Professional Documents
Culture Documents
The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus:
The AACE System of Intensive Diabetes Self-Management—2002 Update. Endocr Pract 2002;8(suppl 1):40-65.
Howard AA, Arnsten JH, Gourevitch MN: Effect of alcohol consumption on diabetes mellitus: A systematic review.
Ann Intern Med 2004;140(3):211-219.
Einhorn D, Reaven GM, Cobin RH, et al: American College of Endocrinology position statement on the insulin
resistance syndrome. Endocr Pract 2003;9(3):237-252.
Rao G: Insulin resistance syndrome. Am Fam Physician 2001;63(6):1159-1163, 1165-1166.
2. Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
Rith-Najarian SJ, Stolusky T, Gohdes DM: Identifying diabetic patients at high risk for lower-extremity amputation in
a primary health care setting. Diabetes Care 1992;15(10):1386-1389.
3. Which of the following lipid-lowering agents can worsen glycemic control? (Mark all
that are true.)
○ Colestipol (Colestid)
○ Ezetimibe (Zetia)
○ Gemfibrozil (Lopid)
○ Niacin
○ Atorvastatin (Lipitor)
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
final report. Circulation 2002;106(25):3143-3421.
Preiss D, Seshasai SR, Welsh P, et al: Risk of incident diabetes with intensive-dose compared with moderate-dose
statin therapy: a meta-analysis. JAMA 2011;305(24):2556-2564.
FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. US Food and
Drug Administration, 2012.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
Sattar N, Preiss D, Murray HM, et al: Statins and risk of incident diabetes: a collaborative meta-analysis of
randomised statin trials. Lancet 2010;375(9716):735-742.
4. A 58-year-old male with type 2 diabetes mellitus comes in during the early
afternoon for his annual physical examination. His current medication regimen
consists of insulin glargine (Lantus), 18 units in the evening; glipizide (Glucotrol),
20 mg/day; metformin (Glucophage), 1000 mg twice a day; and acarbose
(Precose), 100 mg three times a day. He suddenly becomes shaky, diaphoretic, and
pale, and tells you he thinks it is because he skipped lunch before his appointment.
Which of the following would be effective for managing this episode? (Mark all that
are true.)
5. Which of the following medications can cause hyperglycemia? (Mark all that are
true.)
○ Niacin
○ Clozapine (Clozaril)
○ Prednisone
○ Spironolactone
○ Ramipril (Altace)
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists,
North American Association for the Study of Obesity: Consensus development conference on antipsychotic agents
and obesity and diabetes. Diabetes Care 2004;27(2):596-601.
Yusuf S, Sleight P, Pogue J, et al: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular
events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med
2000;342(3):145-153.
American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36(suppl
1):S67-S74.
6. A 55-year-old African-American male sees you for a routine visit. His past medical
history is notable for an 8-year history of diabetes mellitus and a past history of
hypercholesterolemia. His current medications are atorvastatin (Lipitor), 20
mg/day, and extended-release metformin (Glucophage XR), 1000 mg/day. He also
reports a history of peanut allergy manifested by lip angioedema, and carries an
epinephrine auto-injector (EpiPen).
You see the patient 6 months later for a follow-up visit, and a spot urine sample
has an albumin/creatinine ratio of 45 µg/mg.
A) Have the patient return in 6 months for a repeat urine test for albumin and
creatinine
B) Order a 24-hour urine collection for creatinine
C) Recommend that the patient reduce his daily protein intake to 1.5 g/kg/day
D) Begin an ACE inhibitor
E) Begin an angiotensin receptor blocker
Chobanian AV, Bakris GL, Black HR, et al: The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure-The JNC 7 Report. National Heart Lung and Blood
Institute (NHLBI), 2003.
Gross JL, de Azevado MJ, Silveiro SP, et al: Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes
Care 2005;28(1):164-176.
Hunt SA, Abraham WT, Chin MH, et al: ACC/AHA 2005 guideline update for the diagnosis and management of
chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management
of Heart Failure). Circulation 2005;112(12):e154-e235.
American Diabetes Association: Standards of medical care in diabetes—2015: 9. Microvascular complications and
foot care. Diabetes Care 2015;37(Suppl 1):S58-S66.
Mauer M, Zinman B, Gardiner R, et al: Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J
Med 2009;361(1):40-51.
