Diabetes, Obesity and Lipid metabolism Questions

A 36-year-old African Amerian man with no significant past medical history presents with a 3-week history of polyuria, polydipsia and 20-pound weight loss. His BMI is 22. He has a family history of Graves disease in his mother and celiac disease in a younger sister. He had no evidence of ketoacidosis at presentation and there were no skin tags or acanthosis nigricans.

The patient’s A1C was 9 during his brief period of hospitalization. He was discharged home on metformin and glipizide. In addition, the patient started therapeutic lifestyle interventions. Metformin and glipizide were both uptitrated to their maximal doses. His A1C improved to 8.5% during his three-month clinic visit. He reports feeling much better. What diagnosis should his primary care provider consider?

A 22-year-old woman with a history of PCOS is diagnosed with Gestational diabetes mellitus at 25weeks gestation. Which of these statements regarding the management of GDM is inaccurate?

Which of these is not a clinical marker of insulin resistance?

Which of these medications does not have a direct drug-to-drug interaction with orlistat, a weight loss medication?

A patient with insulin resistance requiring U-500 insulin is admitted to the medicine service. You are consulted for management of hyperglycemia due to the patient’s history of significant insulin resistance. What will be your recommendation?

A couple with T1DM is concerned about the risk of T1DM in their unborn child. What will you tell these expectant parents?

What is the first deficit in the evolution of Type 2 diabetes mellitus?

A patient is started on an antipsychotic agent and develops significant weight gain and newly diagnosed dysglycemia. Which of these medications is a preferred antipsychotic agent with an acceptable metabolic profile?

34-year-old Hispanic woman with class III obesity was admitted to the medicine service due to diabetic ketoacidosis in a newly diagnosed diabetic. Her insulin requirements declined significantly, necessitating discontinuation of insulin a few weeks after discharge from the hospital. She is currently well controlled on metformin 500mg BID with an A1C of 6.4%. Her family history is strong for T2DM (mother, two maternal aunts, and a younger sister). Patient has acanthosis nigricans and multiple skin tags. What is the next step in management

Which of these medications should be avoided in a patient with type 2 diabetes mellitus and an estimated GFR < 60?

A 45-year-old woman with a 3-decade history of T1DM. She has noticed a progressively enlarging tumor in her preferred insulin injection site. She has been admitted on two occasions within the past month for diabetic ketoacidosis. You notice a hard nodular mass in the subcutaneous tissue of the anterolateral abdomen. You inform the patient of the rarity of this clinical finding even in patients with a long-standing history of T1DM. What is the most likely diagnosis?

A primary care provider refers a 36-year-old African American man with a hemoglobinopathy (SC genotype) and poorly controlled T1DM to your practice for optimization of glycemic control. He has obstructive hepatopathy as a consequence of long-standing diabetes. His serum albumin is 1.8. Patient has stage IV chronic kidney disease and is being scheduled for placement of an arterio-venous fistula in the near future. Which of these options is the best way to assess glycemic control in this patient?

Which of these is not a goal of optimal glycemic management of cystic fibrosis-related diabetes (CFRD).

A 54-year-old female with T2DM complicated CKD stage IIIA is referred to a nephrologist. Which of these is an indication for renal biopsy in the setting of presumed diabetic nephropathy?

Which of these drugs or combination of drugs has both antiproteinuric effects and a demonstrable preservation of glomerular filtration rate?

A 42-year-old man with morbid obesity, status post Roux-en-Y gastric bypass, who presented to the emergency room after an unresponsive hypoglycemic event. He had a positive Whipple’s triad. What is the most likely diagnosis based on the results of his biochemical tests obtained after a 72hour fast?

A 54-year-old woman with uncontrolled T2DM complicated by nephropathy. She has a consistent blood pressure > 160/90mmHg and is currently on a maximally tolerated dose of lisinopril. What would you recommend next to control her blood pressure?

36-year-old female with PCOS is diagnosed with non-alcoholic fatty liver disease (NAFLD). What is the most important cause of death in NAFLD?

