Which one of the following most increases insulin sensitivity in an overweight patient with diabetes mellitus?
Correct Answer A:
Metformin increases insulin sensitivity much more than sulfonylureas or insulin. This means lower insulin levels achieve the same level of glycemic control, and may be one reason that weight changes are less likely to be seen in diabetic patients on metformin. Acarbose is an alpha-glucosidase inhibitor that delays glucose absorption.
A 40-year-old female comes to your office for a routine examination. She has been in good health and has no complaints other than obesity. Her mother is diabetic and the patient has had a child that weighed 4kg (9 lb) at birth. Her examination is negative except for her obesity. A fasting glucose level is 7.1 mmol/L, and when repeated 2 days later it is 7.5 mmol/L.
Which one of the following would be most appropriate at this point?
The criteria for diagnosing diabetes mellitus include any one of the following: symptoms of diabetes (polyuria, polydipsia, weight loss) plus a casual glucose level 11.1 mmol/L; a fasting plasma glucose level 7 mmol/L; or a 2-hour postprandial glucose level 11.1 mmol/L after a 75-gram glucose load or a glycated hemoglobin (A1C) value of ≥ 6.5%. In the absence of unequivocal hyperglycemia the test must be repeated on a different day.
The criteria for impaired glucose homeostasis include either a fasting glucose level of 6.1-6.9 mmol/L (impaired fasting glucose) or a 2-hour glucose level of 7.8-11 mmol/L on an oral glucose tolerance test or or an A1C of 6.0% to 6.4%. Normal values are now considered 6.1 mmol/L for fasting glucose and 7.8 mmol/L for the 2-hour glucose level on an oral glucose tolerance test.
An 18-year-old male seen in your office is found to be overweight and to have acanthosis nigricans. Both of his parents have a history of diabetes mellitus. His fasting plasma glucose level is 6.2 mmol/L.
Which one of the following is the correct diagnosis?
This patient has prediabetes, which is defined as having a fasting plasma glucose level of 5.6 to 6.9 mmol/L. These patients are at high risk for developing diabetes mellitus later in life. Prediabetes is associated with metabolic syndrome, and weight loss, exercise, and certain pharmacologic agents have been shown to prevent or delay the subsequent development of diabetes mellitus.
Diabetes mellitus is diagnosed in three ways: symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) plus a random plasma glucose level 11.1 mmol/L; a fasting plasma glucose level 7 mmol/L; or a glucose level 11.1 mmol/L on a 2-hour 75-g oral glucose tolerance test. It is important to note that in the absence of unequivocal hyperglycemia the diagnosis must be confirmed by repeat testing on a subsequent day. Once the diagnosis of diabetes is confirmed, further testing is needed to differentiate between type 1, type 2, and maturity-onset diabetes of youth.
In patients with type 2 diabetes mellitus, intensive glycemic control has not been shown to be beneficial for which one of the following diabetic complications?
Correct Answer C:
Intensive management of hyperglycemia, with a goal of achieving nondiabetic glucose levels, helps reduce microvascular complications such as retinopathy, nephropathy, and neuropathy. Foot infections are less common in patients without neuropathy and in patients with good glycemic control. Intensive management of hyperglycemia also has a beneficial effect on cardiovascular disease in patients with type 1 diabetes mellitus but, unfortunately, not in patients with type 2 diabetes mellitus. In fact, there is data to suggest that intensive glycemic control (hemoglobin A1c < 6.5) may be detrimental in certain populations, such as the elderly and those with cardiovascular disease.
A 60-year-old black male is found to have type 2 diabetes mellitus.
Which one of the following should be ordered before initiating treatment with metformin?
Correct Answer B:
Metformin is contraindicated in patients with renal dysfunction, because it is associated with an increased incidence of lactic acidosis.
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