Our August 4th Question quizzed test takers on CV Disease risk management and diabetes. Although 49% of respondents chose the correct answer, 51% did not. We thought that this was an important topic to discuss further, so we can pass on correct info to people living with diabetes.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question
Question: RJ is 67 years old with a 40+ year history of type 1 diabetes. GFR is 62, UACR is < 30, A1c is 6.7%, B/P is 132/72, LDL cholesterol is 98, RJs BMI is 28.6. RJ uses multiple daily injections and CGM to manage RJs diabetes.
RJ’s other medications include: Levothyroxine 100mcg daily, atorvastatin 40mg daily, Aspirin 81 mg daily and a multivitamin.
Based on your assessment, which of the following interventions would improve RJs outcome?
Answer Choices:
- Add an ACE Inhibitor.
- Lifestyle intervention.
- Suggest addition of an ARB.
- Increase atorvastatin dose.
As shown above, the most common choice was option 2, the second most common answer was option 3, then option 2, and finally option 4.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers will ask about the guidelines for specific ADA Standards of Care. This question is pulled from section 10 of the Standards on CV Disease and Risk Management. To purchase your own ADA Standards, visit our store.
Download our FREE Lipid and Hypertension Cheat Sheets – great resource and invaluable test study tool too!
Answer 1 is incorrect. 23% chose this answer. “Add an ACE Inhibitor.”
Many people chose this juicy answer. It is true that in the past, people with type 1 would be automatically started on an ACE Inhibitor because it was thought starting an ACE would offer renal protection. However, based on extensive research, the American Diabetes Association stopped recommending adding an ACE for people with type 1 without the diagnosis of hypertension a few years back.
The current blood pressure goal for people with diabetes is
140/90.
If a person with type 1 diabetes has hypertension, defined as either systolic
greater than 140 or diastolic more than 80, repeated on 2 different occasions, initiate
blood pressure therapy.
- If the person has albuminuria (UACR 30 or greater), then start them on either an ACE or and ARB.
- If the person has UACR less than 30, choose from any of the 4 classes or anti-hypertensive medications.
Lower blood pressure goal of 130/80? It is recommended to do a cardiovascular risk assessment using the CV Risk Calculator on all people with diabetes. If the 10 year risk of having a CV event is greater than 15%, the blood pressure goal is 130/80 may be appropriate, if it can be safely attained. The choice of blood pressure therapy is further refined by presence or absence of microalbuminuria.
We don’t have enough information to calculate his CV Risk, so based on the information we have, adding an ACE Inhibitor is not indicated at this time. And of course, since we only have one blood pressure, we need to collect more data before taking action.
Answer 2 is correct. 49% of you chose this answer. “Lifestyle intervention.”
This is the best answer. Looking at this profile, we can see that RJ’s BMI is above 25 and LDL is slightly elevated. Let’s refer RJ to a Registered Dietitian. By coaching RJ on healthy food choices, increased whole foods and fiber, and taking a look at animal protein consumption, there is an opportunity to improve not only RJs blood pressure but also RJs LDL cholesterol. In addition, we can evaluate RJs activity level and encourage 150 mins a week of activity plus strengthening that would contribute to his overall health.
Answer 3 is incorrect. About 17% of you chose this answer. “Suggest addition of an ARB.” See rationale under answer 1.
Finally, Answer 4 is incorrect. 10% of you chose this answer. “Increase atorvastatin dose.” Currently, RJ is on high intensity statin therapy with RJs atorvastatin dose of 40mg. He does not present with any concerning CV risk factors or events that would kick RJ into high risk category. We could calculate RJs 10 year risk of CV disease and if it is more than 20% or if RJ doesn’t response to lifestyle changes, we could consider a further increase in the statin dosing. Based on the info we have at this moment, this is not the BEST answer (but it is a consideration : -).
Download our FREE Lipid and Hypertension Cheat Sheets – great resource and invaluable test study tool too!
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Cardiovascular Disease & Diabetes Standards 2020
Watch for Free or 1.5 CEs | $29.00
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
[yikes-mailchimp form=”1″]
![](/wp-content/uploads/2023/01/insta-png-v5.png")
