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CC March 2016 Glycemic Control of Diabetes mellitus

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echoecho's version from 2016-04-25 01:11

Section

Question Answer
What is an integral part of the care of patients with DM?glycemic control
Providers can predictably estimate a patient's average daily glucose level with what test?hgbA1c
The American Diabetes Association (ADA) recommends a hgbA1c test every ____ therapy, when ill), then what is appropriate?episodic home blood glucose monitoring
Home glucose monitoring is recommended for patients on ____ therapy?insulin
If the mean plasma glucose was 126 mg/dl, what would be the estimated hgbA1c?6%
If the mean plasma glucose was 154 mg/dl, what would be the estimated hgbA1c?7%
If the mean plasma glucose was 183 mg/dl, what would be the estimated hgbA1c?8%
If the mean plasma glucose was 212 mg/dl, what would be the estimated hgbA1c?9%
If the mean plasma glucose was 240 mg/dl , what would be the estimated hgbA1c?10%
If the mean plasma glucose was 269 mg/dl, what would be the estimated hgbA1c?11%
If the mean plasma glucose was 298 mg/dl, what would be the estimated hgbA1c?12%
Why is it a reasonable goal for many nonpregnant adults is < 7%?1) because lowering the hgbA1c to < 7% is associated with a reduction in microvascular complications (neuropathy, nephropathy, retinopathy) and, when done shortly after the dx of DM 2) is also associated with a reduction in macrovascular complications (cardiovascular disease and stroke)
*** While the United Kingdom Prospective Diabetes Study (1977-1991) showed nonsignificant reduction in cardiovascular events in the intensive treatment arm, after 10 years of follow-up, the intensive treatment patients had what significant long-term reductions in, despite the fact that differences in HgbA1c compared to less intensive therapy were no longer present after 1 year?myocardial infarctions and all-cause mortality
In other trials involving patients with long-standing DM (ACCORD, ADVANCE, VADT), no significant reduction in cardiovascular events in the intensive treatment groups was seen after ___ to ___ years of follow-up?3; 5
*** A 2015 Cochrane review of intensive vs. conventional control did not show a significant difference in the risk of what, but did show a reduction in microvascular complications in the intensive group somewhat offset by an increase in hypoglycemia and serious adverse events?in the risk of cardiovascular or all-cause mortality
A more aggressive HgbA1c goal of < _____% may be reasonable for patients with newly-diagnosed diabetes, long life expectancy, no cardiovascular disease and/or who require only diet or metformin to achieve control?6.5
List the patient type that less stringent HgbA1c goals of < 8% may be appropriate?1) pts w/ a hx of severe or significant hypoglycemia 2) limited life expectancy 3) severe microvascular or macrovascular complications 4) extensive comorbid conditions or long-standing DM in which control has not be obtained despite a coordinated approach and maximal medical therapy (including insulin)
*** SUMMARY = Glycemic control targets must be adjusted for a variety of individual issues. List these?1) age 2) life expectancy 3) risk of microvascular and macrovascular complications 4) duration of diabetes dx 5) modes of pharmacologic therapy
*** SUMMARY = Frail elderly are at greater risk of _______ when intensive control targets are used?hypoglycemia
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