rules hosted by jeffrey p schaefer msc md frcpc january 14, 2009

Rules

Hosted by Jeffrey P Schaefer MSc MD FRCPCJanuary 14, 2009

SingleJeopardy

Rules• Self-score

• Select a box… go around the room

• Selector has first stab…

• Selector can ‘phone a friend’

• We’re all friends so chime in if you like

• File is located at http://dr.schaeferville.com (presentations)

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What’s theEpidelio?

An Ounceof

Prevention

T & Ttargets

&tests

Make mebetter

OtherStuff

DIABETES GUIDELIND JEOPARDY

DoubleJeopardy

FinalJeopardy

What’s the epidelio?100

Topic I 100 Question

The number of humans with diabetes mellitus in the year 2000.

a) 30 million?

b) 150 million?

c) 380 million?

What is 150 million? (2000)

30 million 1985385 million 2025

Topic I 100 AnswerSingle

Jeopardy


The number of adult Canadiansdiagnosed with diabetes mellitus in

2005.

a)800,000b)1,200,000c)1,800,000


Who are 1,800,000 adult Canadians?

• 5.5 % of the adult Canadian population

• 70% increase since 1998 CDA Guidelines

Topic I 200 QuestionGo To Single

Jeopardy


• Fasting Plasma Glucose ≥ 7.0 mmol, OR• Casual Plasma Glucose ≥ 11.1 mmol +

symptoms of hyperglycemia, OR• 2 hr Plasma Glucose ≥ 11.1 (75 OGTT)

Topic I 300 Answer

What are the diagnosticcriteria for diabetes

mellitus?

Topic I 300 AnswerGo To Single

Jeopardy


Impaired *Fasting Glucose is:a) 5.1 – 6.9 mmol/lb) 5.5 – 6.9 mmol/lc) 5.9 – 6.9 mmol/l

* no calories x 8 hr


What (IFG) is 5.9 – 6.9 mmol/l?

• AND impaired glucose tolerance 7.8 – 11.0 mmol/l at 2 hr 75 OGTT

• BONUS QUESTION

• Either IFG or IGT is known

• Prediabetes

Topic I 400 QuestionGo To Single

Jeopardy


Among those ≥ 40 year, screening for diabetes should be done by:

a) FPG q 3 yearsb) Hgb A1C q 2 yearsc) 75 g OGTT q 1 years


What is FPG q 3 years?

Topic I 500 AnswerGo To Single

Jeopardy

An Ounce of Prevention100

Topic II 100 Question

Approved methods to PREVENTthe onset of Type 1 diabetes mellitus

What are ‘there are none’?

• Nicotinamide trial (ENDIT)

• Insulin injection trial* (DPT-1)

both mainly negative

Topic II 100 AnswerGo To Single

Jeopardy

An Ounce of Prevention 200

•Diet and Exercise (150 min/wk) for 4 years among those at risk resulted in a reduction of Type 2 diabetes of:

a) 15%b) 36%c) 58%


What is 58% (and 5% loss of body

weight)

• Two studies:

• Diabetes Prevention Program

• Finnish Diabetes Prevention Study


Jeopardy


Common to Metformin, Acarbose, Troglitazone, Rosiglitazone, Ramipril, Xenical….


What are drugs shown toreduce the incidence of Type 2

DM?


Jeopardy


Among patients with IGT which of the following should be considered to prevent Type 2 DM? (best answer)

a)metformin or acarboseb)troglitazone or rosiglitazone

c)ramipril or xenical


What is metformin or acarbose?

• Metformin 850 mg po bid

• Acarbose 100 mg po tid


Jeopardy


Among patients with IFG which of the following should be considered to prevent Type 2 DM? (best answer)a)rosiglitazone or piaglizatone

b)ramipril or nicotinamidec)losartan or xenical


What is a thiozolidinedione?

• ‘No Known Cardiac Disease’

• (not just CCVS III, IV)


Jeopardy

Tests & Targets100

For most with diabetes, Hgb A1C should be measured:

a) every 2 monthsb) every 3 monthsc) every 6 months

Topic III 100 Question

What is every 3 months? (D)

• Only among those at target and in a stable lifestyle situation can q 6 months be considered

Topic III 100 AnswerGo To Single

Jeopardy

Tests & Targets 200

Blood glucose ketone testing is CDA recommended for:

a)no one – it has been phased outb)Type 2 diabetes during acute illnessc)Type 1 diabetes during acute illnessd)Type 1 diabetes at least twice per mo


What is Type 1 diabetes during acute illness?

• Has anyone here actually prescribed this?


Jeopardy

Tests & Targets 300

Target Hgb A1C for most patients with diabetes mellitus:

a) < 6.0%b) < 6.5%c) < 7.0%d) < 8.0%


What is Hgb A1c < 7.0%?


