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Test Your Knowledge

Take a quiz and test your knowledge on diabetes and related health concerns.

Test Your Knowledge: Clinical Case Vignette: Smoking and Type 2

You are concerned about Mr. Carlson’s cigarette use because cigarette smoking has been shown to have multiple physiological impacts on health. Which one of the following statements regarding smoking and type 2 diabetes is true? A. It equally affects all-cause mortality in individuals with and without diabetes B. In individuals with diabetes, it causes more rapid progression to micro- and macroalbuminuria C. It has not been linked to worsening glycemic control D. The use of bupropion in contraindicated in diabetes Follow the link to see the answer,

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Clinical Case Vignette: Macronutrients

Mr. Carlson is a man, 52-years of age. He is Caucasian and works as a grocery store manager. His labs show that they were significant for elevated random plasma glucose 166 mg/dL, A1C 7.6% and elevated lipids (TG=175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). His physical exam is notable for central abdominal obesity (waist circumference 42”), BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. He is started on metformin and a dietitian is recommended. The dietitian discusses with him the benefits of medical nutrition therapy on weight, glycemic control, blood pressure, lipid profile, and overall wellbeing. Which following statement regarding macronutrients is true? A. The ratio of carbohydrates, protein and fat is the same for all patients. B. Total calories consumed per day is the key strategy for achieving glycemic control. C. Reduced intake of trans fat lowers the HDL and raises the LDL. D. Saturated fat should be less than 7% of total calories. Follow the link for the answer.

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CLINICAL CASE VIGNETTE: Treating Weight Concerns

After four years of good glycemic control with metformin 1500 mg a day, Mrs. Hunter returns for her 6-month follow-up visit. At this time, her office A1C is 8.2% and she has gained seven pounds. She is very concerned about her weight gain. If weight is a concern, what would be the best antiglycemic drug to add to her regimen? A. A sulfonylurea B. A DPP-4 inhibitor C. A thiazolidinedione D. A GLP-1 receptor agonist Follow the link for the answer.

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BMI for Bariatric Surgery

Mr. Carlson is 52-year old Caucasian grocery store manager you saw last week for a new patient visit. His labs from that visit were significant for elevated random plasma glucose 166 mg/dL, A1C 7.4% and elevated lipids (TG equals 175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). He has returned to your clinic for a follow-up appointment. His physical exam is notable for central abdominal obesity (waist circumference 42”),left eyelid xanthelasma, BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. A repeat A1C test shows A1C 7.6% Mr. Carlson smokes between 1 and 1.5 packs of cigarettes daily. After discussing the labs and your findings with Mr. Carlson, you begin collaborating on a management plan. You write prescriptions for metformin, a statin and ACE inhibitor. Mr. Carlson doesn’t think “taking medication will be too tough” but expresses skepticism about your recommendations for a change in his diet, exercise and smoking programs because he has tried them, without success in the past. What is considered the starting BMI for consideration of bariatric surgery? 1. BMI greater than 28 kg/m2 2. BMI greater than 30 kg/m2 3. BMI greater than 35 kg/m2 4. BMI greater than 37 kg/m2 Follow the link for the answer.

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Clinical Case Vignette Follow-up: Two Steps Back

Mrs. Hunter is 36-year-old African-American who comes to your office for her annual wellness exam. She has excessive weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. You and Mrs. Hunter set a goal for A1C<6.5%. She returns 3 months later for a follow-up visit and her office labs show an A1C 6.8%. You congratulate her on her progress and ask her to return in another 3–4 months. When she does, she is above her goal with an A1C 8.1%. She explains that she has gone back to full-time work and just doesn’t have the time to get to the gym anymore. At this time, what would your next step be and what would her individualized glycemic targets be?

A. Encourage lifestyle modifications and start metformin with a target A1C less than 6.5%
B. Encourage lifestyle modifications and start metformin with a target A1C less than 7.5%
C. Encourage lifestyle modifications and start a 2-drug combination target A1C target less than 7%
D. Encourage lifestyle modifications and do not initiate drug therapy at this time

Follow the link for the answer.

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Clinical Case Vignette: Treatment Next Steps

Mrs. Hunter is a 36-year-old African-American who comes to your office for her annual wellness exam. She has excess weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. This measurement is confirmed several days later. Based on Mrs. Hunter’s profile, what would a reasonable next step be? A. Encourage lifestyle modifications and start metformin with an A1C target of < 7.0%.
B. Encourage lifestyle modifications and start metformin with an A1C target of < 6.0%.
C. Encourage lifestyle modifications and do not initiate drug therapy at this time.
D. Encourage lifestyle modifications and start metformin and a sulfonylurea.
Follow the link for the answer.

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A1C Inaccuracy

In which of the examples can HbA1c be inaccurate? (When presented to 200 medical professionals, 20% got it wrong.) A. Recent blood transfusion B. Renal failure C. G6PD deficiency D. Medication Uwe (e.g. aspirin) E. All of the above Follow the link for the answer.

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Clinical Case Study: Metformin Side Effects

Mr. Hernandez' lab results are A1C 7.5%, FPG 137 mg/dL, LDL 190 mg/dL, HDL 38 mg/DL and triglycerides 232 mg/dL. He is started on metformin, lifestyle modifications, an ACE inhibitor, and a statin. He was asked to return in 3 months' time to evaluate how everything is going. However, he fails to keep his appointment. He returns 1 year after his initial diagnosis for a recurrent yeast infection. His A1C is currently 7.7%. Upon questioning, he admits that while he has been good about taking his “heart meds,” he has not taken the “sugar pill” because he didn’t like it. What side effect did the patient most likely find intolerable? A. Diarrhea and abdominal cramping B. Paresthesias C. Increased appetite D. Insomnia Follow the link for the answer.

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