Bilous R, Chaturvedi N, Sjolie AK, et al: Effect of candesartan on microalbuminuria and albumin excretion in
diabetes: Three randomized trials. Ann Intern Med 2009;151(1):11-20, W3-W4.
7. True statements regarding carbohydrate intake and diabetes mellitus include
which of the following? (Mark all that are true.)
American Diabetes Association: Nutrition recommendations and interventions for diabetics. Diabetes Care
2008;31(suppl 1):S61-78.
Barclay A, Gilbertson H, Marsh K, Smart C: Dietary management in diabetes. Aust Fam Physician
2010;39(8):579-583.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
8. A 51-year-old male with type 2 diabetes mellitus controlled with diet is found to
have a serum triglyceride level of 350 mg/dL, an LDL-cholesterol level of 101
mg/dL, and an HDL-cholesterol level of 45 mg/dL.
Which one of the following supplements would most likely reduce his serum
triglyceride levels?
A) Vitamin E
B) Vitamin C
C) Omega-3 fatty acids
D) Folate
E) Chromium
Kris-Etherton PM, Harris WS, Appel LJ, for the Nutrition Committee: Fish consumption, fish oil, omega-3 fatty acids,
and cardiovascular disease. Circulation 2002;106(21):2747-2757.
Fletcher B, Berra K, Ades P, et al: Managing abnormal blood lipids: A collaborative approach. Circulation
2005;112(20):3184-3209.
Miller M, Stone NJ, Ballantyne C, et al; American Heart Association Clinical Lipidology, Thrombosis, and Prevention
Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis
and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease:
Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation
2011;123(20):2292-2333.
9. Which one of the following is INEFFECTIVE for treating pain syndromes arising from
diabetic neuropathy?
McCarberg B: Pharmacotherapy for neuropathic pain: The old and the new. Adv Stud Med 2006;6(9):399-408.
Newton WP, Collins L: What is the best treatment for diabetic neuropathy? J Fam Pract 2004;53(5):403-406.
Bril V, England J, Franklin GM, et al: Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of
the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine,
and the American Academy of Physical Medicine and Rehabilitation. Neurology 2011;76(20):1758-1765.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
10. At a routine health maintenance visit, a 42-year-old obese male is found to have a
fasting plasma glucose level of 118 mg/dL. Which one of the following is the most
appropriate initial intervention for preventing or delaying the development of
diabetes mellitus in this patient?
American Diabetes Association, National Institute of Diabetes and Digestive and Kidney Diseases: Prevention or
delay of type 2 diabetes. Diabetes Care 2004;27(suppl 1):S47-S54.
Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. N Engl J Med 2002;346(6):393-403.
Tuomilehto J, Lindstrom J, Eriksson JG, et al: Prevention of type 2 diabetes mellitus by changes in lifestyle among
subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343-1350.
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
American Diabetes Association: Standards of medical care in diabetes—2013. Diabetes Care 2013;36(Suppl
1):S11-S66.
American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36(suppl
1):S67-S74.
11. A 77-year-old obese male sees you for a routine visit. He has a 20-year history of
hypertension, a 12-year history of type 2 diabetes mellitus complicated by the
development of microalbuminuria and proliferative diabetic retinopathy, and a
Skyler JS, Bergenstal R, Bonow RO, et al: Intensive glycemic control and the prevention of cardiovascular events:
Implications of the ACCORD, ADVANCE, and VA diabetes trials: A position statement of the American Diabetes
Association and a scientific statement of the American College of Cardiology Foundation and the American Heart
Association. Diabetes Care 2009;32(1):187-192.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
12. True statments regarding dipeptidyl peptidase-4 inhibitors include which of the
following? (Mark all that are true.)
○ They are more effective than metformin for lowering hemoglobin A1c
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
Dicker D: DPP-4 inhibitors: impact on glycemic control and cardiovascular risk factors. Diabetes Care 2011;34(Suppl
2):S276-S278.
○ Progressive nephropathy
○ Acanthosis nigricans
○ Autonomic neuropathy
○ Increased cardiovascular risk
○ Chronic interstitial nephritis
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
○ Smoking cessation
○ Aerobic exercise
○ Postmenopausal hormone therapy
○ Vitamin E, 400–800 IU/day
○ Aspirin, 81 mg/day
Miller ER III, Pastor-Barriuso R, Dalal D, et al: Meta-analysis: High-dosage vitamin E supplementation may increase
all-cause mortality. Ann Intern Med 2005;142(1):37-46.
