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Share Terms in this set (521) Original DCCT The Diabetes Control and Complications Trial (pub. 1993) The Diabetes Control and Complications Trial (pub. 1993) 1) Showed 60% reduced ... development of microvascular complications in T1DM w/ INTENSE THERAPY 2) Over 6.5 years, the intense therapy group mean A1c was 7% compared to 9% in the control group 3) Was conducted from 1983 to 1993 UKPDS The United Kingdom Prospective Diabetes Study (pub. 1998) The United Kingdom Prospective Diabetes Study (UKPDS, pub. 1998) 1) Followed ppl w/ NEW type 2 for 10 years 2) Intense therapy resulted in mean A1c of <7% which reduced development of micro- AND macro-vascular complications 3) Also suggested that intensive therapy could reduce risk of stroke and MI in diabetes ACCORD Action to Control Cardiovascular Risk in Diabetes (pub. 2008) Action to Control Cardiovascular Risk in Diabetes (ACCORD, pub. 2008) 1) Compared the effects of intensive BG control and cardiovascular outcomes for ppl w/ DM 2) One arm of this study was terminated early due to the findings that intensive glycemic control (A1c of <6%) was actually associated with increased mortality of patients 3) Other arms of ACCORD which study lipids and BP are still being carried out today. Possible causes for elevated post-prandial BG 1) too many carbs in the meal 2) inadequate pre-meal insulin 3) improper/inadequate dosing of oral agents (except metformin) 4) not enough activity in the preceding hours/days Possible causes for elevated fasting BG 1) not enough basal insulin 2) inadequate oral meds in the evening or bedtime 3) infection (if BG is otherwise usually well-controlled) Possible causes for BG being elevated allllll of the time 1) Insufficient med doses 2) Patient requires combination therapy 3) Medication hasn't been taken for a long enough time 4) Not enough exercise 5) Too much carb overall 6) Excessive stress Possible causes for BG being erratic/inconsistent 1) Erratic timing of meals or amount of carbs in meals 2) Irregular insulin injection technique 3) Insulin has lost its potency 4) Excessive stress ADA criteria for diabetes diagnosis A1c > or = 6.5% OR FBG of > or = 126 mg/dL (fasting = no kcal for 8 hrs) OR 2-hr plasma glucose > or = 200 during an OGTT* (*Per the WHO, an OGTT should be performed using a glucose load of 75 grams) ADA criteria for the diagnosis of diabetes in CHILDREN The child must be overweight AND and 2 of the following... - fam hx of DM in 1st or 2nd degree relatives - Native American, African American, Hispanic/Latino, Asian American, Pacific Islander - signs of insulin resistance (i.e. acanthosis nigricans, HTN, dyslipidemia, or PCOS) - maternal hx of GDM during the child's gestation For children at risk for DM, what should be tested every 3 years? Fasting BG should be tested in children at risk for DM every 3 years. Times when ppl w/ T1DM should test for ketones - when BG is consistently >300 - if on a weight-loss diet - when ill (especially if febrile or during infection) Times when ppl w/ DMII should test for ketones - when ill - during infection - on hypocaloric weight-loss diets Medicare eligibility requirements - over 65 yo - disabled (any age) - end-stage renal disease (any age) Medicare - Part A specifics/coverage - hospitalizations - skilled nursing - home health - hospice (beneficiary pays deductible) Medicare - Part B specifics/coverage - physician office visits - outpatient services - laboratory costs - equipment and supplies (this is elective and the beneficiary pays premiums) Medicare - Part C specifics/coverage AKA "Medicare Advantage" (pays everything not covered by part A or B) - extended hospital stays/extra hospital days *beneficiary pays a monthly premium Medicare - Part D specifics/coverage A prescription drug insurance - lowers the costs of medications *beneficiaries have to... 1) pay a monthly premium and... 2) choose drug-coverage from participating private companies Veterans Administration (VA) insurance specifics/coverage Full coverage for*... - veterans suffering from service-related medical conditions - vets who served in specific wars - or vets who meet low-income criteria *vets who don't meet these requirements can also get care with co-payments Indian Health Services (IHS) insurance specifics/coverage medical care is provided free of charge to American Indians and Alaska Natives who are members of federally recognized tribes TRICARE insurance coverage/specifics Offers health-care services to... - active duty military - retired military - their relatives - their survivors Bureau of Primary Health Care - provides medical services to vulnerable, underserved people having geographic, financial, or cultural barriers to health care - beneficiaries pay on a sliding scale basis at federally qualified centers, many of them in rural areas Type 1 DM pathophysiology - destruction of the beta cells of the pancreas - Islet cell antibodies appear early in T1 and begin their attack on the pancreas - onset seems sudden (i.e. hyperglycemia, ketoacidosis, etc) but takes time to develop - genetic pre-disposition exists BUT many ppl w/ the genetic risk don't develop the disease - environmental or viral triggers are thought to be required for T1 to express itself - _____-cell antibodies occur early in the course of T1DM and attack the ____ cells of the pancreas. Islet cell-antibodies/beta cells of pancreas A high titer of _______-_______ ________ase is considered the best immunologic predictor of the development of T1DM. A high titer of glutamic-acid decarboxylase (GAD) is considered the best immunologic predictor of the development of T1DM. [Show More]

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