. Metformin or glyburide (long-term safety is not known; glyburide is associated with
higher rates of neonatal hypoglycemia and macrosomia)
When should an ACE/ARB be initiated in a diabetic patient? - ✔️✔️Urinary albumin
excretion > 30 mg/24 hrs (or urine albumin to creatinine ratio > 30 mg/g)
Pts can have HTN or not to receive ARB/ACEi for kidney protection
What medications can be used in a patient without albuminuria, but who has HTN? -
✔️✔️Any drug for the 4 classes of first-line BP medications (thiazide, ACEi, ARB, CCB)
When should diabetic patients be screened for neuropathy? - ✔️✔️Annually
