CDCES cheat sheet

Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, causing absolute insulin deficiency; islet autoantibodies include GAD65, IA-2, ZnT8, and insulin.

Type 2 diabetes involves insulin resistance plus progressive beta-cell dysfunction, producing relative insulin deficiency; it accounts for about 90%–95% of diagnosed diabetes in U.S. adults.

Diagnostic thresholds: A1C ≥6.5%, fasting plasma glucose ≥126 mg/dL, 2-hour plasma glucose ≥200 mg/dL during a 75-g OGTT, or random glucose ≥200 mg/dL with classic symptoms.

Prediabetes ranges: A1C 5.7%–6.4%, fasting plasma glucose 100–125 mg/dL, or 2-hour OGTT glucose 140–199 mg/dL.

The Diabetes Prevention Program found intensive lifestyle intervention reduced progression from impaired glucose tolerance to type 2 diabetes by 58%, versus 31% with metformin.

Gestational diabetes is glucose intolerance first recognized during pregnancy; it raises later maternal type 2 diabetes risk and is typically screened for at 24–28 weeks.

MODY is monogenic, autosomal dominant diabetes often diagnosed before age 25; common forms involve GCK or HNF1A and are not autoimmune.

LADA is slowly progressive autoimmune diabetes in adults; patients are initially non-insulin-requiring and often have islet autoantibodies.

Risk of microvascular complications rises with glycemic exposure, diabetes duration, hypertension, and dyslipidemia.

A1C goal is <7% for most nonpregnant adults; less stringent goals (e.g., <8%) suit limited life expectancy, severe hypoglycemia risk, or advanced complications.

Preprandial capillary glucose target is 80–130 mg/dL; peak postprandial glucose target is <180 mg/dL, measured 1–2 hours after the start of a meal.

Metformin is first-line pharmacotherapy for type 2 diabetes unless contraindicated; it is contraindicated at eGFR <30 mL/min/1.73 m².

SGLT2 inhibitors with proven benefit reduce heart failure hospitalization and CKD progression; GLP-1 receptor agonists with proven benefit reduce major adverse cardiovascular events.

Insulin and sulfonylureas carry the highest hypoglycemia risk; metformin, DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists have low intrinsic hypoglycemia risk.

Rapid-acting insulin analogs (lispro, aspart, glulisine) begin in 5–15 minutes, peak near 1 hour, and last 3–5 hours; regular insulin begins in about 30 minutes.

GLP-1 receptor agonists are contraindicated with a personal or family history of medullary thyroid carcinoma or MEN2; common effects include nausea, vomiting, and weight loss.

SGLT2 inhibitors cause glycosuria and can cause genital mycotic infections, volume depletion, and euglycemic diabetic ketoacidosis.

A1C reflects roughly 3 months of mean glycemia but is unreliable with hemoglobin variants, anemia, recent transfusion, or advanced kidney disease.

Medical nutrition therapy can lower A1C by approximately 0.3%–1.0% in type 2 diabetes and is most effective when delivered by a registered dietitian nutritionist.

One carbohydrate choice equals 15 g of carbohydrate; mealtime insulin dosing can use an individualized insulin-to-carbohydrate ratio.

Adults with diabetes are advised to consume at least 14 g of fiber per 1,000 kcal, commonly about 25–30 g/day.

Weight loss of 5%–7% of body weight improves glycemia and reduces progression to type 2 diabetes; loss of ≥10% can produce greater metabolic benefit.

Recommended physical activity is at least 150 minutes/week of moderate-intensity aerobic activity plus 2–3 sessions/week of resistance training.

Aerobic activity can lower blood glucose during and for up to 24 hours after exercise, increasing hypoglycemia risk in people using insulin or sulfonylureas.

Prolonged sedentary time should be interrupted every 30 minutes with light activity such as standing or walking.

Very-low-calorie diets can induce type 2 diabetes remission in some adults within 12 months, but remission rates vary and require long-term follow-up.

Alcohol can inhibit hepatic gluconeogenesis and cause delayed hypoglycemia, especially in insulin-treated patients.

DSMES is recommended at four critical times: at diagnosis, annually or when targets are not met, when complicating factors develop, and during transitions in care.

DSMES can reduce A1C by up to 0.6%–1.0% and improves diabetes knowledge, self-care behaviors, and quality of life.

The ADCES7 Self-Care Behaviors are healthy coping, healthy eating, being active, taking medication, monitoring, reducing risks, and problem solving.

Diabetes distress affects roughly 20%–40% of adults with diabetes and is distinct from major depression, though the two commonly co-occur.

The PHQ-9 screens for depressive symptoms; the Diabetes Distress Scale (DDS) or PAID measures diabetes-specific emotional distress.

Motivational interviewing is collaborative and autonomy-supportive; core skills include open questions, affirmations, reflections, and summaries (OARS).

The transtheoretical model stages are precontemplation, contemplation, preparation, action, maintenance, and possible relapse.

Teach-back confirms understanding by asking patients to explain information in their own words; it is a health-literacy strategy.

Food insecurity, medication cost, housing instability, and transportation barriers are social determinants that directly affect diabetes self-management.

A1C is checked at least every 3 months when not at goal and at least every 6 months when at goal.

CGM targets: time in range 70–180 mg/dL >70%, time below 70 mg/dL <4%, time below 54 mg/dL <1%, time above 180 mg/dL <25%, and time above 250 mg/dL <5%.

Glucose management indicator (GMI, %) = 3.31 + 0.02392 × mean glucose in mg/dL.

Albuminuria is defined as urine albumin-to-creatinine ratio ≥30 mg/g; adults with diabetes should be screened annually with UACR and eGFR.

Retinopathy screening begins within 5 years of type 1 diagnosis and at type 2 diagnosis, then annually or every 1–2 years if no retinopathy.

Annual comprehensive foot exam includes 10-g monofilament testing, vibration or pinprick sensation, pulses, and visual inspection for ulcers or deformity.

Hypoglycemia treatment: 15 g fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat until glucose is >70 mg/dL; use glucagon for severe hypoglycemia.

DKA criteria include glucose >250 mg/dL, arterial pH <7.3, bicarbonate <18 mEq/L, anion gap, and ketonemia or ketonuria; HHS has glucose >600 mg/dL and osmolality >320 mOsm/kg with minimal ketones.

Pregnancy targets in diabetes: A1C <6% if achievable without hypoglycemia, fasting <95 mg/dL, 1-hour postprandial <140 mg/dL, and 2-hour postprandial <120 mg/dL.