PHRD6095 Pharmacotherapy Lecture 3 - Diabetes Prevention

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daynuhmay
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283381
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PHRD6095 Pharmacotherapy Lecture 3 - Diabetes Prevention
Updated:
2014-09-17 22:53:51
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Diabetes Prevention
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Diabetes Prevention
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  1. pre-diabetes A1C range
    5.7 - 6.4%
  2. prediabetes FPG range
    100 - <126 mg/dl
  3. pre-diabetes OGTT range
    140- <200 mg/dl
  4. most important factors contributing to the epidemic of overweight & obesity in the US
    • poor diet
    • physical inactivity
  5. diabetes additional risk factors
    • physical inactivity
    • first degree relative w/ diabetes
    • high risk/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
    • women who delivered baby >9lbs or w/ GDM
    • HTN
    • HDL <35mg/dL and/or TG>250mg/dL
    • women w/ PCOS
    • A1C  5.7%, IGT, or IFG on previous test
    • other conditions assoc' w/ insulin resistance
    • hx of CVD
  6. ADA criteria for testing for diabetes in asymptomatic adults (3)
    • 1) BMI 25 & have 1+ additional risk factors
    • 2) w/o risk factors, testing begins at 45yo
    • 3) if results normal, q3yr; annually for pre-diabetes results
  7. ADA criteria for testing for T2DM in asymptomatic children
    • overweight + 2 risk factors (fam hx, race, insulin resistance, maternal h/o GDM)
    • age of initiation: 10 or onset of puberty
    • test q3yr
  8. primary goal of DPP
    prevent/delay development of T2DM in persons w/ impaired glucose tolerance (IGT)
  9. patient pop of DPP
    • age 25yo
    • prediabetes (based on FPG or OGTT)
    • BMI 24 
    • all ethnic groups
  10. treatments in the DPP study
    • intensive lifestyle
    • metformin
    • placebo
  11. DPP primary outcome
    • diabetes
    • FPG 126mg/dL 

    or

    • 2hr post OGTT 200mg/dL
    • (confirmed w/ repeat test)
  12. details of DPP lifestyle intervention
    •  loss of body weight & maintenance of loss (dietary fat goal <25% cal; 1200-1800cal/day) 
    •  150min/week physical activity
  13. which age group in the DPP study did metformin work best?
    younger pts (25-44)
  14. which age group in the DPP study did lifestyle modifications work best?
    older pts (60yo)
  15. primary result of the DPP study
    • lifestyle intervention was most effective in reducing diabetes (in all ages)
    • metformin was most effective in BMI 35 & not effective in >60yo
  16. pts w/ IGT, IFG, or A1c 5.7-6.4% should be referred to an effective support program targeting:
    • weight loss of 7%
    • increased physical activity of at least 150min/week of moderate activity
  17. when is metformin tx for prevention of T2DM considered?
    • IGT
    • IFG
    • A1C 5.7-6-4%
    • esp w/ BMI >35, <60yo, & women w/ prior GDM
  18. what is the dose of metformin for prevention/delay of T2DM in pts w/ fitting criteria?
    at least 850mg bid (or 1700mg daily)
  19. drug therapies proven effective in diabetes prevention trials
    • metformin
    • acarbose
    • orlistat
    • rosiglitazone
    • vogliobose
    • pioglitazone
  20. what is the primary determinant of weight loss?
    energy restriction (NOT macronutrient composition)
  21. % of daily carb caloric intake for adults
    45-65%
  22. % of daily fat caloric intake for adults
    20-35%
  23. % of daily protein caloric intake for adults
    10-35%
  24. options for daily calorie goals for weight loss
    • 1) 500 calories/day less than current intake
    • 2) (current weight x 12) - 500
    • 3) estimation tables/calculators
    • 4) guideline/organization std rec's

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