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Nurse Practitioner:
doi: 10.1097/01.NPR.0000388896.22813.80
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Diagnosing Diabetes with A1C: Implications and considerations for measurement and surrogate markers

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INSTRUCTIONS Diagnosing diabetes with A1C

TEST INSTRUCTIONS

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Diagnosing diabetes with A1C

General Purpose: To provide the NP with information about the diagnosis and management of diabetes and the use of glycemic markers. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Outline the recommendations from selected professional organizations for diagnosing and treating diabetes. 2. Discuss the interpretation of glycemic markers in glycemic control.

1. On average, what proportion of patients achieve glycemic control?

a. 1/4

b. 1/3

c. 1/2

d. 3/4

2. The new ADA recommendations state that diabetes may be diagnosed using

a. a single, fasting A1C.

b. two serial A1C assays.

c. three serial A1C assays.

d. four serial readings with a POC device.

3. The new diagnostic cut point for the diagnosis of diabetes is an A1C of

a. 6.4% or greater.

b. 6.5% or greater.

c. 6.7% or greater.

d. 6.8% or greater.

4. Which one of the following is an AACE and ACE primary goal for diabetes therapy

a. Prescribe only investigational drugs in current clinical trials.

b. Consider all medication options regardless of cost.

c. Design therapies with the primary outcome to lower postprandial glucose levels.

d. Decrease the risk and severity of hypoglycemic episodes.

5. The AACE and ACE recommend guiding therapy based on A1C measurements every

a. 1 to 2 weeks.

b. 4 to 6 weeks.

c. 2 to 3 months.

d. 4 to 6 months.

6. Which population is least likely to be affected by a hemoglobin variant that could interfere with the accuracy of a point of care device?

a. Scandinavian.

b. Asian.

c. African American.

d. Mediterranean.

7. Which statement about glycemic measurements is true?

a. A1C measurements may be skewed if there is altered erythrocyte turnover.

b. The cut point for increased risk for diabetes is an A1C range of 5.4–5.7%.

c. FPG, OGTT, and A1C are used interchangeably for glucose monitoring.

d. POC devices should be ADA-certified.

8. What percentage of A1C is generally from glycemia 60 to 120 days before measurement?

a. 10%

b. 15%

c. 25%

d. 30%

9. The estimated average glucose (eAG) value for a patient with an A1C of 7% is

a. 97 mg/dl.

c. 154 mg/dl.

b. 126 mg/dl.

d. 183 mg/dl.

10. False high readings of A1C may result from

a. blood transfusion.

b. rheumatoid arthritis.

c. splenomegaly.

d. chronic ingestion of salicylates.

11. For pregnant women with type 1 diabetes, a more accurate glycemic test is

a. A1C.

b. fructosamine levels.

c. glycation gap.

d. 1,5 AG assay.

12. A high glycation gap is associated with

a. diabetic nephropathy.

b. splenomegaly.

c. hemolytic anemia.

d. hypertriglyceridemia.

13. High levels of glycated albumin have been strongly related to all except

a. coronary artery disease.

b. microvascular complications.

c. splenomegaly.

d. diabetic nephropathy.

14. Aggressive therapy and reduction of A1C is contraindicated in patients diagnosed with diabetes for at least

a. 6 years.

b. 8 years.

c. 10 years.

d. 12 years.

15. The ARIC study identified which test as more strongly associated with risk of diabetes in at-risk nondiabetic adults?

a. 2-hour OGTT

b. A1C

c. FPG

d. glycation gap

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