Type 2 Diabetes: Where Have we been and Where are we Going?

1. By the year 2030, worldwide, approximately how many people will have diabetes?

A. 100 million B. 240 million C. 366 million D. 600 million

2. Type 2 diabetes mellitus (T2DM) among children and adolescents is increasing at an alarming rate. In this population, what percentage of newly diagnosed cases of diabetes are T2DM?

A. 1% B. 5% C. 10% D. 45%

3. Diabetes is the leading cause of

A. New-onset blindness in patients aged 20 to 74 years in the United States (U.S.) B. Renal failure in the U.S. C. Nontraumatic limb amputation in the U.S. D. All of the above

4. All of the following are TRUE regarding the pathophysiology of T2DM, EXCEPT:

A. There is a gradual decline in insulin secretion B. There is an increase in glucagon secretion C. There is an increase in the production of gastrointestinal (GI) incretins D. There is an increase in hepatic glucose production

5. What is the category name of the peptide hormones considered to be part of the glucagon superfamily, which include glucagon-like peptide (GLP)-1 and gastric inhibitory polypeptide (GIP)?

A. Secretins B. DPP-4 C. Gastroglymugons D. Incretins

6. When you administer a dose of oral glucose, you get a greater insulin response than you would get if you achieved the same blood glucose level with an intravenous injection. This effect is called

A. The Incretin Effect B. The IV Glucose Paradox C. The Glucagon Effect D. The Marcus-Gunn Effect

7. The glucose-lowering effect of GLP-1 is caused by

A. Increased insulin secretion B. Slowing of gastric emptying C. Direct stimulation of central nervous system areas responsible for appetite articulation D. All the above are correct

8. The endogenous hormone GLP-1 is not a viable compound for pharmacologic use because

A. Scientists have not been able to delineate its structure B. Scientists have not been able to find a pragmatic method to synthesize GLP-1 C. Its effects would not be useful D. It has a very short half-life and would require constant infusion

9. The ADA/EASD (American Diabetes Association/European Association for the Study of Diabetes) currently recommend a glycated hemoglobin (A1C) goal in most patients with T2DM of _______.

A. < 8.5% B. < 7% C. ≤ 6.5% D. < 6%

10. According to the ADA treatment guidelines for patients with T2DM, patients should usually receive metformin as first-line therapy. What would be a good Step 2 option (to add to metformin) in a patient who is close to goal (A1C < 8%) and who has major concerns about weight gain?

A. SU B. GLP-1 receptor agonist C. Insulin D. Pioglitazone

11. According to the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), which of the following combinations would be reasonable in a patient with an A1C between 7.6% and 9%:

A. Metformin and a GLP-1 receptor analogue B. Metformin and a dipeptidyl peptidase (DPP)-4 inhibitor C. Metformin and a secretagogue D. Any of the above would be acceptable (barring any patient-specific contraindications)

12. Which of the following statements regarding sulfonylureas (SUs) is FALSE:

A. The SUs have been used since their introduction in the late 1950s B. The expected A1C lowering with SUs is 1% to 2% C. SUs are associated with weight loss D. SUs may cause serious hypoglycemia

13. Metformin can cause GI side effects. These side effects are usually transient and can be mitigated with appropriate dosing and titration. Approximately what percentage of patients experience GI symptoms with metformin therapy?

A. 1% B. 10% C. 30% D. 100%

14. Which of the following medications has been the subject of significant controversy regarding its possible link with cardiovascular disease? In addition, its use is now restricted to patients who cannot control their diabetes with other medications?

A. Rosiglitazone B. Insulin glargine C. Pioglitazone D. Sitagliptin

15. Which of the following statements is TRUE regarding the gliptins (DPP-4 inhibitors):

A. They are associated with weight gain B. They are inexpensive C. They are poorly tolerated D. When used as monotherapy they are typically associated with A1C reductions of 0.5% to 0.75%

16. The activity of the 2 GLP-1 receptor analogues exenatide and liraglutide include

A. Slowing of gastric emptying B. Increasing insulin concentrations C. Suppression of appetite D. All the above

17. Which of the following is FALSE regarding exenatide:

A. It is dosed once daily B. It is resistant to deactivation by DPP-4 C. It is a synthetic version of a peptide secreted by the Gila monster D. It needs to be administered within 60 minutes prior to meals

18. There is a relationship between adherence and the number of daily doses taken. In a study involving patients with T2DM, patients taking single daily doses had compliance rates of 79%. Compliance dropped to ___% in patients taking 3 daily doses.

A. 75% B. 62% C. 51% D. 38%

19. What is the mean reduction in A1C reported after pharmacists' diabetes interventions (ranging from education to direct patient management), when compared with usual care?

A. None B. 0.1% C. 0.3% D. 0.62%

20. According to one study, what pharmacist activity was associated with the greatest reduction in A1C levels in patients?

A. Routine medication counseling B. Pharmacists practicing with prescriptive authority C. Diabetes education D. Telephone calls to patients

Evaluation Questions

21. In an effort to better determine the overall impact of continuing education activities, the Postgraduate Institute for Medicine (PIM) is conducting measurements of educational effectiveness. Listed below are several demographic questions to better identify who is in the audience and several statements for which we would like you to rate your level of agreement/disagreement. All information obtained in this process will be used and reported in aggregate only, without individual attribution. Thank you for your participation. What is your profession?

A. Pharmacist B. Pharmacy Technician C. Other

22. What is your area of specialization?

A. Clinical Pharmacy B. Managed Care C. Retail/Community Pharmacy D. Research E. Industry/Manufacturing F. Regulatory/Government G. Other

23. Approximately how many patients with type 2 diabetes does your practice see per week?

A. < 5 B. 5 -10 C. 11 – 20 D. > 20 E. Not applicable to my setting

24. How many years have you been in practice?

A. < 5 B. 5 -10 C. 11 – 20 D. > 20

25. To what extent do you agree with the following statements? The GLP-1 agonists promote weight loss in patients with type 2 diabetes, in range from 1 to 3 kg, when used as monotherapy or in combination with other agents.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

26. Newly diagnosed type 2 diabetes patients with symptomatic hyperglycemia and an A1C level > 9% should receive insulin therapy as first-line treatment.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

27. Patient counseling by the pharmacists regarding medications and lifestyle modifications has been shown to improve therapeutic outcomes for patients with type 2 diabetes.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

28. Current ADA guidelines indicate A1C goals of ≥ 7% may be appropriate for most patients with type 2 diabetes.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

29. Now that you have participated in this activity, how often do you plan to engage in the following practice behavior? Recommend diabetes screening for all patients over the age of 45 regardless of diabetes risk factors.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not within my scope of practice