Diabetes

Question 1

Which anti-glycemic agents are most likely to be associated with weight reduction in patients with T2DM?
a. TZDs
b. GLP-1 agonists
c. Insulin
d. Meglinitides

Answer 1

b. GLP-1

Amylin mimetics and biguinides (metformin) are also associated with weight loss.

DPP-4 inhibitors are weight neutral.

Most others associated with weight gain.

Question 2

Which rapid-acting insulin analogue has been shown to be the most compatible for insulin pump use?
a. insulin lispro
b. insulin aspart
c. insulin glargine
d. insulin glulisine

Answer 2

b. insulin aspart

Aspart has demonstrated the greatest chemical and physical stability in the insulin pump (good up to 3 days) with the lowest rate of overall occlusion.

Glargine is long-acting and not for pumps

Question 3

Measurement of glucose patterns in patients with T2DM often reveals that the highest pre-prandial glucose level of the day is before breakfast.
a. True
b. False

Answer 3

a. True

Thought to be caused by disordered hepatic glucose production overnight. Thus, one goal of therapy might be to have a value of 100 mg/dL before going to sleep at night. Basal insulin is the easiest way to correct morning fasting hyperglycemia.

Question 4

Guidelines from the ACP recommends that an A1c of less than 7% is appropriate for most patients with T2DM.
a. True
b. False

Answer 4

b. False

Lower value increases risk for hypoglycemic episodes and injury from low glycemia, but reduces long-term microvascular complications.

Goals should be tailored to the patient’s preferences, risk for complications from diabetes, comorbidity, and life expectancy.

7% or less is not typically considered safe or desirable for elderly patients.

Question 5

Intensive glucose lowering with advanced type 2 diabetes is a high risk of cardiovascular disease is highly recommended to reduce mortality by most professional organizational guidelines.
a. True
b. False

Answer 5

a. True

T2DM is a strong, independent risk factor for cardiovascular disease and death.

Reducing A1c to normal A1c does not result in significantly lower number of major cardiovascular events after 5 years than does an approach that uses similar methods to reduce to 7-7.9%.

Intensive approach led to more deaths - why we target 7% not 5.5%