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Chapter 28: Diabetes and Cardiovascular Disease

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A 41-year-old woman with a history of atrial fibrillation presents to your office. Which of the following is incorrect?

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A. A normal glycated hemoglobin should be < 6.0%, while a glycated hemoglobin of 6.0% to 6.5% is considered prediabetes

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B. A glycated hemoglobin level of 6.5% or higher on two separate occasions indicates diabetes

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C. Prediabetes can be diagnosed by a fasting plasma glucose of 100 mg/dL or more (impaired fasting glucose), a postglucose load of 140 to 199 mg/dL (impaired glucose tolerance), or both

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D. Diabetes can be diagnosed by a fasting plasma glucose > 126 mg/dL or a 2-hour postprandial glucose of > 200 mg/dL during an oral glucose tolerance test involving a glucose solution containing the equivalent of 75 grams of glucose dissolved in water

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E. Diabetes can be diagnosed in the patient who has a random plasma glucose of > 200 mg/dL with classic symptoms of hyperglycemia

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The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 28) The universally recognized criteria for the diagnosis of prediabetes and diabetes are as follows: (1) a normal glycated hemoglobin should be < 5.7%, (2) a glycated hemoglobin of 5.7% to 6.4% is considered prediabetes, and (3) a level of 6.5% or higher on two separate occasions indicates diabetes (option B).1 Prediabetes can be diagnosed by a fasting plasma glucose of 100 mg/dL or more (impaired fasting glucose), a postglucose load of 140 to 199 mg/dL (impaired glucose tolerance), or both (option C). Other recognized criteria include a fasting plasma glucose > 126 mg/dL or a 2-hour postprandial glucose of > 200 mg/dL during an oral glucose tolerance test involving a glucose solution containing the equivalent of 75 grams of glucose dissolved in water (option D). Diabetes can also be diagnosed in the patient who has a random plasma glucose of > 200 mg/dL with classic symptoms of hyperglycemia (option E).

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An obese 17-year-old woman now present with her second pregnancy. Which of the following is incorrect?

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A. Patients who are overweight or obese with a body mass index (BMI) of > 25 kg/m2 or in the case of Asian Americans of 23 kg/m2 or higher should be screened for diabetes

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B. Children and adolescents who are overweight or obese should be screened for diabetes

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C. With regard to gestational diabetes, patients with risk factors should be tested in the first prenatal visit. At 28 weeks’ of gestation, pregnant women who are not previously known to have diabetes should be tested for gestational diabetes

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D. Women with a history of gestational diabetes are considered to have prediabetes and should receive lifestyle interventions for the prevention of diabetes

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E. All are correct

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