CDE Complications 4 — Questions and Answers
Question 1: A patient with type 2 diabetes and CKD stage 3 (eGFR 45) requires glucose-lowering therapy. Which medication requires dose adjustment or caution at this eGFR?
- Linagliptin
- Metformin (Correct answer)
- Sitagliptin only
- Insulin glargine
Correct answer: Metformin
Metformin is contraindicated when eGFR falls below 30 and should be used with caution between 30–45 mL/min/1.73m² due to risk of lactic acidosis.
Question 2: What is the primary goal of off-loading in the treatment of a plantar diabetic foot ulcer?
- Improve blood glucose control directly
- Reduce mechanical pressure on the wound to promote healing (Correct answer)
- Prevent osteomyelitis spread
- Enhance antibiotic delivery to the wound
Correct answer: Reduce mechanical pressure on the wound to promote healing
Off-loading removes mechanical pressure from the ulcer site, which is essential for healing neuropathic plantar ulcers.
Question 3: Which finding best distinguishes proliferative diabetic retinopathy from severe nonproliferative retinopathy?
- Presence of microaneurysms
- Hard exudates in the macula
- New vessel formation (neovascularization) (Correct answer)
- Cotton wool spots
Correct answer: New vessel formation (neovascularization)
Proliferative diabetic retinopathy is defined by neovascularization — new, fragile blood vessels that grow on the retina or optic disc.
Question 4: A diabetic patient develops nephrotic-range proteinuria (>3.5 g/day). Which condition has likely developed?
- Microalbuminuria
- Early diabetic nephropathy
- Advanced diabetic nephropathy (overt nephropathy) (Correct answer)
- Urinary tract infection
Correct answer: Advanced diabetic nephropathy (overt nephropathy)
Nephrotic-range proteinuria indicates advanced (overt) diabetic nephropathy with significant glomerular damage and high risk of end-stage renal disease.
Question 5: Which cardiovascular risk factor is MOST strongly associated with accelerated atherosclerosis in patients with diabetes?
- Isolated elevated LDL
- Hypertriglyceridemia alone
- The combination of hypertension, dyslipidemia, and hyperglycemia (Correct answer)
- Low HDL alone
Correct answer: The combination of hypertension, dyslipidemia, and hyperglycemia
The clustering of hypertension, dyslipidemia, and hyperglycemia in diabetes synergistically accelerates atherosclerosis and cardiovascular disease.
Question 6: A patient with diabetic peripheral neuropathy reports severe burning pain in the feet. Which medication class is FDA-approved specifically for diabetic peripheral neuropathic pain?
- NSAIDs
- Opioids as first-line therapy
- Duloxetine (SNRI) and pregabalin (Correct answer)
- Metformin
Correct answer: Duloxetine (SNRI) and pregabalin
Duloxetine and pregabalin are FDA-approved first-line treatments for painful diabetic peripheral neuropathy.
Question 7: Which statement about diabetic macular edema (DME) is accurate?
- DME only occurs in proliferative retinopathy
- DME is the leading cause of vision loss in people with diabetes (Correct answer)
- DME cannot be treated and always leads to blindness
- DME only affects peripheral vision
Correct answer: DME is the leading cause of vision loss in people with diabetes
Diabetic macular edema is the most common cause of vision loss in people with diabetes and can occur at any stage of retinopathy.
CDE Complications 4
A patient with type 2 diabetes and CKD stage 3 (eGFR 45) requires glucose-lowering therapy.
Which medication requires dose adjustment or caution at this eGFR?