Diabetes care Exam: Quiz!

Metformin is the first-line drug treatment for type 2 diabetes, especially in patients with a history of myocardial infarction. It is recommended as the initial therapy by various guidelines due to its proven efficacy, safety profile, and cardiovascular benefits. Metformin works by reducing hepatic glucose production and improving insulin sensitivity. It has been shown to decrease the risk of cardiovascular events and mortality in diabetic patients. Therefore, considering the patient's history of myocardial infarction and the need for drug treatment, metformin is the appropriate choice.

According to ADA guidelines, diabetes is diagnosed if HbA1c is greater than or equal to 6.5% in at least 2 measurements. This means that if a person's HbA1c level is consistently 6.5% or higher in multiple tests, they can be diagnosed with diabetes. This threshold is used to determine the presence of diabetes based on the average blood sugar levels over a period of time.

Acarbose is an antidiabetic drug that is associated with the rare condition of multiple gas-containing cysts in the submucosal or subserosal layer of the intestine, known as pneumatosis. This condition can be linked to various gastrointestinal conditions such as bowel gangrene and inflammatory bowel disease. While mechanical ventilation and endoscopic procedures can also be causes, in this case, the association is with the use of Acarbose as an antidiabetic medication.

TZDs (thiazolidinediones) and Saxagliptin should not be used in patients with type 2 diabetes (T2D) and congestive heart failure (CHF). This is because TZDs can cause fluid retention and exacerbate CHF symptoms, while Saxagliptin has been associated with an increased risk of heart failure in some studies. Therefore, it is important to avoid these drugs in T2D patients with CHF to prevent worsening of their heart condition.

Sulfonylureas and meglitinides are classes of drugs that stimulate the pancreas to produce more insulin. Sulfonylureas work by closing potassium channels in the beta cells of the pancreas, which causes an increase in insulin release. Meglitinides also stimulate insulin release by binding to the ATP-sensitive potassium channels in the beta cells. Therefore, both a and b are correct answers as they represent classes of drugs that stimulate the pancreas to produce more insulin.

Rosiglitazone is the correct answer because it raised serious concerns about cardiovascular safety, leading the FDA to issue guidance to evaluate cardiovascular risk in new therapies for treating type 2 diabetes in 2008. This indicates that there were significant issues with the cardiovascular safety profile of rosiglitazone, prompting regulatory action to ensure the evaluation of cardiovascular risks in similar medications.

Linagliptin can be used in patients with CKD (eGFR

Testing for diabetes in asymptomatic individuals should be considered in overweight or obese individuals who have one or more of the following risk factors: first-degree relative with diabetes, hypertension (≥140/90 mmHg or therapy for hypertension), or women with polycystic ovary syndrome. Being an active smoker is not considered a risk factor for diabetes in this context, therefore, testing for diabetes is not recommended for active smokers who are overweight or obese.

The American Diabetes Association (ADA) has established criteria for the diagnosis of diabetes, which includes elevated levels of fasting plasma glucose (FPG) of 110 mg/dL or higher, HbA1C levels of 6.5% or higher, and 2-hour plasma glucose (PG) levels of 200 mg/dL or higher. Additionally, the presence of classical symptoms of hyperglycemia and random PG levels of 200 mg/dL or higher can also be used for diagnosis. However, FPG levels of 110 mg/dL or higher are not one of the criteria for the diagnosis of diabetes according to ADA.

Dapagliflozin has shown benefit in cardiovascular outcomes in patients with and without type 2 diabetes mellitus (T2DM) who have congestive heart failure (CHF). This drug belongs to a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors, which work by inhibiting the reabsorption of glucose in the kidneys and promoting its excretion in the urine. In clinical trials, dapagliflozin has been shown to reduce the risk of cardiovascular events, including heart failure hospitalization and cardiovascular death, in patients with CHF, both with and without T2DM.

