1. C-peptide measurement allows assessment of endogenous insulin
production. Which statements are true of C-peptide:
-
C-peptide levels are more
useful than antibody measurements in the differentiation between type 1
and type 2 diabetes.
-
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).
-
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:
-
One third required laser
photocoagulation.
-
Less than one tenth
suffered myocardial infarction, stroke, or cardiovascular death.
-
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
-
Increased oxidative
stress, as shown by measurement of urinary isoprostanes
-
Increased risk of
myocardial infarction
-
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:
-
Those in the intervention
group had reduced glycemic variability, offsetting their elevation in
A1c.
-
Those in the intervention
group had multiple other forms of medical care because of greater
contact with health professions, reducing their likelihood of
complications.
-
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%.
-
All of the above
5. Continuous glucose monitoring (CGM) allows measurement of:
-
Capillary glucose, giving
a measure similar to actual arterial glucose level
-
Interstitial glucose,
giving a measure closely resembling venous glucose, but reduced by
approximately 20% from this level
-
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
-
When the CGM glucose
level is between 90-140 mg/dl
-
Only after the CGM
glucose has been relatively constant for 20-40 minutes
-
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:
-
Less than 10% of such
comparisons
-
10-20% of such
comparisons
-
21-35% of such
comparisons
-
36%-50% of such
comparisons
8. Randomized controlled studies of use of CGM in type 1 diabetic
persons have shown:
-
No evidence of
improvement in glycemic control, but evidence of reduction in frequency
of hypoglycemia.
-
No evidence of
improvement in hypoglycemia, but evidence of improvement in glycemic
control.
-
Evidence suggesting both
that glycemic control can be improved and that frequency of hypoglycemia
can be reduced.
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