2. Rules Hosted by Jeffrey P Schaefer MSc MD FRCPC January 14, 2009

3. Single Jeopardy 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) http://dr.schaeferville.com

4. 100 200 300 400 500 100 200 300 400 500 100 200 300 400 500 100 200 300 400 500 100 200 300 400 500 What’s the Epidelio? An Ounce of Prevention T & T targets & tests Make me better Other Stuff DIABETES GUIDELIND JEOPARDY Double Jeopardy Final Jeopardy

5. What’s the epidelio? 100 Topic I100Question The number of humans with diabetes mellitus in the year 2000. a) 30 million? b) 150 million? c) 380 million?

6. What is 150 million? (2000) 30 million  1985 385 million  2025 Topic I100Answer Single Jeopardy

7. What’s the epidelio? 200 The number of adult Canadians diagnosed with diabetes mellitus in 2005. a)800,000 b)1,200,000 c)1,800,000 Topic I200Question

8. Who are 1,800,000 adult Canadians? 5.5 % of the adult Canadian population 70% increase since 1998 CDA Guidelines Topic I200Question Go To Single Jeopardy

9. What’s the epidelio? 300 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 I300Answer

10. What are the diagnostic criteria for diabetes mellitus? Topic I300Answer Go To Single Jeopardy

11. What’s the epidelio? 400 Impaired *Fasting Glucose is: a) 5.1 – 6.9 mmol/l b) 5.5 – 6.9 mmol/l c) 5.9 – 6.9 mmol/l * no calories x 8 hr Topic I400Question

12. 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 I400Question Go To Single Jeopardy

13. What’s the epidelio? 500 Among those ≥ 40 year, screening for diabetes should be done by: a)FPG q 3 years b)Hgb A1C q 2 years c)75 g OGTT q 1 years Topic I500Question

14. What is FPG q 3 years? Topic I500Answer Go To Single Jeopardy

15. An Ounce of Prevention 100 Topic II100Question Approved methods to PREVENT the onset of Type 1 diabetes mellitus

16. What are ‘there are none’? Nicotinamide trial (ENDIT) Insulin injection trial* (DPT-1) both mainly negative Topic II100Answer Go To Single Jeopardy

17. 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% Topic II200Question

18. What is 58% (and 5% loss of body weight) Two studies: Diabetes Prevention Program Finnish Diabetes Prevention Study Topic II200Answer Go To Single Jeopardy

19. An Ounce of Prevention 300 Common to Metformin, Acarbose, Troglitazone, Rosiglitazone, Ramipril, Xenical…. Topic II300Question

20. What are drugs shown to reduce the incidence of Type 2 DM? Topic II300Answer Go To Single Jeopardy

21. An Ounce of Prevention 400 Among patients with IGT which of the following should be considered to prevent Type 2 DM? (best answer) a)metformin or acarbose b)troglitazone or rosiglitazone c)ramipril or xenical Topic II400Question

22. What is metformin or acarbose? Metformin 850 mg po bid Acarbose 100 mg po tid Topic II400Answer Go To Single Jeopardy

23. An Ounce of Prevention 500 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 nicotinamide c)losartan or xenical Topic II500Question

24. What is a thiozolidinedione? ‘No Known Cardiac Disease’ (not just CCVS III, IV) Topic II500Answer Go To Single Jeopardy

25. Tests & Targets 100 For most with diabetes, Hgb A1C should be measured: a)every 2 months b)every 3 months c)every 6 months Topic III100Question

26. What is every 3 months? (D) Only among those at target and in a stable lifestyle situation can q 6 months be considered Topic III100Answer Go To Single Jeopardy

27. Tests & Targets 200 Blood glucose ketone testing is CDA recommended for: a)no one – it has been phased out b)Type 2 diabetes during acute illness c)Type 1 diabetes during acute illness d)Type 1 diabetes at least twice per mo Topic III200Question

28. What is Type 1 diabetes during acute illness? Has anyone here actually prescribed this? Topic III200Answer Go To Single Jeopardy

29. Tests & Targets 300 Target Hgb A1C for most patients with diabetes mellitus: a)< 6.0% b)< 6.5% c)< 7.0% d)< 8.0% Topic III300Question

30. What is Hgb A1c < 7.0%? Topic III300Answer Go To Single Jeopardy

31. Tests & Targets 400 Target Fasting or Pre-Prandial glucose for most patients with diabetes mellitus: a)4.0 – 7.0 mmol/l b)4.2 – 7.5 mmol/l c)4.4 – 7.8 mmol/l d)4.8 – 8.0 mmol/l Topic III400Question

32. What is 4.0 – 7.0 mmol/l? Topic III400Answer Go To Single Jeopardy

33. Tests & Targets 500 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 Topic III500Question

34. What is 5.0 to 10.0 mmol/l? Topic III500Answer Go To Single Jeopardy

35. Make me better 100 For the management of Type 1 DM, rapid acting insulin (aspart or lispro) is preferred to regular insulin because: a)lower Hgb A1c b) more predictable absorption c)less hypoglycemia d)less painful injection Topic IV100Question

36. What is less hypoglycemia? BONUS QUESTION How many grams of oral glucose is recommended for symptoms of hypoglycemia? 15 grams Topic IV100Answer Go To Single Jeopardy

37. 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)rosiglitazone b) insulin c) metformin d) repaglinide e) acarbose Topic IV200Question

38. What is metformin? Topic IV200Answer Go To Single Jeopardy

39. Make me better 300 Dipeptidyl Peptidase IV is an enyzme that: a)Cleaves insulin b)Cleaves pre-pro-insulin c)Cleaves glucagon d)Cleaves glucogon like peptide Topic IV300Question

40. 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) Topic IV300Answer Go To Single Jeopardy

41. 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 inhibitor b)DPP-IV inhibitor c)insulin d)insulin secretagogue (metiglinide or sulfonylurea) e)thiozolidinedione f)weight loss agent Topic IV400Question

42. What are any of these? Topic IV400Answer Go To Single Jeopardy

43. Make me better 500 DAILY DOUBLE!!!!!!! wager please According to CDA guidelines, what are the major advantages of a DPP-IV inhibitor? Topic IV500Question

44. What are: efficacy rare hypoglycemia improved post-prandial control weight neutral once a day dosing Topic IV500Answer Go To Single Jeopardy

45. Other Stuff 100 Topic V100Question 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/l b)7.0 – 10.0 mmol/l c)6.0 – 9.0 mmol/l d) no need for an infusion

46. What is a 7.0 – 10.0 mmol/l? Topic V100Answer Go To Single Jeopardy

47. 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 patients c)less stringent than in younger patients Topic V200Question

48. 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]. Topic II200Answer Go To Single Jeopardy

49. Other Stuff 300 The in-hospital management of diabetes should include the use of sliding scale dosing of insulin. a)True b)False Topic V300Question

50. What is false? Topic V300Answer Go To Single Jeopardy

51. Other Stuff 400 All (unless contra-indicated) patients with diabetes should receive which vaccinations? Topic V400Question

52. What are influenza (annually) and pneumococcus vaccinations? Topic V400Answer Go To Single Jeopardy

53. 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% Topic V500Question

54. What is 40% Topic V500Answer Go To Single Jeopardy

55. FINAL JEOPARDY Place your wagers… History of Medicine

56. 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)

57. 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.