BCACP Ambulatory Diabetes Management 5 — Questions and Answers
Question 1: A patient with T2DM, obesity (BMI 38), and A1C of 8.5% asks about weight-loss options. Which diabetes medication has the most robust evidence for weight loss and A1C reduction?
- Glimepiride
- Insulin glargine
- Semaglutide (Ozempic/Wegovy) (Correct answer)
- Sitagliptin
Correct answer: Semaglutide (Ozempic/Wegovy)
Semaglutide has demonstrated the greatest weight loss among diabetes medications, with trials showing up to 15% body weight reduction along with significant A1C lowering.
Question 2: Which of the following best describes the rationale for using a fixed-ratio combination of basal insulin and a GLP-1 receptor agonist (e.g., iGlarLixi)?
- It reduces the number of injections and mitigates GLP-1-related nausea while limiting insulin-induced weight gain (Correct answer)
- It provides both basal and bolus insulin coverage in one injection
- It eliminates the need for oral diabetes medications
- It is specifically indicated for type 1 diabetes management
Correct answer: It reduces the number of injections and mitigates GLP-1-related nausea while limiting insulin-induced weight gain
Fixed-ratio co-formulations like iGlarLixi combine the glycemic benefits of both agents, reduce injection burden, and the GLP-1 component helps offset insulin-related weight gain and nausea.
Question 3: A patient on metformin and glipizide has an A1C of 7.9% and a BMI of 32. She has no cardiovascular or renal disease. Which agent is most appropriate to add for further A1C lowering while promoting weight loss?
- Insulin NPH
- Pioglitazone
- Exenatide (Byetta) (Correct answer)
- Glyburide
Correct answer: Exenatide (Byetta)
A GLP-1 receptor agonist like exenatide is appropriate to add for patients needing further A1C reduction and weight loss in the absence of CVD or CKD indications.
Question 4: What is the time-in-range (TIR) goal recommended by the ADA for adults with diabetes using CGM?
- >50% of time between 70-180 mg/dL
- >70% of time between 70-180 mg/dL (Correct answer)
- >80% of time between 80-200 mg/dL
- >60% of time between 70-140 mg/dL
Correct answer: >70% of time between 70-180 mg/dL
The ADA recommends a TIR goal of >70% (more than 16.8 hours/day) within the range of 70-180 mg/dL for most adults with diabetes.
Question 5: A patient newly diagnosed with T2DM asks whether he can reverse his diabetes through lifestyle changes. What is the most accurate pharmacist response?
- T2DM is permanent and cannot be reversed under any circumstances
- Intensive lifestyle intervention can lead to remission (A1C <6.5% without medications) in some patients, especially early after diagnosis (Correct answer)
- Only bariatric surgery can achieve T2DM remission
- Remission requires achieving a normal BMI and is not possible above BMI 25
Correct answer: Intensive lifestyle intervention can lead to remission (A1C <6.5% without medications) in some patients, especially early after diagnosis
Evidence from studies like the DiRECT trial shows intensive lifestyle intervention with significant weight loss can lead to T2DM remission, particularly when achieved early in the disease course.
Question 6: When should an ambulatory care pharmacist recommend a glucagon emergency kit for a patient with diabetes?
- Only for patients on insulin who live alone
- For any patient on insulin or sulfonylureas who is at significant risk for severe hypoglycemia (Correct answer)
- Only when A1C is above 9% indicating poor control
- Exclusively for patients with hypoglycemia unawareness syndrome
Correct answer: For any patient on insulin or sulfonylureas who is at significant risk for severe hypoglycemia
Glucagon emergency kits should be prescribed to patients on insulin or insulin secretagogues (sulfonylureas, meglitinides) who are at risk for severe hypoglycemia, and caregivers should be trained on its use.
Question 7: A patient with T2DM and diabetic peripheral neuropathy reports burning and tingling in his feet. Which medication is considered a first-line option for diabetic peripheral neuropathic pain?
- Opioid analgesics
- NSAIDs
- Duloxetine or pregabalin (Correct answer)
- Aspirin
Correct answer: Duloxetine or pregabalin
Duloxetine (an SNRI) and pregabalin (a calcium channel alpha-2-delta ligand) are FDA-approved first-line treatments for diabetic peripheral neuropathic pain.
BCACP Ambulatory Diabetes Management 5
A patient with T2DM, obesity (BMI 38), and A1C of 8.5% asks about weight-loss options.
Which diabetes medication has the most robust evidence for weight loss and A1C reduction?