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pre-diabetes A1C range
5.7 - 6.4%
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prediabetes FPG range
100 - <126 mg/dl
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pre-diabetes OGTT range
140- <200 mg/dl
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most important factors contributing to the epidemic of overweight & obesity in the US
- poor diet
- physical inactivity
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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
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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
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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
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primary goal of DPP
prevent/delay development of T2DM in persons w/ impaired glucose tolerance (IGT)
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patient pop of DPP
- age 25yo
- prediabetes (based on FPG or OGTT)
- BMI 24
- all ethnic groups
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treatments in the DPP study
- intensive lifestyle
- metformin
- placebo
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DPP primary outcome
- diabetes
- FPG 126mg/dL
or
- 2hr post OGTT 200mg/dL
- (confirmed w/ repeat test)
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details of DPP lifestyle intervention
- loss of body weight & maintenance of loss (dietary fat goal <25% cal; 1200-1800cal/day)
- 150min/week physical activity
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which age group in the DPP study did metformin work best?
younger pts (25-44)
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which age group in the DPP study did lifestyle modifications work best?
older pts ( 60yo)
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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
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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
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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
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what is the dose of metformin for prevention/delay of T2DM in pts w/ fitting criteria?
at least 850mg bid (or 1700mg daily)
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drug therapies proven effective in diabetes prevention trials
- metformin
- acarbose
- orlistat
- rosiglitazone
- vogliobose
- pioglitazone
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what is the primary determinant of weight loss?
energy restriction (NOT macronutrient composition)
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% of daily carb caloric intake for adults
45-65%
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% of daily fat caloric intake for adults
20-35%
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% of daily protein caloric intake for adults
10-35%
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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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