Mosca L, Benjamin EJ, Berra K, et al: Effectiveness-based guidelines for the prevention of cardiovascular disease in
women—2011 update: A guideline from the American Heart Association. Circulation 2011;123(11):1243-1262.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
15. Hypoglycemia is a possible side effect of which of the following diabetes agents?
(Mark all that are true.)
○ Insulin
○ Pioglitazone (Actos)
○ Metformin (Glucophage)
○ Sulfonylureas
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
Nathan DM, Buse JB, Davidson MB, et al: Medical management of hyperglycemia in type 2 diabetes: A consensus
algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association
and the European Association for the Study of Diabetes. Diabetes Care 2009;32(1):193-203.
Phung OJ, Scholle JM, Talwar M, Coleman CI: Effect of noninsulin antidiabetic drugs added to metformin therapy on
glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA 2010;303(14):1410-1418.
Actos (pioglitazone): Ongoing safety review - Potential increased risk of bladder cancer. US Food and Drug
Administration, 2011.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
16. True statements regarding dietary fat intake in patients with diabetes mellitus
include which of the following? (Mark all that are true.)
American Diabetes Association: Nutrition recommendations and interventions for diabetics. Diabetes Care
2008;31(suppl 1):S61-78.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
17. True statements regarding coronary heart disease in patients with diabetes
mellitus include which of the following? (Mark all that are true.)
American Diabetes Association: Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care
2003;26(suppl 1):S28-32.
Hurst RT, Lee RW: Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: Mechanisms and
management. Ann Intern Med 2003;139(10):824-834.
Nathan DM, Cleary PA, Barklund JY, et al: Diabetes Control and Complications Trial/Epidemiology of Diabetes
Interventions and Complications (DCCT/EDIC) Study Research Group: Intensive diabetes treatment and
cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353(25):2643-2653.
BARI Investigators: The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol
2007;49(15):1600-1606.
Hillis LD, Smith PK, Anderson JL, et al: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A report
of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
Circulation 2011;124(23):e652-e735.
American Diabetes Association: Standards of medical care in diabetes—2013. Diabetes Care 2013;36(Suppl
1):S11-S66.
Farkouh ME, Domanski M, Sleeper LA, et al; FREEDOM Trial Investigators: Strategies for multivessel
revascularization in patients with diabetes. N Engl J Med 2012;367(25):2375-2384.
Deb S, Wijeysundera HC, Ko DT, et al: Coronary artery bypass graft surgery vs percutaneous interventions in
coronary revascularization: A systematic review. JAMA 2013;310(19):2086-2095.
18. The threshold fasting plasma glucose level recommended for confirming the
diagnosis of diabetes mellitus is
_______ mg/dL
American Diabetes Association: 2. Classification and diagnosis of diabetes. Diabetes Care 2015;38(suppl):S8-S16.
19. A patient with type 2 diabetes mellitus is found to have an LDL-cholesterol level of
140 mg/dL, an HDL level of 45 mg/dL, and a triglyceride level of 425 mg/dL.
Which one of the following lipid-lowering agents should be avoided in this patient
because of its effect on serum triglycerides?
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
final report. Circulation 2002;106(25):3143-3421.
Miller M, Stone NJ, Ballantyne C, et al; American Heart Association Clinical Lipidology, Thrombosis, and Prevention
Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis
and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease:
Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation
2011;123(20):2292-2333.
20. Endocrinopathies associated with diabetes mellitus include which of the following?
(Mark all that are true.)
○ Cushing’s syndrome
○ Acromegaly
○ Pheochromocytoma
○ Gastrinoma
○ Glucagonoma
American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36(suppl
1):S67-S74.
21. According to National Cholesterol Education Program guidelines, criteria for the
diagnosis of metabolic syndrome include which of the following? (Mark all that are
true.)
22. A 62-year-old female is diagnosed with type 2 diabetes mellitus on the basis of
consecutive fasting plasma glucose levels of 138 mg/dL and 143 mg/dL. Current
American Diabetes Association guidelines recommend which of the following as
part of her initial management? (Mark all that are true.)