A 32-year-old Female Gravida 2 para 1, with a history of PCOS, presents at 16weeks gestation. She had diet controlled gestational diabetes during her first pregnancy, which resolved post delivery. What should be done next?

67-year-old female with a history of T2DM complicated by retinopathy and neuropathy, was brought to the ED by EMS after a hypoglycemic event. Her chronic anti-hyperglycemic regimen includes metformin, glipizide, and linagliptin. She has an estimated GFR of 50 to 55 (Serum creatinine 1.6 to 1.7) over the preceding two years. The patient was recently started on trimethoprim-sulfamethoxazole for a skin infection. She was found unresponsive in her living room. Her blood glucose was 30mg/dl. The patient recovered after two ampoules of 50% Dextrose and an intramuscular injection of glucagon. What is the most likely explanation for this patient’s hypoglycemic event?

A 30-year-old with class III obesity and PCOS is referred to the endocrine clinic for further management of severe insulin resistance. She is currently on 70 units of Levemir insulin twice a day, Novolog insulin 60units with each meal 3 times a day and SQ liraglutide 1.8mg daily. Her current glycated hemoglobin is 8.4%. You plan on switching her from U-100 insulin to Humulin R U-500 insulin. What is the best approach in this clinical setting?

A 54-year-old man with type 2 diabetes mellitus, hypertension, dyslipidemia, and heart failure. His estimated GFR is 50, normal liver function tests and glycated hemoglobin of 11. His fasting blood glucose readings range from 80mg/dl to 100mg/dl with average daily glucose of 185 mg/dl. He has a remote history of splenectomy due to a blunt abdominal injury and recurrent acute pancreatitis. He is currently on a maximally tolerated dose of metformin. His primary care provider is considering an additional agent to metformin due to his uncontrolled glycohemoglobin. Which of these management options is the next best step?

A 28-year-old woman with class I obesity is motivated to lose weight. She has started an exercise and diet program. Despite adherence to these therapeutic lifestyle interventions, she has been unable to lose 5% of her weight. Her current medications include an oral contraceptive and a daily “health supplement”.  The patient is diagnosed with subclinical hypothyroidism due to a TSH of 7 and a normal free T4. Her TPO antibody status is negative. What is the most likely reason for her difficulty in losing weight?

A 48-year-old woman with a 6-year history of type 2 diabetes
mellitus is referred for a second opinion regarding her
unexplained high hemoglobin A1c level. She has been treated
with basal plus mealtime insulin for 3 years. She performs selfmonitoring
of blood glucose 6 to 8 times daily, with values
ranging between 75 and 120 mg/dL (4.2-6.7 mmol/L) before
meals and between 110 and 130 mg/dL (6.1-7.2 mmol/L) 2
hours after meals. She reports rare hypoglycemic episodes.

Her review of systems is notable for recent fatigue and
lightheadedness. Her medications include aspirin and ramipril.
For years, her hemoglobin A1c level has been in the range of
6.5% to 6.9% (48-52 mmol/mol), but 4 months ago it was 7.8%
(62 mmol/mol) and a recent value was 8.5% (69 mmol/mol).

Laboratory test results:
• Hemoglobin = 8.9 g/dL (12.1-15.1 g/dL)
(SI: 89 g/L [121-151 g/L])
• Serum creatinine = 0.8 mg/dL (0.6-1.1 mg/dL)
(SI: 70.7 μmol/L [53.0-97.2 μmol/L])
• Liver function, normal
• TSH, normal
• Urine albumin-to-creatinine ratio = 205 mg/g creat (<30 mg/g creat)

Which of the following is the most likely
cause of her high hemoglobin A1c?

A 31-year-old man with a 16-year history of type 1 diabetes
mellitus complicated by nephropathy and retinopathy is referred
for help achieving better glycemic control. His regimen consists
of insulin degludec, 18 units at bedtime, and insulin lispro with
meals using an insulin-to-carbohydrate ratio of 1:12. He
performs self-monitoring of blood glucose 4 times daily, with
values ranging between 200 and 300 mg/dL (11.1-16.7 mmol/L).
His hemoglobin A1c level has been between 8.5% and 10.0%
(69-86 mmol/mol). His medications include lisinopril,
rosuvastatin, and biotin.

