1. Compared with long-acting glucagon-like peptide-1 receptor agonists (GLP-1 RAs), short-acting GLP-1 RAs display which of the following benefits?
A. A more profound reduction in postprandial blood glucose
B. A more robust ability to lower body weight
C. Greater cardiovascular (CV) risk reduction
D. A smaller risk for causing hypoglycemia
E. Unsure
2. Which of the following statements regarding the overarching components of the “Decision Cycle for Patient-Centered Glycemic Management in Type 2 Diabetes,” as described in the American Diabetes Association (ADA) 2022 Standard of Medical Care in Diabetes is true?
A. Emphasizes provider decision-making to avoid clinical inertia
B. Recommends a collaborative relationship between the patient and provider to identify opportunities to overcome barriers
C. Provides a management plan that is the same for everyone
D. Is meant to be implemented once, at the time of diagnosis only
E. Unsure
3. Mr. Mackie is a 55-year-old man with type 2 diabetes (T2D). Three months ago he presented to the emergency department with an ischemic stroke, and was also diagnosed with T2D during that hospital admission. At that time, Mr. Mackie's A1C was 7.2%; his goal A1C was recommended to be less than 7%. Antihyperglycemic therapy was not initiated because he wanted to try to manage his hyperglycemia with behavioral modifications. His new A1C in your outpatient clinic today was 6.9%; his other laboratory tests and vitals are otherwise normal, although his body mass index (BMI) is 31 kg/m2. What recommendation do you give the prescriber to optimize his health at this time?
A. He should start metformin to help delay the progression of T2D.
B. He should continue behavioral modifications without starting any antihyperglycemic therapy given his A1C is below his goal.
C. He should start a GLP-1 RA with evidence for CV benefit despite his controlled glycemic status.
D. He should start a dipeptidyl peptidase-4 (DPP-4) inhibitor with evidence for CV benefit despite his controlled glycemic status.
E. Unsure
4. Mrs. George is a 66-year-old woman with T2D and chronic kidney disease (CKD, stage 3A). Today her A1C is 8% and her estimated glomerular filtration rate is 56 mL/min, both of which are relatively unchanged from 6 months ago. She continues to take metformin 1,000 mg twice daily, losartan 100 mg daily, and atorvastatin 20 mg at night. According to the Kidney Disease: Improving Global Outcomes (KDIGO) 2020 Clinical Practice Guideline for Diabetes Management in CKD guidelines, which of the following action steps would be most important to consider at this time?
A. Start a GLP-1 RA proven to improve kidney outcomes
B. Start a sodium-glucose cotransporter 2 (SGLT2) inhibitor with primary evidence for kidney benefit
C. Increase her losartan dose
D. Augment her atorvastatin to high intensity
E. Unsure
5. Janice is ready to address her long-standing hyperglycemia from T2D. In the past she has attempted behavioral modifications and taken metformin on and off, but reports being attentive to using the medication, implementing a better diet, and engaging in regular physical activity over the last 6 months to improve her glycemic control and lose weight. Her A1C has improved from 11% to 8.2%. Today she is willing to initiate a second-line therapy to manage her diabetes. Based on this information, which therapeutic options are reasonable for her at this time?
A. Sulfonylurea, DPP-4 inhibitor, or basal insulin
B. GLP-1 RA or a thiazolidinedione
C. SGLT2 inhibitor or a GLP-1 RA
D. Basal insulin or DPP-4 inhibitor
E. Unsure
6. Mrs. Casey is a 47-year-old woman. She was diagnosed with T2D about 4 years ago. She reports struggling to manage her body weight for most of her adult life. Given that her A1C and BMI are still above goal today, she asks if it would be worth increasing her weekly injected semaglutide dose to more than 1 mg. How do you respond?
A. Injected semaglutide doses greater than 1 mg weekly do not provide additional glycemic benefit.
B. Higher semaglutide doses do not reduce weight any more than the 1-mg weekly injected dose.
C. Increasing weekly injected semaglutide to 2 mg will improve A1C further, but not body weight.
D. Increasing the dose of weekly injected semaglutide to 2 mg will help lower both A1C and body weight.
E. Unsure
7. For which patient with T2D would a GLP-1 RA not be the best next antihyperglycemic therapy option?
A. A 30-year-old man with T2D (A1C of 7.2%), cardiomyopathy, and heart failure (HF) using glipizide twice daily
B. A 40-year-old woman with T2D (A1C of 8.6%), obesity, and fibromyalgia using metformin
C. A 55-year-old man with T2D (A1C of 7.7%) and stage 3b CKD using dapagliflozin
D. A 60-year-old woman with T2D (A1C of 6.8%), who had a heart attack 5 years ago, has a history of recurrent vaginitis, and is engaging in behavioral modifications
E. Unsure
8. BR is a patient with T2D who is considering treatment with an injectable GLP-1 RA. While BR is not opposed to injections, he would prefer a single-dose injection device so that he does not have to deal with pen needles. Which of the following products is available commercially in a single-dose pen device that does not require use of pen needles?
A. Liraglutide
B. Dulaglutide
C. Injectable semaglutide
D. Lixisenatide
E. Unsure
9. JW is a patient with T2D. His current A1C is 7.7% despite treatment with metformin extended release 1,000 mg twice daily. JW does not have a history of ASCVD, HF, or CKD, and is not considered high risk for these comorbidities. In the absence of these compelling indications, all of the following are recommended as key considerations by the ADA when selecting an add-on glucose-lowering agent to lower A1C, EXCEPT:
A. The need to minimize hypoglycemia
B. The need to minimize weight gain or promote weight loss
C. The need to minimize medication costs
D. The manufacturer of the product
E. Unsure
10. Tirzepatide is a new medication approved for the treatment of T2D. Tirzepatide is best categorized as which of the following?
A. A dual GLP-1/DPP-4 inhibitor
B. A dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor antagonist
C. A dual GLP-1/GIP receptor agonist
D. A dual GLP-1/SGLT2 inhibitor
E. Unsure