○ Lifestyle intervention
○ Metformin (Glucophage)
○ An oral sulfonylurea
○ A thiazolidinedione
○ Pramlintide (Symlin)
Nathan DM, Buse JB, Davidson MB, et al: Medical management of hyperglycemia in type 2 diabetes: A consensus
algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association
and the European Association for the Study of Diabetes. Diabetes Care 2009;32(1):193-203.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
○ Acarbose (Precose)
○ Metformin (Glucophage)
○ Non-sulfonylurea secretagogues
○ Pioglitazone (Actos)
○ Orlistat (Alli, Xenical)
American Diabetes Association: Prevention or delay of type 2 diabetes. Diabetes Care 2004;27(suppl 1):S47-S54.
Rao SS, Disraeli P, McGregor T: Impaired glucose tolerance and impaired fasting glucose. Am Fam Physician
2004;69(8):1961-1968,1971-1972.
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
24. A 29-year-old female with polycystic ovary syndrome (PCOS) asks if you can
correct her oligomenorrhea. Her fasting glucose level is 100 mg/dL and her
hemoglobin A1c is in the desirable range.
Which of the following diabetes medications have been found to improve insulin
sensitivity and the ovulation rate in PCOS? (Mark all that are true.)
○ Glyburide (DiaBeta)
○ Metformin (Glucophage)
○ Pioglitazone (Actos)
○ Miglitol (Glyset)
○ Repaglinide (Prandin)
Nissen SE, Wolski K: Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular
causes. N Engl J Med 2007;356(24):2457-2471.
Singh S, Loke YK, Furberg CD: Long-term risk of cardiovascular events with rosiglitazone: A meta-analysis. JAMA
2007;298(10):1189-1195.
Ehrmann DA: Polycystic ovary syndrome. N Engl J Med 2005;352(12):1223-1236.
Diamanti-Kandarakis E, Christakou CD, Kandaraki E, Economou FN: Metformin: An old medication of new fashion:
Evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome. Eur J Endocrinol
2010;162(2):193-212.
Palomba S, Falbo A, Zullo F, Orio F Jr: Evidence-based and potential benefits of metformin in the polycystic ovary
syndrome: A comprehensive review. Endocr Rev 2009;30(1):1-50.
Actos (pioglitazone): Ongoing safety review - Potential increased risk of bladder cancer. US Food and Drug
Administration, 2011.
American College of Obstetricians and Gynecologists: Polycystic ovary syndrome. ACOG Practice Bulletin, no 108,
2009.
FDA Drug Safety Communication: FDA requires removal of some prescribing and dispensing restrictions for
rosiglitazone-containing diabetes medicines. US Food and Drug Administration, 2014.
25. A 53-year-old obese male with a history of type 2 diabetes mellitus sees you for
the first time. He tells you that his previous physician had him see a dietician and
started him on metformin (Glucophage), 500 mg twice daily. He brings in a copy
Which of the following would be appropriate advice? (Mark all that are true.)
Sigal RJ, Kenny GP, Boule NG, et al: Effects of aerobic training, resistance training, or both on glycemic control in
type 2 diabetes: A randomized trial. Ann Intern Med 2007;147(6):357-369.
Marwick TH, Hordern MD, Miller T, et al: Exercise training for type 2 diabetes mellitius: Impact on cardiovascular
risk: A scientific statement from the American Heart Association. Circulation 2009;119(25):3244-3262.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
26. A 35-year-old male sees you for a routine health maintenance visit. He admits he
has gained a few pounds over the past few years. He is 173 cm (68 in) tall and
weighs 82 kg (181 lb), giving him a BMI of 27.3 kg/m2.
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
Amori RE, Lau J, Pittas AG: Efficacy and safety of incretin therapy in type 2 diabetes: Systematic review and
meta-analysis. JAMA 2007;298(2):194-206.
Actos (pioglitazone): Ongoing safety review - Potential increased risk of bladder cancer. US Food and Drug
Administration, 2011.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
Information for healthcare professionals: Reports of altered kidney function in patients using exenatide (marketed
as Byetta). US Food and Drug Administration, 2009.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes, 2015: A
patient-centered approach: Update to a position statement of the American Diabetes Association and the European
Association for the Study of Diabetes. Diabetes Care 2015;38(1):140-149.
28. A significantly higher risk for prediabetes and diabetes mellitus has been noted in
persons with a body mass index (BMI) ≥25 kg/m2 who have which of the following
racial/ethnic backgrounds? (Mark all that are true.)
○ African-American
American Diabetes Association: Standards of medical care in diabetes—2015: 2. Classification and diagnosis of
diabetes. Diabetes Care 2015;37(Suppl 1):S8-S16.