Laboratory test results:
• Hemoglobin A1c = 9.0% (4.0%-5.6%)
(75 mmol/mol [20-38 mmol/mol])
• Serum creatinine = 2.2 mg/dL (0.7-1.3 mg/dL)
(SI: 194.5 μmol/L [61.9-114.9 μmol/L])
• Urine albumin-to-creatinine ratio = 3886 mg/g creat (<30 mg/g creat)
• Liver function, normal
• TSH = 7.5 mIU/L (0.5-5.0 mIU/L)
• Serum fructosamine = 210 μmol/L (200-285 μmol/L)

The discrepancy between this patient’s
hemoglobin A1c and fructosamine levels
is most likely caused by which of the
following?

A 42-year-old man with a 22-year history of type 1 diabetes
mellitus is seeing you for a follow-up visit. He has had poor
glycemic control over the past few years while on insulin pump
therapy. He is reluctant to increase his pump settings because of
the potential for weight gain. He has tried metformin and
pramlintide in the past, but he could not tolerate the
gastrointestinal adverse effects. His hemoglobin A1c value is
now 7.8% (62 mmol/mol), and his BMI is 27 kg/m2.

His basic metabolic panel, liver function, and TSH level are
normal. You suggest off-label use of empagliflozin to lower his
hemoglobin A1c and reduce his weight. He asks about potential
adverse effects.

You tell him that empagliflozin could increase his risk of which of the following?

A 32-year-old woman with type 1 diabetes mellitus is 6 weeks’
pregnant. Her most recent hemoglobin A1c value is 6.9% (52
mmol/mol). She is taking insulin detemir, 8 units in the morning
and 12 units in the evening, in addition to prandial doses of insulin
aspart based on an insulin-to-carbohydrate ratio of 1:10 and a
sensitivity (or correction) factor of 1:40. Her overnight (3 AM) and
fasting blood glucose levels range between 110 and 122 mg/dL
(6.1-6.8 mmol/L), and her peak (1-hour) postprandial glucose
levels range between 112 and 129 mg/dL (6.2-7.2 mmol/L).

Which of the following should you
recommend during this pregnancy?

A 35-year-old man has a 15-year history of type 1 diabetes
mellitus complicated by nonproliferative diabetic retinopathy. He is
concerned about renal complications of diabetes. His most recent
hemoglobin A1c level is 7.8% (62 mmol/mol) on insulin glargine
and mealtime insulin aspart.
Two separate measurements of his urine albumin-to-creatinine
ratio are 20 and 12 mg/g creat. His estimated glomerular filtration
rate is 82 mL/min per 1.73 m2 (>60 mL/min per 1.73 m2).
On physical examination, his blood pressure is 128/72 mm Hg
and BMI is 24 kg/m2.

Which of the following is the most effective
approach to reduce future risk of clinically
significant diabetic nephropathy in this
patient?

A 19-year-old man presents for continued management of
diabetes mellitus, having “aged-out” of pediatric endocrine care.
Diabetes was diagnosed at age 16 years when glycosuria and
moderate hyperglycemia were documented on a yearly checkup.
Insulin therapy was started immediately. His current insulin dose
is approximately 0.3 units/kg per day, administered as multiple
daily injections, and his current hemoglobin A1c level is 6.4% (46
mmol/mol) with occasional hypoglycemia. His family history is
positive for diabetes in his mother, maternal grandfather, and an
older sibling, all diagnosed at age 19 years or younger. His BMI
is 23 kg/m2.

Tests for glutamic acid decarboxylase antibodies, islet-cell
antibodies, insulinoma-associated protein 2 antibodies, and
ZnT8 antibodies are negative; he did not have antibody testing
at the time of diagnosis. His serum C-peptide concentration is
1.1 ng/mL (0.4 nmol/L).

