Disclaimer: The following guide is my best guess on what content will be on the exam. I do not know what exactly will be on the exam but I have helped over a thousand health care professionals pass the exam.
Chapter 8- Targets for Glycemic Control
Importance: Very high- Re-read a few times, be very familiar with chapter
Approximate time recommended: 45 min
I have highlighted what I think will be important for the exam. However you should read the entire chapter. All areas in grey (key messages and recommendations) are also important for the exam.
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Open in new tab Under the heading of: Introduction
I have highlighted the important studies but there is an easy way to remember the outcomes as they all follow a certain pattern. The studies showed significant reductions microvascular complications but macrovascular outcomes either came much later or were not significantly reduced.
Memorize Figure 1
Instead of memorizing another table (Table 1) please remember this easy formula to convert A1c to average blood glucose: ((A1c-6) x 2 ) + 6= Average blood glucose in mmol/L. So for example if a patient has an A1c of 6.1% (0.061) then
((6.1-6) x 2 ) +6
((0.1) x2) +6
0.2+6
6.2 average blood glucose
A copy of Figure 1 can be found on pg 3 of the Quick Reference Guide
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Practice Questions (press show answer to reveal answer)
What is the A1c target for a 65 year old male with chronic obstructive pulmonary disorder, fatty liver, obesity, erectile dysfunction and has had frequent episodes of minor hypoglycemia lately?
A) ≤ 6.5% (0.065)
B) ≤ 7.0% (0.07)
C) ≤ 8.5% (0.085)
D) ≤ 9.0% (0.09)
A) Incorrect- this patient is at risk of hypoglycemia as he is frequently experiencing hypoglycemia. This patient would not be a good candidate to target for a lower A1c. First we should work to reduce his episodes of hypoglycemia and maybe later we could aim for a target A1c of 6.5% but for now an A1c of 7% would be a better option.
B) Correct- none of his other co-morbidities make him a frail patient. Also he is suffering from minor hypoglycemia not severe episodes so he does not need to have a higher A1c target.
C) Incorrect- A higher A1c would be suitable if he was frail, had dementia, had severe hypoglycemia, was functionally dependent or had limited life expectancy. He has a number of other co-morbidities but none of those qualify him for a higher A1c target.
D) Incorrect- An A1c target of 9% (0.09) would not apply to this patient
What is the legacy effect?
A) The benefit of reduced cardiovascular events seen in patients taking SGLT-2 inhibitors
B) The benefit of reduced retinopathy seen when aiming for lower A1c target of 6.5%
C) The benefit of retinopathy seen in patients who have recently achieved control of their diabetes
D) The benefit of reduced cardiovascular events seen in patients taking GLP analogs
E) The benefit of reduced cardiovascular events seen in patients who had early control of diabetes
A) Incorrect- while certain SGLT-2 inhibitors are favored for their benefits in cardiovascular disease, these medications weren’t around when the UKPDS and DCCT found the legacy effect
B) Incorrect- The legacy effect was the positive effects on micro and macrovascular events seen in patients in the intensive treatment group even after their A1c had increased and was similar to regular treatment group years after the UKPDS and DCCT ended
C) Incorrect- The legacy effect was the positive effects on micro and macrovascular events seen in patients in the intensive treatment group even after their A1c had increased and was similar to regular treatment group years after the UKPDS and DCCT ended
D) Incorrect- while certain GLP analogs are favored for their benefits in cardiovascular disease, these medications weren’t around when the UKPDS and DCCT found the legacy effect
E) Correct- The legacy effect was the positive effects on micro and macrovascular events seen in patients in the intensive treatment group even after their A1c had increased and was similar to regular treatment group years after the UKPDS and DCCT ended