pc5 1.4 T1DM management

A1c, fasting plasma glucose, Oral glucose tolerance test, symptoms of hyperglycemia/crisis WITH random plasma glucose

what labs could be used for the dx of diabetes

6.5% or higher

what A1c level is needed for dx of diabetes

no

can point of care testing diagnoses be used for diabetes dx

126 mg/dL or higher

what fasting plasma glucose(FPG) is diagnostic for diabetes

200 mg/dL or higher

what oral glucose tolerance test (OGTT) is diagnostic for diabetes

200 mg/dl or higher

for dx of diabetes with hyperglycemia/crisis with a random plasma glucose, requires what random plasma glucose level

yes

is repeat testing needed for dx of diabetes

5.7-6.4 %

prediabetes A1c level

100-125 mg/dL (impaired fasting glucose)

prediabetes FPG level

140-199 mg/dL

prediabetes 2-hour plasma glucose OGTT level

FPB

when A1c is high should FPG or PPBG be targeted

glutamic acid decarboxylase (GAD)

what is the first antibody tested for T1DM

IA-2, ZnT8, insulin antibodies(if haven't had insulin), C peptide

after GAD testing is negative, what additional antibodies are tested next to determine T1DM vs T2DM

T1Dm

do low C- peptide levels, under 200, indicate T1DM or T2DM

T2DM

do high C-peptide levels, over 600, indicate T1DM or T2DM

intermediate, should reassess in 2-5 years

C-Peptide 200-600 indicates what

first degree relatives of people with T1DM

who should be screened for T1DM

GAD, IA-2, ZnT8, insulin

tests used for screening first degree relatives of T1DM pts

teplizumab mzwv

treatment to delay onset of symptomatic T1DM

8 yo +, stage 2 T1DM

what patients can have teplizumab mzwv

BMI over 25 + at least one risk factor

who should be screened for T2DM in non Asian Americans

BMI over 23 + at least one risk factor

who should be screened for T2DM in Asian Americans

first degree relative w DM, high risk ethnicity/race, CVD, HTN, elevated TG, low HDL, PCOS, physical inactivity, insulin resistance

risk factors for T2DM

over 250

what TG level is a risk factor for T2DM

under 35

what HDL level is a risk factor for T2DM

acanthosis nigricans, severe obesity, metabolic dysfunction associated steatotic liver disease

what is insulin resistance indicated by

fasting plasma glucose, A1c, 2 hour OGTT

screening test for T2DM

annual

how often are pre diabetes individuals screened for T2DM

at least every 3 years

how often are women with history of gestational MD screened for T2DM

every 1-3 years

how often are individuals over 35 years old screened for T2DM

before antivirals, when changing tx, 3-6 months after start/change in tx, annually

how often are individuals with HIV screened for T2DM

weight over 85th percentile and at least one risk factor

children with what should be screened for T2DM

material history of gestational DM during that child's gestation, family history, African american, latino, native american, asian american, signs of insulin resistance

risk factors for T2DM in children

acanthosis nigricans, HTN, dyslipidemia, PCOS, large or small for gestational age birthweight

signs of insulin resistance in children

10 yo or puberty onset

at what age are children screened for diabetes if meet criteria

every 3 years, more if BMI increasing

how often are children screened for diabetes

24-28 weeks

when is gestational diabetes tested for

one step, two step

types of screening for gestational diabetes

two step

what screening for gestational diabetes may not require a fasting glucose

cf related, posttransplant, monogenic, latent autoimmune diabetes of adulthood, pancreatic, drug induced hyperglycemia

other classifications of diabetes

under 6.5%

A1c goal for patients with good health/function, low treatment risks and burdens

under 7%

A1c goal for most adults

under 7% or under 7.5%

A1c goal for healthy older adults

under 8%

A1c goal for older adults with complex/intermediate health

no A1c goal

A1c goal for older adults with very complex/poor health or any adults with limited life expectancy

over 70%

for most adults what is the goal for CGM blood glucose level percentage time in range