Which of the following is the optimal
management of this patient’s diabetes

Which of the following is true regarding the risk of cardiovascular disease (CVD) in patients with diabetes?

What is the leading cause of death in patients with type 1 diabetes?

What is the age at which transition to high cardiovascular risk occurs in men and women with diabetes?

Which of the following is true regarding the effects of diabetes on bone?

In patients with type 1 diabetes, which of the following is associated with an increased risk of fractures?

What is the relationship between bone mineral density (BMD) and fracture risk in patients with diabetes?

Which of the following is NOT a potential factor contributing to increased bone fragility in diabetes?

What is the effect of diabetes on bone health?

Which of the following factors is known to be a risk factor for fractures in patients with diabetes?

What is the effect of thiazolidinediones on bone health in patients with diabetes?

What is the role of bone mineral density (BMD) in assessing fracture risk in patients with diabetes?

What should be the first step in the management of bone health in patients with diabetes?

What are the typical microbiological spectrum of diabetic foot infections?

What is the role of anaerobes in diabetic foot infections?

A 65-year-old patient with diabetes presents with a foot ulcer. Which of the following clinical findings increases the likelihood of osteomyelitis in this patient?

Which imaging modality is highly sensitive and specific for osteomyelitis and superior to radiographs, three-phase bone scans, and white blood cell scans?

Which of the following is NOT sufficient to make the diagnosis of infection in a diabetic foot wound?

Which of the following inflammatory markers can be useful for monitoring response to therapy in diabetic foot infections?

Which of the following is the preferred method for removing callus and nonviable tissue in diabetic foot infections?

In the management of diabetic foot infections, the purpose of wound dressing is to:

Which of the following is NOT a reason for hospitalization in patients with mild or moderate diabetic foot infections?

Which type of clinical specimens is preferred for reliable culture in the case of diabetic foot infections?

In the setting of osteomyelitis, which is the preferred method of sample collection for culture?

A patient with a mild diabetic foot infection should initially receive outpatient oral antimicrobial therapy targeting which microorganisms?

In the case of moderate diabetic foot infection, which microorganisms should empiric therapy cover?

Severe diabetic foot infections require which type of antibiotic therapy?

In cases of diabetic foot osteomyelitis, what is the ideal source for culture and sensitivity results to guide antimicrobial therapy?

Which adjunctive therapy has been shown to achieve complete ulcer closure more often in patients with diabetic foot ulcers?

Which of the following is NOT a gastrointestinal manifestation of diabetic autonomic neuropathy (DAN)?

What is the primary treatment for diabetic gastroparesis?

What percentage of females with type 1 diabetes reported urinary incontinence at the 10-year follow-up time point after completion of the Diabetes Control and Complications Trial (DCCT)?

What is the first-line therapy for erectile dysfunction in patients with diabetes?

When should screening for diabetic autonomic neuropathy (DAN) begin for patients with type 2 diabetes?

What is the primary cause of diabetic gastroparesis?

How does acute hyperglycemia affect gastric emptying?

What is the primary diagnostic tool for establishing the presence of gastroparesis?

Which of the following is NOT a primary treatment for diabetic gastroparesis?

A 65-year-old patient with a history of long-term diabetes presents with chronic diarrhea. Which of the following factors is NOT a potential underlying mechanism for diabetic diarrhea?

In patients with diabetic enteropathy, the diarrhea is usually characterized by:

Which of the following medications used in patients with diabetes mellitus can cause diarrhea?

Which of the following conditions is NOT part of the differential diagnosis for diabetic enteropathy?

What is an appropriate symptomatic treatment for diabetic diarrhea?

Which of the following autoantibodies is not associated with Type 1A diabetes?

What is the primary characteristic of Latent Autoimmune Diabetes in Adults (LADA)?

Which of the following is a common genetic feature shared between LADA and Type 2 diabetes?

What is the primary cause of Type 1B diabetes?

Which of the following situations can lead to diabetic ketoacidosis (DKA) in patients with Type 2 diabetes?