Jeopardy

Tests & Targets 400

Target Fasting or Pre-Prandial glucose for most patients with diabetes mellitus:

a) 4.0 – 7.0 mmol/lb) 4.2 – 7.5 mmol/lc) 4.4 – 7.8 mmol/ld) 4.8 – 8.0 mmol/l


What is 4.0 – 7.0 mmol/l?


Jeopardy

Tests & Targets500

Target 2 hour post prandial glucose for most patients with diabetes mellitus:

a) 3.0 – 8.0 mmol/l

b) 4.0 – 9.0 mmol/l

c) 5.0 – 10.0 mmol/l

d) 6.0 – 11.0 mmol/l


What is 5.0 to 10.0 mmol/l?


Jeopardy

Make me better100

For the management of Type 1 DM, rapid acting insulin (aspart or lispro) is preferred to regular insulin because:

a) lower Hgb A1cb) more predictable absorption

c) less hypoglycemiad) less painful injection

Topic IV 100 Question

What is less hypoglycemia?

BONUS QUESTION

• How many grams of oral glucose is recommended for symptoms of hypoglycemia?

• 15 grams

Topic IV 100 AnswerGo To Single

Jeopardy

Make me better 200

Compensated patients with Type 2 DM who do not achieve targets with lifestyle modification should have this agent considered first…

a) rosiglitazoneb) insulin

c) metformind) repaglinidee) acarbose


What is metformin?


Jeopardy

Make me better 300

Dipeptidyl Peptidase IV is an enyzme that:

a) Cleaves insulinb) Cleaves pre-pro-insulinc) Cleaves glucagond) Cleaves glucogon like peptide


What is cleaves Glucagon Like Peptide (GLP)?

• GLP Actions– inhibits gastric motility– inhibits gastric acid secretion– inhibits glucagon secretion– augments glucose stimulated insulin secretion– ‘expands’ beta-cell mass– induces satiety (central action)


Jeopardy

Make me better 400

For Type 2 dm on metformin who fail to achieve targets, which of the following agents are next in line per CDA?

a) alpha-glucosidase inhibitorb) DPP-IV inhibitorc) insulind) insulin secretagogue (metiglinide or

sulfonylurea)e) thiozolidinedionef) weight loss agent


What are any of these?


Jeopardy

Make me better 500

DAILY DOUBLE!!!!!!!wager please

According to CDA guidelines, what are the major advantages of a DPP-IV

inhibitor?


What are:efficacy

rare hypoglycemiaimproved post-prandial control

weight neutral once a day dosing


Jeopardy

Other Stuff100

Topic V 100 Question

Among patients who present with an acute coronary syndrome and PG ≥ 12.0, an insulin infusion should be started to maintain glucose between:

a)8.0 – 12.0 mmol/lb)7.0 – 10.0 mmol/lc)6.0 – 9.0 mmol/ld) no need for an infusion

What is a 7.0 – 10.0 mmol/l?

Topic V 100 AnswerGo To Single

Jeopardy

Other Stuff 200

Among otherwise healthy elderly people with diabetes, glycemic targets should be…

a) more stringent than in younger patients

b) the same as that in younger patientsc) less stringent than in younger patients


What is the same as in younger patients.?

Otherwise healthy elderly people with diabetes should be treated to achieve the same glycemic, blood pressure and lipid targets as younger people with diabetes [Grade D, Consensus].

In people with multiple comorbidities, a high level of functional dependency or limited life expectancy, the goals should be less stringent [Grade D, Consensus].


Jeopardy

Other Stuff 300

The in-hospital management of diabetes should include the use of sliding scale dosing of insulin.

a) Trueb)False


What is false?


Jeopardy

Other Stuff 400

All (unless contra-indicated) patients with diabetes should receive which vaccinations?


What are influenza (annually) and pneumococcus

vaccinations?


Jeopardy

Other Stuff 500

Among males with diabetes mellitus age ≥ 60 years, what is the percentage of complete erectile dysfunction?

a) 20%b) 30%c) 40%


What is 40%


Jeopardy

FINAL JEOPARDY

Place your wagers…

History of Medicine

FINAL JEOPARDY

In what year did Drs. Frederick Banting, Charles Best, James Collip, and John MacLeod inject the first human with insulin?

(accept a 95% CI of +/- 5 years)

When was 1922?

• 1920: Banting had an idea• 1921: isolated pancreatic extract• 1922: first tests on Leonard

Thompson Jan 11, 1922• 1923: Banting & MacLeod win

Nobel Prize• 1923: Best turned efforts toward

mass production 1,800 – 2,200 Units/kg pancreas

Leonard Thompson: diagnosed age 14 Type I DM. Died of pneumonia 13 years later.

rules hosted by jeffrey p schaefer msc md frcpc january 14, 2009

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