Diabetes Treatment Quiz

April 16, 2019

Seasons change, but diabetes remains an intriguing year-round challenge. Here's a short quiz on diabetes treatment from Dr. Edward Chao.

Seasons change, but diabetes remains an intriguing year-round challenge. Here's a short quiz on diabetes treatment from Dr. Edward C. Chao, D.O.

1. Which of the following best describes what to do when you note hypoglycemia?

A) Immediately consume a candy bar.
B) Test glucose, then consume 15 g of carbohydrate, and recheck 15 minutes later.
C) Correct without first checking. It’s not important to know what the glucose reading is; besides, patients can usually guess their glucose.

Next:  The answer

The correct answer is (B). The 15/15 rule advises patients to first test their glucose level if they suspect they may be experiencing hypoglycemia (including if having symptoms, such as sweating, shaking, and irritable mood). Correct with 15 g of carbohydrate, such as 1/2 cup of fruit juice, or a handful of raisins. The fat in candy bars slows absorption of the sugar. Recheck 15 minutes after correcting, to ensure that the level has normalized.

Next question.

2. Which is true of patients with diabetic kidney disease (DKD)?

A) ACE-i or ARB are NOT recommended for preventing diabetic nephropathy.
B) Test for microalbuminuria (MAU) every two years.
C) Blood pressure and glucose control do not help prevent progression of renal insufficiency.
D) Most patients who have DKD follow the usual path of progression from glomerular hyperfiltration, progressive albuminuria, decreasing eGFR, to ESRD.
E) DKD affects a relatively small percentage of individuals with DM.

Next:  The answer

The correct answer is (A). Interestingly, there has been no evidence to support starting these agents for prevention of nephropathy.

Test for MAU annually. Many patients deviate from the classical progression to ESRD. DKD affects approximately 40% of patients with T2DM and about 30% of T1DM individuals in the U.S.

FOR FURTHER READING:
Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: Challenges, progress, and possibilities. Clin J Amer Soc Nephrol. 2017; 12(12): 2032-2045.

Next question.

3. What’s true about clinical inertia?

A) Only patients demonstrate this.
B) It’s uncommon and not really an issue.
C) Physicians and other health care professionals (HCP) can have this.
D) Clinical inertia refers to the seemingly immovable bureaucracy when you’re trying to get insurance prior authorization.

Next:  The answer

The correct answer is (C). Both patients and HCP can be susceptible to clinical inertia, which is a lack of changing diabetes treatment, even in the face of suboptimal glycemic control. Patients may ask, “Can we not change anything for 6 months, and I’ll get back on track with my exercise and diet?”

FURTHER READING:
Okemah J, Peng J, Quinones M. Addressing clinical inertia in type 2 diabetes mellitus: a review. Adv Ther. 2018; 35(11): 1735-1745.

Next question.

4. What is a commonly cited reason for suboptimally testing glucose?

A) Handling test strips
B) Pain
C) Obtrusive process
D) Carrying equipment to perform self-monitoring of blood glucose (SMBG).
E) All of the above.

Next:  The answer

The correct answer is (E). All are among the leading reasons in a study of 150 European patients with DM.

FURTHER READING:

Wijsman I. Patient-reported barriers in diabetes management and areas of opportunity for healthcare professionals. Poster presentation at the 14th Annual Conference of the Federation of European Nurses in Diabetes (FEND); 2009 September 25-26; Vienna, Austria.

Next question.

5. Which of the following is true of what’s on the horizon for diabetes care?

A) The artificial pancreas (or closed-loop system) will be an incremental improvement over what we currently have available.
B) The implanted exenatide system being re-reviewed by the FDA can store 12 months of medication.
C) AI (artificial intelligence) will replace us all within the next 5 years or less.
D) A completely needleless means to measure glucose still eludes researchers.

Next:  The answer

The correct answer is (D). Contact lenses, wristwatches, and others have been designed and tested (the GlucoWatch had been withdrawn from the market in 2007; patients frequently cited skin irritation and a 3-hour warm-up time as reasons they discontinued use.