Test Your Knowledge

A recent Cochrane Review found which one of the following to be true about the effects of cannabis-based medicines on neuropathic pain?

A. All cannabis-based medicines (herbal, plant-derived, synthetic) pooled together were more effective than placebo for pain relief.
B. Herbal cannabis medicines were more effective than placebo for pain relief.
C. There was a high level of evidence that cannabis-based medicines were more effective than placebo for pain relief.
D. All of the above are true.
E. None of the above is true.

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From 2002 to 2016, US deaths from chronic kidney disease (CKD) increased by how much?

A. 20%
B. 32%
C. 38%
D. 38%
E. 58%

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Based on a meta-analysis of cardiovascular outcomes in type 2 diabetes studies, the findings suggest that a 15% relative risk reduction in nonfatal myocardial infarcts is associated with an A1c reduction of approximately:

A. .50%
B. 1.0%
C. 1.5%
D. 2.0%

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Which is more efficacious in improving glucose levels in individuals with type 2 diabetes -- morning, afternoon, or evening exercise? Or does it matter? Follow the link to see.

According to a recent study, which of the following is true among patients with type 2 diabetes (T2DM) and recent acute coronary syndrome (ACS)?

A. The risk for major adverse cardiovascular events (MACE) significantly increased with systolic blood pressure (SBP) less than 130 mm Hg.
B. The risk for MACE significantly increased with diastolic BP (DBP) less than or equal to 80 mm Hg.
C. The risk for MACE significantly decreased with SBP less than 130 mm Hg.
D. The risk for MACE significantly decreased with DBP less than or equal to 80 mm Hg.
E. A&B
F. C&D

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Which of the following commonly prescribed drugs to treat type 2 diabetes carries a high risk of cardiovascular events, including heart attack, stroke, heart failure, or amputation, according to a recent study?

- Basal insulin
- Biguanides
- Meglitinide derivatives
- Alpha-glucosidase inhibitors
- Glucagon-like peptide–1 (GLP-1) agonists
- Dipeptidyl peptidase IV (DPP-4) Inhibitors
- Selective sodium-glucose transporter-2 (SGLT-2) inhibitors

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When is the HbA1c not reliable?

A. Recent blood transfusion
B. Renal failure
C. Medication use (e.g. aspirin)
D. G6PD deficiency
E. All of the above

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John S. is a 63-year-old Caucasian man with significant abdominal obesity, type 2 diabetes, hypertension, and dyslipidemia as well. On the basis of an exercise stress test, John was recently diagnosed with silent ischemia. John’s current medications include metformin, a DPP-4 inhibitor, an ACE inhibitor/HCTZ agent, a calcium channel blocker, a high-dose statin, and ezetimibe. John’s relevant physical exam and laboratory findings are as follows:

BMI 34.8 kg/m2
Blood pressure 140/86 mm Hg
HbA1C 7.2%
Total cholesterol 150 mg/dL
LDL-C 79 mg/dL
HDL-C 42 mg/dL
Triglycerides 145 mg/dL
non-HDL-C 118 mg/dL
eGFR 65 mL/min/1.73 m2
ACR 100 mg albumin/g creatinine

You explain John’s options for antihyperglycemic therapy. Which of the following answers most accurately describes the extraglycemic benefits of the different options?

A. The GLP-1 receptor agonists may improve endothelial function and reduce infarct size and the SGLT2 inhibitors are likely to improve arterial blood flow.
B. The DPP-4 inhibitors are not safe for people with cardiovascular disease, while the proven cardiovascular benefits of GLP-1 receptor agonists are consistent across the class.
C. DPP-4 inhibitors and SGLT2 inhibitors both reduce blood pressure, which accounts for their similar effects on heart failure.
D. The cardiovascular benefits of both the GLP-1 receptor agonists and SGLT2 inhibitors derive mainly from their effects on weight.

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Can you guess which article published this year was the most popular of all?

Which of the following ADA statements about recommended treatment algorithms for type 2 diabetes is true?

A. The ADA algorithm includes a specific hierarchy of recommended therapies while the AACE algorithm does not.
B. The ADA’s algorithm specifies agents to be considered for cardiovascular risk reduction.
C. Both AACE and the ADA stratify the choice of initial therapy according to baseline HbA1C less than 7.5% or greater than/equal to 7.5%.
D. The risk-benefit profiles of antihyperglycemic classes are not reflected in the AACE or ADA algorithm.

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