NR 601 Week 5 and 6 study summary for quiz

Wk 5: Diabetes

DM diagnosis; HbA1C >6.5, FPG: 125, random glucose>200, 2 hr postprandial plasma glucose> 200, and DM S/S; polydipsia, polyuria, wt loss

A1C

Recommendations c To avoid misdiagnosis or missed diagnosis, the A1C test should be performed using a method that is certified by the NGSP and standardized to the Diabetes Control and Complications Trial (DCCT) assay. B c Marked discordance between measured A1C and plasma glucose levels should raise the possibility of A1C assay interference due to hemoglobin variants (i.e.,hemoglobin opathies) and consideration of using an assay without interference or plasma blood glucose criteria to diagnose diabetes.  In conditions associated with increased red blood cell turnover, such as sickle cell disease, pregnancy (second and third trimesters),hemodialysis, recent blood loss or transfusion, or erythropoietin therapy, only plasma blood glucose criteria should be used to diagnose diabetes.

ADA SCREENIGN RECOMMENDATIONS: when to screen to repeat screens based on findings

A second test is required for confirmation unless pt clearly has hyperglycemic crisis or classic s/s of hyperglycemia.

The same test be repeated or a different test be performed without delay using a new blood sample

if the A1C is7.0% (53mmol/mol) and a repeat resultis6.8% (51 mmol/mol), the diagnosis of diabetes is confirmed. If two different tests (such as A1C and FPG) are both above the diagnostic threshold, this also confirms the diagnosis

On the other hand, if a patient has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with consideration of the possibility of A1C assay interference

For all people, testing should begin at age 45 years

If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable

To test for prediabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are equally appropriate

Testing for prediabetes should be considered in children and adolescents who are overweight or obese (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight .120% of ideal for height) and who have additional risk factors for diabetes

Criteria for testing for diabetes or prediabetes in asymptomatic adults

<!--[if !supportLists]-->1.      <!--[endif]-->Testing for prediabetes and risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI >25 kg/m2 or >23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes:

<!--[if !supportLists]-->·       <!--[endif]-->First degree relative with DM

<!--[if !supportLists]-->·       <!--[endif]-->High risk race; AA, latino, native American, Asian American, pacific islander

<!--[if !supportLists]-->·       <!--[endif]-->History of CVD

<!--[if !supportLists]-->·       <!--[endif]-->HTN (>140/90 or on tx for HTN)

<!--[if !supportLists]-->·       <!--[endif]-->HDL cholesterol level <35>250

<!--[if !supportLists]-->·       <!--[endif]-->Women with polycystic ovary syndrome

<!--[if !supportLists]-->·       <!--[endif]-->Physical inactivity

<!--[if !supportLists]-->·       <!--[endif]-->Other clinical conditions associated with insulin resistance; severe obesity acanthosis nigricans

<!--[if !supportLists]-->2.      <!--[endif]-->Pt with prediabetes ((A1C >5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly)

<!--[if !supportLists]-->3.      <!--[endif]-->Women who were diagnosed with GDM should have lifelong testing at least every 3 years

<!--[if !supportLists]-->4.      <!--[endif]-->For all other patients, testing should begin at age 45 years.

<!--[if !supportLists]-->5.      <!--[endif]-->If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status.

Guideline recommendations to start medications

Metformin therapy for prevention of type 2 DM should be considered in those with prediabetes, especially for those with BMI>35, those aged <60>

First line medication options and medication side effects

Metformin

<!--[if !supportLists]-->-          <!--[endif]-->good for glucose control and also good for reducing risk of macro and microvascular outcomes, especially those overweight and obese patients

<!--[if !supportLists]-->-          <!--[endif]-->the best risk benefit profile drug for type 2 DM

<!--[if !supportLists]-->-          <!--[endif]-->does not stimulate endogenous insulin secretionà enhance tissue responsiveness to insulin

<!--[if !supportLists]-->-          <!--[endif]-->well-absorbed in the small intestine, peak plasma concentrations in 2 hours, rapidly excreted by the kidneys

<!--[if !supportLists]-->-          <!--[endif]-->impaired renal function, Cr for men >1.5, and >1.4 for women is contraindication

<!--[if !supportLists]-->-          <!--[endif]-->500mg once daily and increase to BID in 1 to 2 weeks, max is 2000 to 2500mg/day

<!--[if !supportLists]-->-          <!--[endif]-->The most common side effect: GI UPSET (Nausea, diarrhea, bloating, abdominal pain)