29. Which of the following oral agents should be used with caution in patients with
advanced heart failure? (Mark all that are true.)
○ Thiazolidinediones
○ Metformin (Glucophage)
○ Sulfonylureas
○ Meglitinides
○ α-Glucosidase inhibitors
Holmboe ES: Oral antihyperglycemic therapy for type 2 diabetes: Clinical applications. JAMA 2002;287(3):373-376.
Inzucchi SE: Oral antihyperglycemic therapy for type 2 diabetes—Scientific review. JAMA 2002;287(3):360-372.
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
30. Clinical conditions associated with insulin resistance syndrome include which of
the following? (Mark all that are true.)
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
31. True statements regarding aspirin therapy in patients with diabetes mellitus
include which of the following? (Mark all that are true.)
American Diabetes Association: Standards of medical care in diabetes—2015: 8. Cardiovascular disease and risk
management. Diabetes Care 2015;38(Suppl 1):S49-S57.
32. True statements regarding diabetic retinopathy include which of the following?
(Mark all that are true.)
Mohammed Q, Gillies MC, Wong TY: Management of diabetic retinopathy: A systematic review. JAMA
2007;298(8):902-916.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
33. Which of the following can cause a high anion gap metabolic acidosis? (Mark all
that are true.)
○ Severe diarrhea
34. Select the three most effective oral agents for lowering hemoglobin A1c in
diabetic patients.
○ Thiazolidinediones
○ Metformin (Glucophage)
○ Sulfonylureas
○ Dipeptidyl-peptidase 4 inhibitors
○ α-Glucosidase inhibitors
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
35. A 67-year-old male with type 2 diabetes mellitus is evaluated for intermittent
claudication and is found to have a right ankle-brachial index of 0.65. He has no
history of hypertension and his urine is negative for microalbuminuria. Mark all
options below that are true in this situation.
36. A 28-year-old patient with a 10-year history of type 1 diabetes mellitus is found to
have reduced vibratory sensation in both feet, as well as reduced sensation to
10-g monofilament. Which of the following exercise activities should be
recommended? (Mark all that are true.)
○ Swimming
○ Jogging
○ Bicycling
○ Prolonged walking
○ Rowing
American Diabetes Association: Physical activity/exercise and diabetes mellitus. Diabetes Care 2003;26(suppl
1):S73-S77.
American College of Sports Medicine; American Diabetes Association: Exercise and type 2 diabetes: American
College of Sports Medicine and the American Diabetes Association: Joint position statement. Exercise and type 2
diabetes. Med Sci Sports Exerc 2010;42(12):2282-2303.
37. A 55-year-old male with type 2 diabetes mellitus has a chronic history of reduced
Glucose............250 mg/dL
AST (SGOT)............260 U/L (N 10–40)
ALT (SGPT)............210 U/L (N 10–55)
FSH............5.0 U/mL (N 1.0–12.0)
LH............8.1 U/mL (N 2.0–12.0)
Testosterone............180 ng/mL (N 280–1250)
A) Glucagonoma
B) Hemochromatosis
C) Pheochromocytoma
D) Acromegaly
E) Cushing’s syndrome
Brandhagen DJ, Fairbanks VF, Baldus W: Recognition and management of hereditary hemochromatosis. Am Fam
Physician 2002;65(5):853-860.
Pietrangelo A: Hereditary hemochromatosis: Pathogenesis, diagnosis, and treatment. Gastroenterology
2010;139(2):393-408, 408.
38. A 72-year-old male sees you for a routine annual visit. His past medical history is
notable for type 2 diabetes, hyperlipidemia, stage 3 chronic kidney disease,
transient ischemic attacks, carotid endarterectomy, and bladder cancer. His
current medications are metformin (Glucophage), 500 mg twice daily; sitagliptin
(Januvia), 50 mg/day; nateglinide (Starlix), 120 mg 3 times daily with meals;
simvastatin, (Zocor), 40 mg/day; and aspirin, 81 mg/day.
The patient’s blood pressure is 134/76 mm Hg and his BMI is 28.2 kg/m2. The
physical examination is notable only for scattered actinic keratoses on his
forearms and absent pedal pulses.
Laboratory Findings
Which of the following would be appropriate at this time? (Mark all that are true.)
Smith SC Jr, Benjamin EJ, Bonow RO, et al; World Heart Federation and the Preventive Cardiovascular Nurses
Association: AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other
Atherosclerotic Vascular Disease: 2011 update: A guideline from the American Heart Association and American
College of Cardiology Foundation. Circulation 2011;124(22):2458-2473.
AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, et al: Niacin in patients with low HDL cholesterol
levels receiving intensive statin therapy. N Engl J Med 2011;365(24):2255-2267.
Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task
Force: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with
stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart
Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for
Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and
Interventions, and Society of Thoracic Surgeons. Circulation 2012;126(25):e354-e471.
Kirkman MS, Briscoe VJ, Clark N, et al: Diabetes in older adults. Diabetes Care 2012;35(12):2650-2664.
American Geriatrics Society 2012 Beers Criteria Update Expert Panel: American Geriatrics Society updated Beers
Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60(4):616-631.
Mancini GB, Baker S, Bergeron J, et al: Diagnosis, prevention, and management of statin adverse effects and
intolerance: Proceedings of a Canadian Working Group Consensus Conference. Can J Cardiol 2011;27(5):635-662.
Zocor (simvastatin tablets). US Food and Drug Administration, 2012.
Stone NJ, Robinson J, Lichtenstein AH, et al: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce
atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. Circulation 2014;129(25 Suppl 2):S1-S45.
American Diabetes Association: Standards of medical care in diabetes—2015: 8. Cardiovascular disease and risk
management. Diabetes Care 2015;38(Suppl 1):S49-S57.
Laboratory Findings
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN: Hyperglycemic crises in adult patients with diabetes. Diabetes Care
2009;32(7):1335-1343.
40. A 71-year-old male with a history of type 2 diabetes mellitus and long-standing
hypertension sees you because of worsening ankle edema, weight gain, and
“getting more winded” when climbing stairs. His current medications are glipizide
(Glucotrol), 10 mg/day; pioglitazone (Actos), 30 mg/day; extended-release
metformin (Glucophage XR), 1000 mg/day; acarbose (Precose), 25 mg three times
a day; lisinopril (Prinivil, Zestril), 40 mg/day; and hydrochlorothiazide, 12.5
mg/day.
Which one of his medications is most likely responsible for his symptoms?
A) Metformin
Singh S, Loke YK, Furberg CD: Long-term risk of cardiovascular events with rosiglitazone: A meta-analysis. JAMA
2007;298(10):1189-1195.
Lincoff AM, Wolski K, Nicholls SJ, et al: Pioglitazone and the risk of cardiovascular events in patients with type 2
diabetes mellitus: A meta-analysis of randomized trials. JAMA 2007;298(10):1180-1188.
US Food and Drug Administration: Manufacturers of some diabetes drugs to strengthen warning on heart failure risk.
August 14, 2007.
41. Which one of the following types of insulin should never be mixed with any other
form of insulin?
A) Lente
B) Ultralente
C) Insulin glargine
D) NPH
E) Insulin lispro
42. Which one of the following agents is most likely to produce weight loss in the
diabetic patient?
A) Thiazolidinediones
B) GLP-1–receptor agonists
C) Sulfonylureas
D) Metformin (Glucophage)
E) α-Glucosidase inhibitors
Love-Osborne K, Sheeder J, Zeitler P: Addition of metformin to a lifestyle modification program in adolescents with
insulin resistance. J Pediatr 2008;152(6):817-822.
Ripsin CM, Kang H, Urban RJ: Management of blood glucose in type 2 diabetes mellitus. Am Fam Physician
2009;79(1):29-36.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
43. What is the minimum degree of weight loss recommended to reduce the risk of
diabetes mellitus in a patient with impaired glucose tolerance?
Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. N Engl J Med 2002;346(6):393-403.
Tuomilehto J, Lindstrom J, Eriksson JG, et al: Prevention of type 2 diabetes mellitus by changes in lifestyle among
subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343-1350.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
Which one of the following is the most likely cause of her potassium elevation?
45. A 42-year-old female with a body mass index (BMI) of 31 kg/m2 has a 3-week
Which one of the following is most likely to reverse her glucose toxicity and
improve her glycemic response?
Holmboe ES: Oral antihyperglycemic therapy for type 2 diabetes: Clinical applications. JAMA 2002;287(3):373-376.