A 38-year-old patient presents with unintentional weight loss, subtherapeutic response to metformin, and no history of overweight or obesity. Which of the following tests should be considered to clarify the diagnosis?

Which of the following factors is NOT a criterion for considering antibody testing in adult patients with newly diagnosed diabetes?

Which of the following diabetes-associated autoantibodies should NOT be measured for diagnostic purposes if the patient has received insulin therapy for ≥2 weeks?

Which of the following conditions is considered a slowly progressive variant of type 1 diabetes?

Which genetic polymorphisms have the largest effect on the risk of developing type 1A diabetes?

What is the most common form of monogenic diabetes, accounting for 2 to 5 percent of diabetes cases?

Which gene mutation is most commonly identified in MODY cases, occurring in 52 to 65 percent of cases?

In patients with a GCK gene mutation, what is the primary treatment for their diabetes?

Which gene mutation is associated with a syndrome that includes early-onset diabetes, pancreatic atrophy, abnormal renal development, hypomagnesemia, and genital abnormalities?

Which of the following characteristics might indicate a high suspicion of monogenic diabetes?

What is the recommended treatment for patients with monogenic diabetes due to HNF1A or HNF4A mutations?

Which of the following is a characteristic of maternally inherited diabetes and deafness (MIDD)?

Wolfram syndrome is associated with which of the following manifestations?

Fulminant diabetes is characterized by which of the following?

A 45-year-old male patient presents with a history of chronic pancreatitis. Which of the following statements regarding glucose intolerance and diabetes in this patient is most accurate?

Which disease shares features with both type 1 and type 2 diabetes and involves decreased insulin production and insulin resistance?

Which endocrine abnormality is NOT typically associated with overt diabetes but can interfere with glucose metabolism?

Which of the following viral infections has been associated with an increased incidence of diabetes, but it is uncertain if there is a cause-and-effect relationship?

A 42-year-old female patient presents with increased thirst, frequent urination, and blurry vision. A random blood glucose test shows a value of 210 mg/dL (11.7 mmol/L). What is the most likely diagnosis for this patient?

According to the American Diabetes Association (ADA) criteria, what fasting plasma glucose (FPG) range is considered to indicate impaired fasting glucose (IFG)?

A 28-year-old pregnant woman undergoes a 75 g oral glucose tolerance test (OGTT). Her two-hour plasma glucose value is 195 mg/dL (10.8 mmol/L). What is the most likely diagnosis for this patient?

In the diagnostic criteria for diabetes, which of the following A1C values is considered to be diagnostic for diabetes mellitus?

A 45-year-old male with a family history of type 2 diabetes comes to your clinic for a routine checkup. He reports being asymptomatic. You decide to run some tests. Which diagnostic test would be most convenient for diagnosing diabetes in this patient?

Which of the following is NOT a criterion to diagnose diabetes in an asymptomatic individual?

In which scenario would the diagnosis of diabetes mellitus be easily established?

Which of the following is NOT a goal of medical nutritional therapy for gestational diabetes mellitus (GDM)?

What percentage of patients with GDM can achieve target glucose levels with lifestyle modification alone?

What is the minimum recommended daily carbohydrate intake for all pregnant people according to Dietary Reference Intakes (DRI)?

Which of the following dietary interventions has NOT been shown to improve glycemic control in GDM?

Which type of snack is recommended at bedtime for patients with GDM to prevent accelerated ketosis overnight?

What is the recommended duration of moderate-intensity aerobic activity for adults with diabetes?

When should patients with gestational diabetes mellitus (GDM) self-monitor their blood glucose levels?

What are the American Diabetes Association (ADA) and American College of Obstetricians and Gynecologists (ACOG) recommended upper limits for fasting and postprandial blood glucose concentrations in patients with GDM?

What is the primary benefit of exercise that increases muscle mass for patients with diabetes?

A pregnant patient with GDM has a majority of postprandial hyperglycemia and fetal abdominal circumference >75th percentile. What is the most appropriate initial insulin regimen for this patient?

