Diabetes Type 2 Diabetes 5 — Questions and Answers
Question 1: Which surgical procedure has been shown to induce remission of type 2 diabetes in obese patients by reducing caloric absorption and altering gut hormones?
- Laparoscopic adjustable gastric banding
- Roux-en-Y gastric bypass (Correct answer)
- Sleeve gastrectomy only
- Liposuction
Correct answer: Roux-en-Y gastric bypass
Roux-en-Y gastric bypass achieves the highest rates of type 2 diabetes remission, partly through altered GLP-1 and gut hormone secretion independent of weight loss alone.
Question 2: Which class of drug used in type 2 diabetes works by inhibiting the enzyme that breaks down incretin hormones?
- GLP-1 receptor agonists
- DPP-4 inhibitors (Correct answer)
- SGLT-2 inhibitors
- Alpha-glucosidase inhibitors
Correct answer: DPP-4 inhibitors
DPP-4 inhibitors (gliptins) block dipeptidyl peptidase-4, the enzyme that degrades GLP-1 and GIP, thereby prolonging incretin action and enhancing insulin secretion.
Question 3: A patient with type 2 diabetes reports seeing halos around lights and blurred vision. Which screening test should be performed annually to monitor this complication?
- Tonometry for intraocular pressure
- Dilated funduscopic eye examination (Correct answer)
- Visual field perimetry
- Corneal topography
Correct answer: Dilated funduscopic eye examination
Annual dilated fundus examination by an ophthalmologist is the standard screening for diabetic retinopathy to detect early vascular changes before vision loss occurs.
Question 4: Which hormonal imbalance is central to the pathophysiology of type 2 diabetes in the liver?
- Excess insulin causing fatty liver
- Insulin resistance leading to unregulated hepatic glucose production (Correct answer)
- Glucagon deficiency reducing glycogenolysis
- Cortisol excess suppressing gluconeogenesis
Correct answer: Insulin resistance leading to unregulated hepatic glucose production
In type 2 diabetes, hepatic insulin resistance allows glucagon to drive uncontrolled gluconeogenesis and glycogenolysis, contributing to elevated fasting blood glucose.
Question 5: Which physical activity recommendation is consistent with ADA guidelines for adults with type 2 diabetes?
- Only yoga and stretching are safe
- At least 150 minutes of moderate-intensity aerobic activity per week (Correct answer)
- Exercise should be avoided to prevent hypoglycemia
- 10 minutes of vigorous activity per month is sufficient
Correct answer: At least 150 minutes of moderate-intensity aerobic activity per week
The ADA recommends at least 150 minutes per week of moderate-intensity aerobic activity, distributed over at least 3 days, to improve insulin sensitivity and glycemic control.
Question 6: Which finding on a monofilament test of the foot indicates loss of protective sensation in a diabetic patient?
- Pain felt at all 10 test sites
- Inability to feel the 10-g monofilament at one or more sites (Correct answer)
- Increased sensitivity to pressure
- Normal vibratory sense only
Correct answer: Inability to feel the 10-g monofilament at one or more sites
Failure to detect a 10-gram Semmes-Weinstein monofilament at any test site indicates loss of protective sensation and high risk for diabetic foot ulceration.
Question 7: A patient with type 2 diabetes and established atherosclerotic cardiovascular disease needs a second agent after metformin. Which drug class is preferred per ADA guidelines?
- Sulfonylureas
- Thiazolidinediones
- GLP-1 receptor agonists or SGLT-2 inhibitors with proven CV benefit (Correct answer)
- DPP-4 inhibitors
Correct answer: GLP-1 receptor agonists or SGLT-2 inhibitors with proven CV benefit
For patients with established ASCVD, ADA guidelines prioritize GLP-1 agonists or SGLT-2 inhibitors with demonstrated cardiovascular mortality benefit regardless of HbA1c.
Diabetes Type 2 Diabetes 5
Which surgical procedure has been shown to induce remission of type 2 diabetes in obese patients by reducing caloric absorption and altering gut hormones?