BCACP Ambulatory Diabetes Management 4 — Questions and Answers
Question 1: A patient with T2DM is taking saxagliptin and develops lower extremity edema and shortness of breath. Which adverse effect of saxagliptin is most likely responsible?
- Nephrotoxicity from saxagliptin
- Increased risk of heart failure hospitalization (Correct answer)
- Peripheral neuropathy exacerbation
- Drug-induced lupus
Correct answer: Increased risk of heart failure hospitalization
The SAVOR-TIMI trial showed saxagliptin was associated with a significantly increased risk of heart failure hospitalization, an FDA-labeled warning.
Question 2: What is the recommended A1C target for most non-pregnant adults with diabetes according to ADA Standards of Care?
- Less than 6.0%
- Less than 6.5%
- Less than 7.0% (Correct answer)
- Less than 8.0%
Correct answer: Less than 7.0%
ADA recommends an A1C target of <7.0% for most non-pregnant adults with diabetes to reduce microvascular complications.
Question 3: Which insulin type has the longest duration of action and is typically dosed once or twice daily as basal insulin?
- Insulin lispro
- Insulin NPH
- Insulin degludec (Correct answer)
- Regular insulin
Correct answer: Insulin degludec
Insulin degludec (Tresiba) has an ultra-long duration of action (>42 hours), making it suitable for once-daily basal dosing with a flat peakless profile.
Question 4: A patient asks about the difference between continuous glucose monitoring (CGM) and traditional fingerstick glucose testing. Which statement is accurate?
- CGM measures venous plasma glucose directly
- CGM measures interstitial fluid glucose, which lags behind blood glucose by 5-15 minutes (Correct answer)
- CGM is equally accurate as fingerstick during rapid glucose changes
- CGM eliminates the need for any fingerstick confirmations
Correct answer: CGM measures interstitial fluid glucose, which lags behind blood glucose by 5-15 minutes
CGM sensors measure interstitial fluid glucose, which lags behind blood glucose by approximately 5-15 minutes, particularly during rapid changes.
Question 5: A patient with poorly controlled T2DM (A1C 10.5%) develops blurred vision. What is the most likely cause and recommended next step?
- Medication side effect; switch to a different agent
- Osmotic swelling of the lens due to hyperglycemia; optimize glucose control and refer to ophthalmology (Correct answer)
- Diabetic macular edema requiring immediate laser treatment
- Hypoglycemia-induced visual changes; increase caloric intake
Correct answer: Osmotic swelling of the lens due to hyperglycemia; optimize glucose control and refer to ophthalmology
Acute blurred vision in poorly controlled diabetes is often due to osmotic changes in the lens from hyperglycemia; improving glycemic control and ophthalmology referral is appropriate.
Question 6: When counseling a patient on self-monitoring of blood glucose (SMBG), which monitoring schedule is most appropriate for a stable T2DM patient on basal insulin only?
- Check glucose before every meal and at bedtime (4 times daily)
- Check fasting glucose daily and 2-hour postprandial weekly
- Check fasting glucose daily to guide basal insulin titration (Correct answer)
- No routine SMBG needed if on basal insulin alone
Correct answer: Check fasting glucose daily to guide basal insulin titration
For patients on basal insulin, fasting glucose monitoring is the most clinically useful data point for titrating the basal dose using treat-to-target algorithms.
Question 7: Which medication used in T2DM requires monitoring of liver function tests due to risk of hepatotoxicity and fluid retention?
- Metformin
- Sitagliptin
- Pioglitazone (Correct answer)
- Canagliflozin
Correct answer: Pioglitazone
Thiazolidinediones like pioglitazone can cause fluid retention and weight gain; while hepatotoxicity was a major concern with troglitazone (withdrawn), LFT monitoring and awareness of edema risk remain relevant.
BCACP Ambulatory Diabetes Management 4
A patient with T2DM is taking saxagliptin and develops lower extremity edema and shortness of breath.
Which adverse effect of saxagliptin is most likely responsible?