Nathan DM, Buse JB, Davidson MB, et al: Management of hyperglycemia in type 2 diabetes: A consensus algorithm
for the initiation and adjustment of therapy: A consensus statement from the American Diabetes Association and
the European Association for the Study of Diabetes. Diabetes Care 2006;29(8):1963-1972.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
46. A 60-year-old female sees you for her annual checkup. Her past medical history is
notable for a 15-year history of type 2 diabetes and hypercholesterolemia. Her
current medications are extended-release metformin (Glucophage XR), 2000
mg/day; extended-release glipizide (Glucotrol XL), 5 mg/day; atorvastatin
(Lipitor), 10 mg/day; and aspirin, 81 mg/day.
The patient tells you that she plans to start “jogging,” and you order an exercise
nuclear stress test which reveals findings suspicious for exercise-induced
ischemia. Coronary angiography reveals a 65% stenosis of the mid-right coronary
artery.
○ The patient’s aspirin dosage should be increased to 325 mg/day since it is now
for secondary prevention
○ The patient’s atorvastatin dosage should be increased
○ The patient’s glipizide dosage should be increased
○ Prompt revascularization has been shown to be superior to intensive medical
therapy in terms of mortality and major cardiovascular events
○ Percutaneous coronary intervention and coronary artery bypass graft (CABG)
surgery are equally effective in patients with diabetes mellitus and coronary
heart disease
BARI Investigators: The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol
2007;49(15):1600-1606.
Hlatky MA, Boothroyd DB, Bravata DM, et al: Coronary artery bypass surgery compared with percutaneous coronary
interventions for multivessel disease: A collaborative analysis of individual patient data from ten randomised trials.
Lancet 2009;373(9670):1190-1197.
BARI 2D Study Group, Frye RL, August P, et al: A randomized trial of therapies for type 2 diabetes and coronary
artery disease. N Engl J Med 2009 ;360(24):2503-2515.
Smith SC Jr, Benjamin EJ, Bonow RO, et al; World Heart Federation and the Preventive Cardiovascular Nurses
Association: AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other
Atherosclerotic Vascular Disease: 2011 update: A guideline from the American Heart Association and American
College of Cardiology Foundation. Circulation 2011;124(22):2458-2473.
Farkouh ME, Domanski M, Sleeper LA, et al; FREEDOM Trial Investigators: Strategies for multivessel
revascularization in patients with diabetes. N Engl J Med 2012;367(25):2375-2384.
Stone NJ, Robinson J, Lichtenstein AH, et al: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce
atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. Circulation 2014;129(25 Suppl 2):S1-S45.
American Diabetes Association: Standards of medical care in diabetes—2015: 8. Cardiovascular disease and risk
management. Diabetes Care 2015;38(Suppl 1):S49-S57.
47. Patients must eat within 15 minutes of administration of which one of the
following types of insulin?
A) Lente
B) Ultralente
C) Insulin glargine
D) NPH
E) Insulin lispro
48. The United Kingdom Prospective Diabetes Study found which one of the following
interventions to be most effective in reducing the risk of stroke and heart failure
in diabetics?
American Diabetes Association: Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care
2003;26(suppl 1):S28-32.
49. You are evaluating a patient with diabetes mellitus and hypertension with 24-hour
ambulatory blood pressure monitoring. You note a rise in systolic blood pressure
during sleep.
This has been shown to be an early indicator of which one of the following?
A) Microalbuminuria
B) Orthostatic hypotension
C) Gustatory sweating
D) Proliferative diabetic retinopathy
E) Systolic hypertension
Lurbe E, Redon J, Kesani A, et al: Increase in nocturnal blood pressure and progression to microalbuminuria in type 1
diabetes. N Engl J Med 2002:347(11):797-805.
Palmas W, Pickering T, Teresi J, et al: Nocturnal blood pressure elevation predicts progression of albuminuria in
elderly people with type 2 diabetes. J Clin Hypertens (Greenwich) 2008;10(1):12-20.
50. The strongest predictor for the development and progression of diabetic
retinopathy is
51. The most common cause of sudden monocular loss of vision in a patient with
diabetic retinopathy is
52. A 58-year-old male with type 2 diabetes mellitus is started on a twice-daily insulin
regimen consisting of 20 units of NPH and 10 units of regular insulin in the
morning, and 10 units of NPH and 4 units of regular insulin in the evening before
dinner. His fasting glucose levels have generally been in the 140–180 mg/dL
range, as have his glucose levels just before lunch and dinner. He complains of
frequent midmorning hypoglycemic episodes requiring midmorning snacks, as
well as hypoglycemic episodes just before bedtime, also requiring snacks.
