BC-ADM cheat sheet

ADA diagnostic thresholds: fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), 2-h OGTT plasma glucose ≥200 mg/dL (11.1 mmol/L), A1C ≥6.5%, or random plasma glucose ≥200 mg/dL with classic hyperglycemia symptoms or hyperglycemic crisis.

In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal results from the same or different samples; a single result in the diagnostic range should be confirmed on a separate day.

Prediabetes ranges: fasting glucose 100-125 mg/dL (impaired fasting glucose), 2-h OGTT 140-199 mg/dL (impaired glucose tolerance), A1C 5.7-6.4%.

A1C reflects mean glycemia over roughly the prior 2-3 months because it depends on the lifespan of erythrocytes; conditions altering red cell turnover (hemolysis, recent transfusion, iron deficiency, pregnancy, hemoglobin variants) reduce its reliability.

Estimated average glucose (eAG) is derived from A1C: eAG (mg/dL) = 28.7 × A1C − 46.7, so A1C 7% corresponds to approximately 154 mg/dL.

Distinguish type 1 from type 2 using islet autoantibodies (GAD65, IA-2, ZnT8, insulin) and C-peptide; low C-peptide with positive autoantibodies supports type 1 diabetes.

Screen for type 2 diabetes in adults with overweight/obesity plus one or more risk factors, and in all adults at age 35 years or older regardless of risk factors.

A1C is not a valid screen for cystic fibrosis-related diabetes; use OGTT. Likewise, OGTT is preferred in pregnancy (one-step 75-g test) rather than A1C.

DSMES is indicated at four critical times: at diagnosis, annually or when not meeting treatment targets, when complicating factors develop, and during transitions in life or care.

DSMES is delivered by ADA-recognized or ADCES-accredited programs and must address the ADCES7 self-care behaviors: healthy coping, healthy eating, being active, taking medication, monitoring, reducing risks, and problem solving.

Structured education improves A1C by roughly 0.5-1.0 percentage points; benefits are greatest when the program includes both education and ongoing support.

Diabetes distress is distinct from major depression and is highly prevalent; screen with validated tools (e.g., PAID, DDS) and refer for targeted intervention rather than assuming nonadherence.

Health literacy and numeracy affect insulin dosing and carbohydrate counting accuracy; teach-back and plain-language materials improve comprehension.

Cultural tailoring, language concordance, and involving family or caregivers improve engagement and outcomes in DSMES.

Medicare and most commercial plans cover DSMES; 10 hours are covered in the first year of initial training and 2 hours annually thereafter for Medicare beneficiaries.

Telehealth and digital DSMES delivery produce outcomes comparable to in-person programs and can improve access in rural or transportation-limited populations.

Metformin is first-line for type 2 diabetes unless contraindicated; hold before iodinated contrast when eGFR is 30-60 mL/min/1.73 m² and do not initiate when eGFR <45; discontinue when eGFR <30.

SGLT2 inhibitors reduce heart failure hospitalization and CKD progression; glucose-lowering benefit diminishes as eGFR falls, but cardiorenal benefit persists.

GLP-1 receptor agonists and dual GIP/GLP-1 agonists produce the greatest weight loss among glucose-lowering agents and reduce major adverse cardiovascular events in patients with established ASCVD.

Basal insulin starting dose is typically 10 units/day or 0.1-0.2 units/kg/day; titrate by 2 units every 3 days until fasting glucose reaches the individualized target.

Fixed-ratio or premixed insulin secretagogues (sulfonylureas, meglitinides) and insulin carry hypoglycemia risk; educate on the Rule of 15 for hypoglycemia: 15 g fast carbohydrate, recheck in 15 minutes.

In type 1 diabetes, basal-bolus or pump therapy is standard; do not delay insulin in adults with type 1 diabetes or in those with catabolic features (weight loss, ketosis, A1C >10%).

Sulfonylureas and insulin should be used cautiously in older adults and those with CKD because of prolonged hypoglycemia; deintensify when A1C falls below the individualized goal.

TZDs (pioglitazone) cause fluid retention and are contraindicated in symptomatic heart failure; DPP-4 inhibitors are weight neutral but should not be combined with GLP-1 receptor agonists.