Dapagliflozin has shown significant cardiovascular benefit in patients with type 2 diabetes (T2D) who have a high risk of cardiovascular disease (CVD). This drug belongs to a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors, which work by reducing blood sugar levels through the elimination of excess glucose in the urine. In addition to its glucose-lowering effects, dapagliflozin has been shown to reduce the risk of major adverse cardiovascular events, such as heart attack, stroke, and cardiovascular death, in patients with T2D and high CVD risk.

SGLT2i, or sodium-glucose co-transporter 2 inhibitors, have been associated with Fournier's gangrene, a serious complication of drug treatment for type 2 diabetes. This class of drugs works by inhibiting the reabsorption of glucose in the kidneys, leading to increased glucose excretion in the urine. However, SGLT2 inhibitors have been linked to an increased risk of genital and urinary tract infections, which can potentially progress to Fournier's gangrene. Therefore, SGLT2 inhibitors should be used with caution in patients with risk factors for this complication.

Hypoglycemia is more common with Glimepride compared to the other drugs listed (Dapagliflozin and Linagliptin). This means that Glimepride has a higher likelihood of causing low blood sugar levels in patients.

SGLT2 inhibitors and long-acting GLP-1 agonists have shown cardiovascular benefits by decreasing MACE (major adverse cardiovascular events). These drugs work by different mechanisms to improve cardiovascular outcomes. SGLT2 inhibitors reduce cardiovascular events by improving glycemic control, reducing blood pressure, and promoting weight loss. Long-acting GLP-1 agonists, on the other hand, improve cardiovascular outcomes by reducing cardiovascular risk factors, such as blood pressure and body weight, and by exerting direct protective effects on the heart. Therefore, the combination of SGLT2 inhibitors and long-acting GLP-1 agonists has been shown to be effective in reducing MACE.

The given answer suggests that patients with diabetes mellitus (DM) but no coronary heart disease (CHD) have a similar rate of myocardial infarction (MI) compared to patients without DM but with CHD. This implies that having DM alone does not significantly increase the risk of MI compared to having CHD alone. It suggests that the presence of DM without CHD does not independently contribute to a higher rate of MI.

The UKPDS study found that a 0.9% reduction in A1C levels at 10 years was associated with a 25% reduction in microvascular endpoints. This means that for every 0.9% decrease in A1C levels, there was a 25% decrease in the risk of developing microvascular complications such as retinopathy, nephropathy, and neuropathy. This highlights the importance of intensive therapy and maintaining good glycemic control in reducing the risk of these complications in patients with diabetes.

In elderly individuals with long-standing diabetes and comorbidities, the recommended HBA1C goal is 7.5-8%. This range is slightly higher compared to the goals for younger individuals with diabetes. The higher goal is set to avoid the risk of hypoglycemia, which can be more dangerous in older adults. Additionally, elderly individuals may have other health conditions that need to be managed, and a slightly higher HBA1C goal allows for a more flexible and individualized approach to diabetes management.

According to ADA guidelines, DPP-4 inhibitors and GLP-1 agonists are not recommended in the treatment of T2D. This is because both of these drugs work by increasing the levels of GLP-1, which can lead to an increased risk of hypoglycemia and gastrointestinal side effects. Additionally, there is limited evidence on the safety and efficacy of combining these two drugs. Therefore, it is advisable to avoid this combination in the treatment of T2D.

Empagliflozin is the drug that requires the least number of patients to prevent one CV (cardiovascular) death in patients with type 2 diabetes (T2D). This is based on clinical studies and evidence that have shown the effectiveness of empagliflozin in reducing cardiovascular events and mortality in T2D patients. Therefore, compared to statins, antihypertensives, aspirin, and liraglutide, empagliflozin has the lowest NNT (number needed to treat) to prevent one CV death in T2D.

The meta-analysis of intensive glucose-lowering trials found that a reduction of systolic BP (4 mmHg) resulted in a better reduction of cardiovascular (CV) events. This means that lowering blood pressure by 4 mmHg had a greater impact on reducing CV events compared to reducing HbA1C levels by 0.9% or reducing LDL cholesterol by 38.6 mg/dL. Lowering blood pressure is an important intervention for preventing CV events and should be prioritized in treatment strategies.