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Test Your Knowledge

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

Question #840

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More stringent hyperglycemia management (target A1C 6-6.5%) in type 2 diabetes might be supported by which one of the following factors: A. Long-standing disease duration B. Moderate-severe vascular complications C. Shorter life expectancy D. Absent-few comorbidities Are you right? Follow the link to find out!

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Question #839

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During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes were assigned to the intensive treatment arm (received a sulfonylurea or insulin, or metformin if overweight) or a conventional treatment arm (dietary interventions only). In the intensive treatment arm, which one of the following benefits became apparent only when a 10-year follow-up study was conducted? A. Reduced risk of microvascular complications B. Clinically lower overall BMI C. Reduced risk of myocardial infarction D. Lower overall mean A1C Did you get it right? Follow the link to find out!

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Question #837

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The list below indicates the ethnicities of the patients whose cases you have just reviewed over the past month. Please choose the correct order showing the relative risk of developing diabetes for each ethnicity in adults 20 years and older. Select one answer: [A] Non-Hispanic blacks, Hispanic, non-Hispanic whites, Asian American [B] Hispanic, Non-Hispanic blacks, non-Hispanic whites, Asian American [C] Non-Hispanic blacks, Hispanic, Asian American, non-Hispanic whites [D] Hispanic , Non-Hispanic blacks, Asian American, non-Hispanic whites Are you right? Follow the link to respond!

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Question #836

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(Continued from Question #835) Mr. Fontello is an overweight, Caucasian 63-year-old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started on nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG<130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%. A rapid-acting insulin analogue was added to his largest meal of the day. Labs taken last year show Mr. Fontello had a serum creatinine 1.2mg/dL with an eGFR 61mL/min. Today, his serum creatinine is 1.6 mg/dL and his eGFR is 44 mL/min. Because guidelines indicate when a patient’s eGFR falls below 60mL/min, dose reduction of medications should be considered, you decide to adjust Mr. Fontello’s medication. In type 2 diabetes, which one of the following medications does not need to be considered for dose reduction? Select one answer: A. Glyburide B. Metformin C. Insulin D. Pioglitazone E. Exenatide Are you right? Follow the link to find out!

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Question 835

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Mr. Fontello is an overweight, Caucasian 63-year old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG below 130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%. What changes would you recommend for his antihyperglycemic regimen? Select one answer: [A] Add a premixed insulin to all three meals of the day [B] Increase his detemir dose [C] Add a sulfonylurea to his regimen [D] Add a rapid-acting insulin analogue to his largest meal of the day Are you right? Follow the link to find out!

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Question #834

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Mrs. Wilson is an overweight 71-year old African American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to.6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is below 7.5% and she has been working hard to get to that level. However, for the first time her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. After discussing her situation with her, you decide to modify Mrs. Wilson’s antihyperglycemic regimen. Which of the following treatment options would you choose? [A] metformin + long-acting analogue + rapid-acting analogue [B] metformin + glyburide + long-acting insulin analogue + rapid-acting analogue [C] metformin + glyburide + NPH + rapid-acting analogue [D] metformin + NPH + rapid-acting analogue Follow the link to see if you're correct!

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Question #833

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Mrs. Wilson is an overweight 71-year-old African-American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to .6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is below 7.5% and she has been working hard to get to that level. However, for the first time in her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. Her office A1C is 8.6%. Based on her history, what would be an acceptable individualized A1C goal for this patient? A. A1C less than 6.5% B. A1C less than 7.0% C. A1C less than 8.0% D. A1C greater than 8.0% Are you right? Follow the link to find out!

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Question #832

Test Your Knowledge

Mrs. Wilson is an overweight 71-year old African American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to.6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is <7.5% and she has been working hard to get to that level. However, for the first time her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. Her office A1C is 8.6%. Based on what you know about the patient, what is the most likely cause of her morning distress? Select one answer: [A] Hyperglycemia [B] Hypoglycemia [C] Anxiety [D] Cognitive Have you got it right? Follow the link to find out!

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Question 831

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Mr. Huang achieves good glycemic control with his lifestyle modifications, metformin and linagliptin and returns every 6 months for follow-up visits. Three years after initiating this treatment plan, he returns to your clinic for his 6-month check-up. When asked how his diabetes management is going at home, he shares that recently he has been “unable to really get out and get as much exercise as he knows he should due to his creaky, old knees acting up.” His current office A1C is 8.8%. You discuss with him what the next management steps may be to achieve his individualized glycemic goal. A long-acting insulin analogue was added to his treatment. What is the best advice you can give Mr. Huang regarding exercise? A. He really needs to find a way to perform 150 min/week of moderate-intensity aerobic exercise. B. At his age, exercise doesn’t make a significant difference any more. C. He should do his best to be active and get as close to 150 min/week as he can. D. He should be as physically active as possible and introduce resistance training at least 2 times per week to his routine. Do you have the right answer? Follow the link to find out!

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April 23, 2016

Test Your Knowledge

Mr. Huang achieves good glycemic control with his lifestyle modifications, metformin and linaglipitin, and returns every 6 months for follow-up visits. Three years after initiating this treatment plan, he returns to your clinic for his 6-month check-up. When asked how his diabetes management is going at home, he shares that recently he has been “unable to really get out and get as much exercise as he know he should due to his creaky, old knees acting up.” His current office A1C is 8.8%. You discuss with him what the next management steps may be to achieve his individualized glycemic goal. What would your next medical management step be? Select one answer: A. Add a rapid-acting insulin analogue B. Add a long-acting insulin analogue C. Add a GLP-1 agonist D. Add a sulfonylurea Are you right? Follow the link to find out!

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