DeWitt DE, Hirsch IB: Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: Scientific review. JAMA
2003:289(17):2254-2264.
Hirsch IB: Insulin analogues. N Engl J Med 2005;352(2):174-183.
Borgoño CA, Zinman B: Insulins: Past, present, and future. Endocrinol Metab Clin North Am 2012;41(1):1-24.
53. A 16-year-old male has a 1-week history of polyuria, polydipsia, and polyphagia.
On laboratory evaluation he is found to have a serum glucose level of 270 mg/dL,
a serum bicarbonate level of 9 mEq/L (N 22–26), a serum pH of 7.0, and a serum
potassium level of 4.0 mEq/L (N 3.5–5.0).
Which one of the following most accurately describes this patient’s total body
potassium?
54. A 58-year-old male with type 2 diabetes mellitus has a blood pressure of 147/92
mm Hg. You start him on benazepril (Lotensin) and order a baseline serum
creatinine level, which is 1.7 mg/dL. Two weeks later his blood pressure is 128/80
mm Hg, and his serum creatinine level is 2.1 mg/dL. His creatinine level is
unchanged 1 week later.
Palmer BF: Renal dysfunction complicating the treatment of hypertension. N Engl J Med 2002;347(16):1256-1261.
Roett MA, Liegl S, Jabbarpour Y: Diabetic nephropathy—The family physician's role. Am Fam Physician
2012;85(9):883-889.
55. Mechanisms of action of exenatide (Byetta) include which of the following? (Mark
all that are true.)
Nathan DM, Buse JB, Davidson MB, et al: Medical management of hyperglycemia in type 2 diabetes: A consensus
algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association
and the European Association for the Study of Diabetes. Diabetes Care 2009;32(1):193-203.
56. A 51-year-old African-American female homemaker sees you for her annual
examination. Her past medical history is notable only for a 2-year history of type
2 diabetes mellitus. Her only medication is metformin (Glucophage), 500 mg twice
daily before breakfast and dinner. She is a nonsmoker. Her family history is
notable for her mother having a heart attack in her late 50s. Her physical
examination is unremarkable, and her blood pressure is 128/76 mm Hg.
Laboratory evaluation reveals a serum creatinine level of 0.8 mg/dL (N 0.6–1.5), a
hemoglobin A1c of 6.9%, and no microalbuminuria. Her lipid profile includes an
LDL-cholesterol level of 105 mg/dL, an HDL-cholesterol level of 42 mg/dL, and a
serum triglyceride level of 160 mg/dL.
American Diabetes Association: Standards of medical care in diabetes—2015: 8. Cardiovascular disease and risk
management. Diabetes Care 2015;38(Suppl 1):S49-S57.
57. A 58-year-old obese male comes to your office with a 2-week history of fatigue
associated with polyuria, polydipsia, and weight loss. You suspect he has type 2
diabetes mellitus. This diagnosis would be corroborated by a random glucose
level greater than or equal to
_______ mg/dL
American Diabetes Association: 2. Classification and diagnosis of diabetes. Diabetes Care 2015;38(suppl):S8-S16.
Laboratory Findings
Adjusting for the hyperglycemia, what is the patient’s corrected serum sodium
level?
_______ mEq/L
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN: Hyperglycemic crises in adult patients with diabetes. Diabetes Care
2009;32(7):1335-1343.
59. A 16-year-old female is admitted to the hospital with a 1-week history of polyuria,
polydipsia, and polyphagia. Examination reveals a lethargic, volume-depleted
female with the smell of acetone on her breath. Her blood pressure is 96/70 mm
Hg, her pulse rate is 120 beats/min, and she has Kussmaul respirations at a rate
of 32/min.
Laboratory Findings
After initiation of intravenous fluid therapy, which one of the following should be
done next?
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN: Hyperglycemic crises in adult patients with diabetes. Diabetes Care
2009;32(7):1335-1343.
60. According to the 2015 American Diabetes Association guidelines, statin therapy
should be considered for which of the following patients with diabetes mellitus?
(Mark all that apply.)
○ A 36-year-old male nonsmoker with normal blood pressure and a normal BMI
Stone NJ, Robinson J, Lichtenstein AH, et al: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce
atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. Circulation 2014;129(25 Suppl 2):S1-S45.
American Diabetes Association: Standards of medical care in diabetes—2015: 8. Cardiovascular disease and risk
management. Diabetes Care 2015;38(Suppl 1):S49-S57.