To promote patient acceptance of adding a new agent to their treatment regimen, it may be helpful to explain that most patients need therapeutic intensification because β-cell failure is ________________ in type 2 diabetes, and the ability of many agents to control blood glucose ____________ over time.
A:
Sudden and abrupt, remains stable
B:
Sudden and abrupt, decreases
C:
Gradual and progressive, remains stable
D:
Gradual and progressive, decreases
2.
The “ominous octet” of pathophysiologic abnormalities that contribute to hyperglycemia includes all of the following except:
A:
Cardiovascular disease
B:
Neurotransmitter dysfunction
C:
Decreased insulin secretion
D:
Decreased incretin effect
3.
In a 24-month study by Samuels et al, patients who missed therapeutic intensification opportunities for _________ had significantly higher _________ than patients who missed for _________, demonstrating the importance of prompt therapeutic intensification.
A:
All 6 quarters, A1C levels, 1-2 quarters
B:
All 6 quarters, weight, 1-2 quarters
C:
3 or more quarters, A1C levels, 1-2 quarters
D:
3 or more quarters, weight, 1-2 quarters
4.
Because GLP-1 acts on several organ systems (eg, pancreas, central nervous system, liver), incretin-based therapies may be used to _______________.
A:
Replace all other treatment options for type 2 diabetes
B:
Cure type 2 diabetes
C:
Address several aspects of the pathophysiology of type 2 diabetes
D:
Assess which aspect of pathophysiology contributes most to the disease state in a particular patient
5.
In a 2009 study by Shah et al, _________ and _________ were associated with increased likelihood that a patient would fill his or her first prescription for a diabetes medication.
A:
Copay $10, sex
B:
Age, sex
C:
Copay $10, A1C level 9%
D:
Age, A1C level 9%
6.
Studies have demonstrated all of the following except:
A:
Individual performance feedback combined with patient-specific reminder sheets improved rates of appropriate drug intensification for patients with type 2 diabetes.
B:
Open access scheduling improved rates of A1C testing as well as A1C, systolic blood pressure, and LDL cholesterol outcomes.
C:
Three-part intervention consisting of 30-minute appointments every 3 months, reminder telephone calls to patients, and standardized diabetes care flow sheet improved treatment guideline adherence, A1C levels and cholesterol levels.
D:
Care manager intervention following notification of overdue patient prescription refill promotes medication reinitiation.
7.
According to the American College of Endocrinology (ACE)/American Association of Clinical Endocrinologists (AACE) guidelines and recommendations published by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD), all of the following statements are true except:
A:
Monotherapy or combination therapy with DPP-4 inhibitors is appropriate according to ACE/AACE guidelines for managing type 2 diabetes.
B:
According to the recommendations published by the ADA and EASD, DPP-4 inhibitors may be appropriate for some patients.
C:
The recommendations published by the ADA and EASD include use of GLP-1 agonists when hypoglycemia or weight loss are concerns.
D:
The recommendations published by the ADA and EASD include use of GLP-1 agonists as monotherapy.
8.
Including agents in development, GLP-1 agonists are expected to decrease A1C by approximately ______%, and the expected A1C decrease with DPP-4 inhibitors is approximately ______%.
A:
0.8-1.9, 1.5-2.0
B:
0.8-1.9, 0.5-1.0
C:
2.0-3.0, 1.5-2.0
D:
2.0-3.0, 0.5-1.0
9.
Head-to-head studies of GLP-1 agonists have demonstrated ______________ with the long-acting GLP-1 agonists exenatide LAR and liraglutide versus exenatide twice daily.
A:
Greater weight loss
B:
Greater nausea
C:
Greater A1C decreases
D:
Smaller A1C decreases
10.
Common adverse events associated with GLP-1 agonists include __________, and those associated with DPP-4 inhibitors include ______________.
$10, sex 
9% 