less than 4%

for most adults what is the goal for CGM blood glucose level percentage TBR < 70

less than 1%

for most adults what is the goal for CGM blood glucose level percentage TBR < 54

under 25%

for most adults what is the goal for CGM blood glucose level percentage TAR > 180

under 5%

for most adults what is the goal for CGM blood glucose level percentage TAR > 250

over 50%

for adults with complex/intermediate health what is the goal for CGM blood glucose level percentage time in range

under 1%

for adults with complex/intermediate health what is the goal for CGM blood glucose level percentage TBR < 70

under 1%

for adults with complex/intermediate health what is the goal for CGM blood glucose level percentage TBR < 54

under 50%

for adults with complex/intermediate health what is the goal for CGM blood glucose level percentage TAR > 180

under 10%

for adults with complex/intermediate health what is the goal for CGM blood glucose level percentage TAR > 250

short diabetes duration, low hypoglycemia risk, low tx risk, pharmacotherapy with CVD/CKD/wt benefits, no cvd complications, few/minor comorbidities

what factors favor more stringent goals

long diabetes duration, high hypoglycemia risk, high treatment risk, pharmacotherapy without nonglycemic benefits, cvd complications, severe comorbidities

what factors favor less stringent goals

under 7%

ADA a1c goal for adults

under 6.5%

AACE/ACE A1c goal for adults

every 3 months

A1c testing frequency for A1c above goal

every 6 months

A1c testing frequency for A1c below goal

80-130

ADA preprandial plasma glucose goals for adults

under 110

AACE/ACE preprandial plasma glucose goals for adults

under 180

ADA postprandial plasma glucose goals for adults

under 140

AACE/ACE postprandial plasma glucose goals for adults

no

do CGM TIR/TBR/TAR ADA and ACE goals differ for adults

70-180

Time in range (TIR) indicates the percentage of time the BG in what range

under 7-7.5%

A1c goal for healthy older adults

under 8%

A1c goal for complex older adults

don't rely on

A1c goal for very complex older adults

80-130

preprandial glucose goal for healthy older adults

90-150

preprandial glucose goal for complex older adults

100-180

preprandial glucose goal for very complex older adults

80-180

bedtime glucose goal for healthy older adults

100-180

bedtime glucose goal for complex older adults

110-200

bedtime glucose goal for very complex older adults

70% or over

TIR CGM goal for healthy older adults

50% or over

TIR CGM goal for complex older adults

under 4%

TBR CGM goal for healthy older adults

under 1%

TBR CGM goal for complex older adults

healthy

an older adult with few coexisting chronic illnesses, intact cognitive and functional status

complex

older adult with multiple co existing chronic illnesses or 2+ instrumental ADL impairments or mild to moderate cognitive impairments

very complex

older adult on LTC or end stage chronic illnesses or moderate to severe cognitive impairment or 2+ ADL dependencies

under 7%

A1c goal for children/adolescents

90-130

preprandial plasma glucose goal for children/adolescents

90-150

bedtime or overnight glucose goal for children/adolescents

126-180

glucose goal for before physical activity for children/adolescents

if not able to identify hypoglycemia, lacking access to insulin analogs or advanced insulin delivery/CGM, cannot check blood glucose regularly

when is an A1c goal of under 7.5% reasonable in children/adolescents

if no developmental/psychological issues and no excessive hypoglycemia

when can children/adolescents follow adult tx targets

70-95

pre prandial glucose goal for T1DM or T2DM pregnant women

70-95

pre prandial glucose goal for GDM pregnant women on insulin

under 95

pre prandial glucose goal for GDM pregnant women not on insulin

110-140

1hr post prandial glucose goal for T1DM or T2DM pregnant women

110-140

1hr post prandial glucose goal for GDM pregnant women on insulin

under 140

1hr post prandial glucose goal for GDM pregnant women not on insulin

100-120

2hr post prandial glucose goal for T1DM or T2DM pregnant women

100-120

2hr post prandial glucose goal for GDM pregnant women on insulin

under 120

2hr post prandial glucose goal for GDM pregnant women not on insulin

they're falsely low

why is A1c not used for tx goals in pregnant women

T1DM only

which pregnant women with diabetes have CGM goals