Perspectives On The News, November, 2007: Type 1 Diabetes and Glucose Monitoring

POST-TEST QUESTIONS

1. C-peptide measurement allows assessment of endogenous insulin production. Which statements are true of C-peptide:
  1. C-peptide levels are more useful than antibody measurements in the differentiation between type 1 and type 2 diabetes.

  2. C-peptide levels were above the lower assay limit in the majority of type 1 diabetic persons entering the Diabetes Control and Complications Trial (DCCT).

  3. In the DCCT, persons with type 1 diabetes and higher C-peptide levels tend to have less retinopathy and nephropathy, lower A1c, and less hypoglycemia
     

2. The Epidemiology of Diabetes Interventions and Complications (EDIC) study allowed nearly two decades of overall follow-up of persons participating in the control group of the DCCT. Findings demonstrate:

  1. One third required laser photocoagulation.

  2. Less than one tenth suffered myocardial infarction, stroke, or cardiovascular death.

  3. The majority of persons in the control group of DCCT/EDIC developed serious diabetic complications.

 

3. Glucose variability, the degree of glucose fluctuations from peaks to nadirs in a given person with diabetes, have been directly shown to be associated with

  1. Increased oxidative stress, as shown by measurement of urinary isoprostanes

  2. Increased risk of myocardial infarction

  3. Increased risk of diabetic microvascular complications

 

4. An explanation of the greater risk of complications of DCCT participants in the control group with A1c 9% than of those in the intervention with A1c 9% might be:

  1. Those in the intervention group had reduced glycemic variability, offsetting their elevation in A1c.

  2. Those in the intervention group had multiple other forms of medical care because of greater contact with health professions, reducing their likelihood of complications.

  3. Those in the intervention group with A1c 9% actually had lower mean glucose levels and hence lesser glycemic exposure than those the control group with A1c 9%.

  4. All of the above

 

5. Continuous glucose monitoring (CGM) allows measurement of:

  1. Capillary glucose, giving a measure similar to actual arterial glucose level

  2. Interstitial glucose, giving a measure closely resembling venous glucose, but reduced by approximately 20% from this level

  3. Interstitial glucose, giving a measure resembling venous glucose, but lagging by approximately 20 minutes from the actual venous glucose level

 

6. CGM calibration should be performed by measurement of capillary glucose

  1. When the CGM glucose level is between 90-140 mg/dl

  2. Only after the CGM glucose has been relatively constant for 20-40 minutes

  3. At any CGM glucose level above 90 mg/dl

 

7. In clinical studies, currently used CGM devices give glucose readings which differ by at least 20% from simultaneous capillary glucose levels:

  1. Less than 10% of such comparisons

  2. 10-20% of such comparisons

  3. 21-35% of such comparisons

  4. 36%-50% of such comparisons

 

8. Randomized controlled studies of use of CGM in type 1 diabetic persons have shown:

  1. No evidence of improvement in glycemic control, but evidence of reduction in frequency of hypoglycemia.

  2. No evidence of improvement in hypoglycemia, but evidence of improvement in glycemic control.

  3. Evidence suggesting both that glycemic control can be improved and that frequency of hypoglycemia can be reduced.