There is no single ideal macronutrient distribution; a variety of eating patterns (Mediterranean, DASH, plant-based, low-carbohydrate) are acceptable, with individualization based on preferences and metabolic goals.

Carbohydrate counting with an insulin-to-carbohydrate ratio and correction factor supports flexible insulin dosing; average carbohydrate factor is roughly 1 unit per 10-15 g carbohydrate for many adults.

Modest weight loss of 5-7% of body weight improves glycemia and reduces progression from prediabetes to diabetes by approximately 58% with intensive lifestyle intervention.

Adults should perform at least 150 minutes per week of moderate-intensity aerobic activity plus 2-3 sessions per week of resistance training, with no more than 2 consecutive days without activity.

Reduce sedentary time by breaking up sitting every 30 minutes with brief bouts of light activity; this improves postprandial glucose independently of structured exercise.

Weight-loss pharmacotherapy is considered at BMI ≥30 kg/m² or ≥27 kg/m² with comorbidity; metabolic surgery is considered at BMI ≥35 kg/m² regardless of glycemic control in type 2 diabetes.

For people with diabetes and CKD, protein intake of 0.8 g/kg/day is recommended; higher intake does not improve outcomes and may worsen kidney function.

Alcohol can cause delayed hypoglycemia in insulin-treated patients; educate on limiting intake and consuming with food, and screen for disordered eating patterns.

A1C targets are individualized; <7% is appropriate for most nonpregnant adults, <6.5% may be appropriate if achievable without hypoglycemia, and <8% is appropriate for limited life expectancy or high hypoglycemia risk.

CGM metrics: time in range (70-180 mg/dL) goal >70%, time below range <4% (level 1, 54-69 mg/dL) and <1% (level 2, <54 mg/dL), time above range <25% (level 1, 181-250 mg/dL) and <5% (level 2, >250 mg/dL).

Coefficient of variation ≤36% indicates stable glycemia; glucose management indicator (GMI) approximates laboratory A1C from mean glucose.

CGM should be offered to people with type 1 diabetes and to those with type 2 diabetes on insulin; real-time CGM supports dosing decisions and reduces hypoglycemia.

Intermittently scanned CGM requires a scan to display current glucose; real-time CGM pushes alerts and alarms, including predictive low-glucose alerts.

Insulin pump therapy (CSII) is appropriate for people with type 1 diabetes who have frequent hypoglycemia, dawn phenomenon, or high variability; sensor-augmented pumps with low-glucose suspend reduce severe hypoglycemia.

Blood glucose meter accuracy should meet ISO 15197 criteria: 95% of readings within ±15 mg/dL of reference at glucose <100 mg/dL and within ±15% at ≥100 mg/dL.

Automated insulin delivery systems require accurate carbohydrate entry and appropriate total daily dose settings; a common starting basal rate is roughly 50% of total daily insulin divided across 24 hours.

Annual screening for diabetic kidney disease uses urine albumin-to-creatinine ratio and eGFR; ACE inhibitors or ARBs are indicated for albuminuria with hypertension, and SGLT2 inhibitors or finerenone slow progression.

Diabetic retinopathy screening begins at diagnosis for type 2 diabetes and within 5 years of diagnosis for type 1, then annually; pregnancy may accelerate retinopathy.

Comprehensive foot examination annually assesses pulses, protective sensation (10-g monofilament), and skin integrity; patients with loss of protective sensation need protective footwear and daily inspection.

Cardiovascular risk reduction includes blood pressure target <130/80 mmHg, statin therapy for most adults with diabetes aged 40-75, and consideration of aspirin for secondary prevention.

Neuropathy screening includes distal symmetric polyneuropathy assessment and autonomic testing; symptomatic treatment options include duloxetine, pregabalin, and gabapentin.

Depression, anxiety, and diabetes distress are common comorbidities; screen at diagnosis and periodically, and refer for behavioral health care when identified.

Macrovascular risk is reduced by smoking cessation, statin therapy, and agents with proven cardiovascular benefit (SGLT2 inhibitors, GLP-1 receptor agonists) in patients with established ASCVD.

Diabetic ketoacidosis management includes isotonic fluid resuscitation, insulin infusion, and potassium replacement; total body potassium is depleted even when serum potassium is normal or high.