CC Nov 2015 Preventing or delaying Type 2 diabetes mellitus

echoecho's version from 2015-12-10 13:59


Question Answer
Persons with prediabetes are at increased risk for developing what?diabetes
What % of persons with impaired glucose tolerance (IGT) will progress to DM over their lifetime?40-50
What is the pathophysiologic mechanisms of prediabetes and diabetes?insulin sensitivity and loss of beta-cell function
*** What can decrease the risk of progression (58% reduction in those with IGT)?intensive lifestyle modification (exercise, weight loss, dietary modification)
The Centers for Disease Control and Prevention (CDC) has developed what program?DPP (National Diabetes Prevention Program)
Describe what the DPP is?1) 1 year program designed to empower patients with prediabetes to take charge of their health 2) patients are supported and educated through meetings (face-to-face or virtual) with a lifestyle coach 22+ times over the course of 12 months
Website for toolkit for DPP?
To be eligible to enter into a diabetes prevention program, list the criteria?1) at least 18 years of age AND 2) overweight (BMI > 24 or BMI > 22 if Asian) AND 3) have a blood test result in the following ranges (hgbA1c 5.7-64 or fasting plasma glucose 100-125 or 2-hour plasma glucose after a 75 gm glucose load of 140-199) OR 4) be previously diagnosed with gestational DM AND 5) have no previous dx of DM
Weight loss is difficult to maintain, and even with maintained weight loss, what % of patients will eventually progress to DM?40-50
What diet appears to reduce the incidence of DM irrespective of weight loss but variability in diets studied and lack of stratification of DM status make interpretation of benefit difficult?Mediterranean
There is a decreased risk of progression associated with smoking cessation, true or false?true
Smoking cessation causing decreased risk of progression benefit is mitigated if what is present?weight gain
Does vit D supplementation show any benefit on the incidence of diabetes?no
What classes of diabetic medications show consistent and impressive results in improving beta-cell function and improving insulin sensitivity. Four studies (TRIPOD, PIPOD, DREAM, and ACT NOW) showed a 50-70% reduction in the conversion of IGT to diabetes)?thiazolidinediones
List 2 medications in the thiazolidinediones category that the FDA has severely restricted?1) rosiglitazone (Avandia) 2) pioglitazone (Actos)
Why is Avandia severely restricted by the FDA?cardiovascular concerns
Why is Actos to be weighed regarding side effects vs. benefits?side effects of risk of fluid retention, heart failure, bone loss and possible bladder cancer
What does Metformin do to improve insulin sensitivity in peripheral tissue? Does it preserve beta-cell function?1) inhibits hepatic glucose production and gluconeogenesis 2) no
*** A study by Sussman found that Metformin at what dose was able to reduce the development of DM in patients at highest risk?Metformin 850 mg BID
The above study defined "highest risk for diabetes" as what?patients with higher fasting blood glucose levels OR HgbA1c and/or those patients with a hx of elevated blood sugars
In patients with the "highest risk for diabetes", the absolute risk reduction for diabetes was ____% with Metformin over 3 years of treatment?21.5
When comparing the intervention groups in the above study, there was a ____% reduction in progression to diabetes in the intensive lifestyle modification arm and a ____% reduction in the Metformin arm?58%; 31%
In the above study, patients who had the lowest risk of developing diabetes (lower fasting blood sugars, HgbA1c and a no hx of elevated blood glucose) had a significantly smaller benefit, a 3 year absolute risk reduction of ___%?4.9%
The ADA states that Metformin is a consideration for prevention of diabetes in what patient type?1) prediabetic patients ESPECIALLY if 2) BMI > 35, age < 60 or are women w/ a hx of gestational DM
Acarbose (Precose), an alpha-glucosidase inhibitor is also effective, possibly by doing what?augmenting incretin secretion and enhancing beta-cell function
What blood pressure medication has shown to decrease progression to DM by 14% in high-risk patients via its effect on the renin-angiotensin system?valsartan (Diovan)
There is interest in incretin-based therapies that enhance glucose secretion, decrease glucagon secretion and proliferate beta cells (in animals only) but it is too early to recommend these agents. Name 2 medications?1) dipeptidyl peptidase iv (DPP IV) inhibitors like sitagliptin (Januvia) 2) glucagon-like peptide (GLP-1) receptor agonist (exenatide (Byetta))
Do sulfonylureas reduce the development of DM?no
*** SUMMARY = List examples of lifestyle modification that can prevent or delay diabetes?1) exercise 2) weight loss 3) dietary modification
*** SUMMARY = The ADA states that Metformin is a consideration for prevention of DM in what patient types?1) prediabetes 2) BMI > 35 3) < 60 y.o. 4) hx of gestational DM
*** SUMMARY = What DM medication category improves beta-cell function and improves insulin sensitivity but the risk of fluid retention, heart failure, bone loss and possible bladder CA limit their usefulness for preventing or delaying DM?thiazolidinediones