In patients with GDM, when should pharmacotherapy be initiated?

Which of the following oral antihyperglycemic agents has been shown to reduce the risk for macrosomia in randomized trials, compared to insulin?

A pregnant patient with gestational diabetes mellitus (GDM) requires insulin therapy. Which rapid-acting insulin analogs have been investigated in pregnancy and demonstrated acceptable safety profiles, minimal transfer across the placenta, and no evidence of teratogenesis?

Which long-acting insulin analog is preferred for use in pregnancy due to more extensive studies and the ability to be dosed twice per day predictably?

When compared with glyburide, metformin has been associated with:

Both metformin and glyburide cross the placenta. What are the fetal levels for metformin and glyburide compared to maternal levels?

What is the classification system for ketosis-prone diabetes (KPD) that is shown to be the most accurate in predicting long-term insulin dependence 12 months after the index diabetic ketoacidosis (DKA) event?

Which ketosis-prone diabetes (KPD) subgroup is characterized by the presence of autoantibodies and preserved beta cell function?

Which factor is NOT considered a potential cause of partially reversible beta cell dysfunction in A-ß+ KPD patients?

What is the term used for a heterogeneous condition characterized by presentation with diabetic ketoacidosis (DKA) in patients who do not fit the typical characteristics of autoimmune type 1 diabetes?

Which ketosis-prone diabetes (KPD) subgroup is characterized by the absence of autoantibodies and preserved beta cell function?

A patient presents with ketosis-prone diabetes (KPD) and diabetic ketoacidosis (DKA). What should be the initial treatment for this patient?

Which test is most commonly used to assess beta cell secretory reserve in ketosis-prone diabetes patients?

Which of the following autoantibodies is NOT commonly measured to assess beta cell autoimmunity in ketosis-prone diabetes?

Which of the following KPD subgroups has the highest chance of discontinuing insulin after 12 months of treatment?

Which type of diabetes is caused by autoimmune β-cell destruction?

Which type of diabetes is diagnosed in the second or third trimester of pregnancy?

What are the hallmark symptoms of type 1 diabetes in children?

What does LADA stand for?

Which type of diabetes is typically associated with insulin resistance and metabolic syndrome?

Which of the following is NOT a general category of diabetes?

Which diagnostic test requires no caloric intake for at least 8 hours before testing?

What is the A1C diagnostic threshold for diabetes?

What does LADA stand for?

Which diagnostic test for diabetes should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay?

Which test should be performed to diagnose diabetes in a patient with classic symptoms of hyperglycemia?

What is the A1C diagnostic threshold for diabetes?

In which conditions should only plasma blood glucose criteria be used to diagnose diabetes?

Which factor may cause African American individuals to have lower A1C levels for a given level of mean glycemia?

How many grams of carbohydrates should a person consume daily for at least 3 days prior to oral glucose tolerance testing?

At what age should screening for prediabetes and type 2 diabetes begin for all people?

Which of the following tests is NOT appropriate for screening for prediabetes and type 2 diabetes?

What is the minimum recommended interval for repeat screening if the initial tests for prediabetes and type 2 diabetes are normal?

What is the recommended carbohydrate intake before an oral glucose tolerance test for diabetes screening?

When should risk-based screening for prediabetes and/or type 2 diabetes be considered in children and adolescents with overweight or obesity?

What is the definition of prediabetes?

At what age should screening for diabetes begin for all people?

How often should people with prediabetes be tested for diabetes?

What is the ADA Diabetes Risk Test used for?

Which condition is associated with insulin resistance and could be a risk factor for prediabetes?

What percentage of all diabetes cases is represented by Type 2 diabetes?

Which of the following factors increases the risk of developing type 2 diabetes?

What is a common characteristic of people with type 2 diabetes concerning insulin levels?

Which of the following is least likely to occur spontaneously in individuals with type 2 diabetes?

Which racial/ethnic subgroups have a higher prevalence of type 2 diabetes?

At what age should testing for diabetes begin for all people?