BCACP Ambulatory Diabetes Management 3 — Questions and Answers
Question 1: A 68-year-old patient with T2DM, HFrEF, and eGFR 55 mL/min/1.73m² is on metformin. Which add-on therapy has evidence for both glycemic control and reduction in heart failure hospitalization?
- Sitagliptin
- Glipizide
- Empagliflozin (Correct answer)
- Liraglutide
Correct answer: Empagliflozin
SGLT2 inhibitors like empagliflozin have demonstrated significant reduction in heart failure hospitalization and are preferred in T2DM patients with HFrEF per ADA guidelines.
Question 2: Which sulfonylurea is considered lowest risk for hypoglycemia due to its short duration of action and lack of active metabolites?
- Glyburide
- Glimepiride
- Glipizide (Correct answer)
- Chlorpropamide
Correct answer: Glipizide
Glipizide has a short duration of action and no active metabolites, making it the preferred sulfonylurea especially in the elderly and those at risk for hypoglycemia.
Question 3: A patient is starting on a basal-bolus insulin regimen. What is the appropriate starting total daily dose (TDD) for an insulin-naive patient using weight-based dosing?
- 0.1 units/kg/day
- 0.2-0.3 units/kg/day
- 0.5-0.6 units/kg/day (Correct answer)
- 1.0-1.2 units/kg/day
Correct answer: 0.5-0.6 units/kg/day
A common starting TDD for basal-bolus insulin in insulin-naive patients is 0.4-0.6 units/kg/day, with half given as basal and half divided as bolus doses.
Question 4: Which DPP-4 inhibitor requires dose adjustment in renal impairment and has the most documented clinical experience?
- Linagliptin
- Sitagliptin (Correct answer)
- Alogliptin
- Saxagliptin
Correct answer: Sitagliptin
Sitagliptin was the first DPP-4 inhibitor approved and requires dose reduction in moderate to severe renal impairment; linagliptin is the only DPP-4i that does NOT require renal dose adjustment.
Question 5: A pharmacist reviews a patient's CGM data showing high fasting glucose values. The patient is on basal insulin 20 units at bedtime. What is the best titration strategy?
- Increase bedtime dose by 10% every 3 days until fasting goal is reached
- Add a bolus insulin dose before breakfast
- Increase basal dose by 2 units every 3 days if fasting glucose consistently >130 mg/dL (Correct answer)
- Switch to a premixed insulin formulation
Correct answer: Increase basal dose by 2 units every 3 days if fasting glucose consistently >130 mg/dL
The treat-to-target approach for basal insulin titration typically involves increasing the dose by 2 units every 3 days when fasting glucose remains above the target threshold.
Question 6: Which of the following is a contraindication to the use of a GLP-1 receptor agonist?
- Obesity with BMI >35
- Personal or family history of medullary thyroid carcinoma (Correct answer)
- Chronic kidney disease stage 3
- History of hypoglycemia on sulfonylureas
Correct answer: Personal or family history of medullary thyroid carcinoma
GLP-1 receptor agonists are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or MEN type 2 due to thyroid C-cell tumor risk seen in animal studies.
Question 7: A patient with T2DM has persistent microalbuminuria (UACR 120 mg/g) despite optimized blood pressure control. Which drug class should be added or ensured is part of the regimen?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs have proven nephroprotective effects in diabetes and are first-line agents for reducing diabetic nephropathy progression in patients with microalbuminuria.
BCACP Ambulatory Diabetes Management 3
A 68-year-old patient with T2DM, HFrEF, and eGFR 55 mL/min/1.73m² is on metformin.
Which add-on therapy has evidence for both glycemic control and reduction in heart failure hospitalization?