Overview of Diabetes
What is the prevalence of diabetes in the US
1 in 7
What 2 classes of drugs are recommended as first-line Add-on to Metformin therapy if a diabetic patient has ASCVD?
GLP-1R Agonists & SGLT-2 Inhibitors
If a patient does not reach target A1c after starting basal insulin, what time-frame would you consider additional treatment options?
6 months
What percent of people with Diabetes achieve A1c targets?
53% (Will accept 50%)
According to the most recent ADA/EASD Consensus statement, what are the 2 most compelling reasons to pick an SGLT-2 inhibitor as first-line add-on to metformin monotherapy?
If Heart Failure or CKD predominates
In order to avoid clinical inertia, what time frame should we be reassessing and modifying treatment with Diabetes agents?
3-6 months
By 2030, what is the projected prevalence of Diabetes in the US
1 in 3
What is the recommended initiation dose of insulin in insulin naïve patients according to the most recent consensus statement?
10-12 IU's or 0.3 IU/kg
Which class of medications target at least 7 of the core defects in the ominous octect?
Fixed Ratio Combination Insulins
What are the 2018 ADA targets for pre-meal blood glucose
80mg/dL-130mg/dL
What are 3 major factors that contribute to therapeutic inertia in Diabetes (mentioned in the Step-Up training)
Patient Factors (non-adherence to medications)
Provider Factors (Failure to initiate or intensify therapy)
System factors (No team approach to care)
Give at least 3 reasons to initiate basal insulin?
1) Symptoms of hyperglycemia and/or evidence of catabolic state
2) Suspicion of T1DM or LADA based on history and presentation
3) Degree of hyperglycemia warrants rapid treatment, very high A1c, impending hospitalization or decompensation?
4) Acute Medical condition in which Rapid correction of glucose is important e.g. Surgery, Infection or open wound & hospitalization
At what basal insulin dose would you consider stopping additional titration and intensifying with additional treatment options?
Above 0.5-1 unit/kg OR
Fasting Blood glucose at goal but A1c /Postprandial glucose above goal.
What 2 scenarios mentioned in the most recent ADA/EASD consensus should you consider initiating an injectable combination such as an Fixed ration Combination Insulin?
A1c>10% and/or 2% above A1c target
Name the 7 organs involved in the ominous octet?
Brain, Liver, Kidney, Muscle, Pancreas, Fat & Intestines
Give at least 4 reasons to refer to a diabetes specialist? Whoever gives the most correct answers from the training wins the points that
1) Atypical features for Type 2 e.g. Suspect Type 1 or LADA
2) Renal failure +/- dialysis or CHF
3) Very high insulin doses >200 units/day who may benefit from concentrated insulin
4) Persistently elevated A1c despite escalation of therapy
5) Interest in diabetes technology e.g. CGM, Insulin Pump or Insulin patches
6) Unexplained highs or lows despite measures to achieve euglycemia