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Test Your Knowledge

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

Screening for Type 2 Part 2

Mrs. O’Doole is a 34 year-old of Irish descent. She works as a florist who and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP, 15 years prior, due to irregular menses. Based upon her medical history and physical, you believe it would be prudent to screen Mrs. O’Doole for type 2 diabetes. You discuss your recommendations with her and she agrees to be tested. The lab returns a fasting plasma glucose (FBG) of 112 mg/dL. You share these results with your patient and inform her, that while only mildly elevated, she has impaired fasting glucose. What is the best choice for initial management of Mrs. O’Doole’s prediabetes? A. Metformin B. Metformin+ Pioglitazone C. Lifestyle modifications + Pioglitazone D. Lifestyle modifications (dietary modifications, weight loss and exercise) Follow the link for the answer.

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Screening for Type 2

Mrs. O’Doole is a 34-year-old of Irish descent. She works as a florist and is married with three children. She arrives at your clinic for her annual wellness exam. Her blood pressure is 130/84 mmHg, pulse 65, BMI 24 kg/m2 and her physical exam is notable for acne and mild hirsutism. Her only current medication is oral birth control pills. She recalls starting OCP 15 years prior, due to irregular menses. What clinical diagnosis would suggest screening Mrs. Hernandez for type 2 diabetes? A. Thyroid dysfunction B. Cushing syndrome C. Polycystic ovary syndrome D. Premature ovarian failure Follow the link for the answer.

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Screening for Type 2

A patient that you haven’t seen for several years comes to your clinic for a wellness check-up. Since her last visit, she has gained about 15 pounds (5’6”, BMI 27 kg/m2). Her stage 1 hypertension is controlled with hydrochlorothiazide. As you discuss her weight gain, you learn that she doesn’t get more than 30 minutes a week of physical activity. You decide it would be best to check her A1C. Which of the following information from her history leads you to screen her for type 2 diabetes? A. Her youngest child weighed 8.5 pounds at birth. B. Two of her cousins have type 2 diabetes. C. She just celebrated her 41st birthday. D. She has a history of hypertension. Follow the link for the answer.

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Exercise Intervention

You are reviewing lifestyle modifications with a 42-year-old, relatively sedentary patient who has been newly diagnosed with prediabetes. Your screening for any cardiovascular risk factors was negative, so she has agreed to a 3-month trial of dietary modifications and increased physical activity. Structured exercise interventions and modest weight loss have been shown to lower the risk of developing type 2 diabetes in high-risk populations by an average of: A. 22% B. 35% C. 58% D. 70% Follow the link for the answer.

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Reducing Heart Risk

According to a recent study, which one of the following diabetes therapies carries a lower risk for adverse cardiovascular (CV) events? 1. Nonspecific, long-acting sulfonylureas (eg, glyburide and glimepiride) 2. Specific, short-acting sulfonylureas (eg, glipizide, tolbutamide) 3. CV risk does not differ between these agents Follow the link for the answer.

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AACE Algorithm

The suggested hierarchy of usage (AACE Algorithm) for a patient on metformin who has not reached goal according to the new 2018 AACE goal in 3 months is: A. GLP-1RA, SGLT-2i, TZD, Basal Insulin, DPP4i B. SGLT-2i, GLP-1RA, TZD. DPP4i, Basal Insulin C. GLP-IRA, DPP4i, GLP-1RA, Bromocriptine QR D. SGLT-2i, TZD, GLP-1RA, Colesevelem E. SGLT-21, GLP-1RA, Basal Insulin, Colesevelem Follow the link for the answer.

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Avoiding Heart Risk

A 68-year-old male presents to your office for a follow-up visit. His past medical history is significant for a myocardial infarction (five years ago) and he has type 2 diabetes. His current medications include an ACE inhibitor, a statin, aspirin, and metformin. Despite good compliance with his medications and beneficial lifestyle changes, he is not able to achieve his individualized target A1C of 7.5-8%. You decide it would be beneficial to add a second antihyperglycemic agent. Which of the following medications should be avoided due to CVD risk? A.Pioglitazone B. Exenatide C. Rosiglitazone D. Sitaglipitin E. None of the above Follow the link for the answer.

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Adding Basal Insulin Analogue Detemir

A 59-year-old patient who was diagnosed with type 2 diabetes five years ago presents to your clinic for an appointment. He has a history of hypertension and dyslipidemia, both currently well-controlled with medication. He has been taking metformin and a DPP-4 inhibitor. He tells you he is concerned about a sore on his foot that is taking a long time to heal. At today’s visit, his office A1C is 8.8%. After discussing his options, you decide to add basal insulin analogue detemir to his regimen. Compared to insulin NPH, what would you expect him to experience while taking detemir? A. Less weight gain B. More hypoglycemia C. More weight gain D. No weight gain or hypoglycemia difference Follow the link for the answer.

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Exercise Benefits

A 39-year-old, overweight (BMI 27 kg/m2) patient comes into your office for his annual wellness examination. Routine labs show random plasma glucose of 176 mg/dL, so you ask him to return for a fasting plasma glucose and A1C. The results show a FPG 139 mg/dL and A1C of 7.7%. He is resistant to the idea of starting medication and is very keen on pursuing a trial period of dietary modifications and an exercise program, especially after you tell him about the benefits of moderate exercise on diabetes. Which of the following statements about exercise is true? A. Exercise reduces basal insulin levels only when paired with proper diet B. Exercise can lead to weight loss, but rarely reduces A1C levels C. Exercise can reduce all-cause mortality by up to 38% D. Exercise must be rigorous and regular to lead to greatest reduction in mortality Follow the link for the answer.

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Insulin Therapy Barriers

A 51-year-old patient returns to your office for a follow-up visit. She is currently taking metformin and glipizide after being diagnosed with type 2 diabetes 8 years ago. She shows you her self-care logs that indicate she has been eating a healthy diet and walking daily. She has been maintaining her weight (BMI 26kg/m2). Despite her excellent efforts, her A1C is 7.8%, above her target of A1C<7.0%. When you start to discuss adding a basal insulin dose to her regimen, she bursts into tears. All of the following are common barriers to insulin therapy initiations EXCEPT: A. Fear that hyperglycemia will make her ill. B. Fear others will treat her differently because she needs regular injections. C. Fear of needles or that insulin injections are painful. D. Fear that insulin causes death or complications. Follow the link to see the answer.

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