CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing depression. b. Neither cognitive impairment nor dementia occurs more frequently than in nondiabetics. c. Heart attacks and strokes are at least twice as frequent in diabetics than in comparison subjects. d. Autonomic neuropathy may contribute to sexual dysfunction in type 2 diabetics. 2. Three major surveys, two conducted in the US and one in the United Kingdom, found that approximately of residents in nursing facilities have diabetes. a. 10% b. 15% to 30% c. 30% to 40% d. 40% to 50% 3. The hyperosmolar hyperglycemic state, a serious complication of type 2 diabetes in older individuals, is a result of: a. decreased insulin activity. b. increased output of glucose by the liver and kidneys. c. increased serum osmolality d. all of these. 4. The risk of developing type 2 diabetes is NOT increased by: a. occasional intake of large amounts of sugar-rich foods. b. having an infant weighing more than 9 pounds at birth. c. being an African-American. d. having a diabetic sibling. 5. All of the following EXCEPT may be a presenting feature of type 2 diabetes in elderly individuals. a. a recent gain in body weight b. a recent loss of body weight c. skin infection d. decreased pain perception 6. Hyperglycemia not secondary to type 2 diabetes may be a result of treatment with: a. conventional antipsychotic drugs. b. newer antipsychotic drugs. c. either of these. d. neither of these.
AMDA Test on Diabetes Mellitus CPG page 2 7. Hyperglycemia in older non-diabetic adults who have pancreatitis, pancreatic cancer, or injury to the pancreas as well as those undergoing pancreatectomy. a. is not observed b. may be detected 8. The oral glucose tolerance test: a. is mandatory when working up individuals who may have type 2 diabetes. b. should be performed at regular intervals when following those already diagnosed with diabetes. c. is not recommended for routine clinical use. 9. With respect to the dietary management of residents with diabetes, which statement is correct? a. The concept of a diabetic diet and diets excluding concentrated sweets or added sugar remains valid. b. Lowering the intake of sucrose-sweetened foods will reliably improve glycemic control. c. A restricted diet rarely compromises the quality of life for frail, elderly patients. d. For obese diabetics who are unable to lose weight for any reason, maintaining near-normal blood glucose levels as tolerated is a reasonable alternative. 10. When refining the management of diabetic patients: a. doses of oral antidiabetic agents, and insulin if used, should be adjusted to properly balance food consumption. b. food consumption should be adjusted to balance current doses of oral antidiabetic agents and insulin. 11. A relevant consideration when deciding on whether to institute combination therapy with multiple oral antidiabetic drugs is that: a. two secretagogues drugs that promote the production or release of insulin have been proved to have additive effects b. combination drug treatment may be tried when monotherapy has failed when the criterion fasting plasma glucose value is above140 mg/dl. c. if two-drug treatment fails and improved glycemic control is considered important for a given patient, adding a third oral agent of the same class may prove effective. 12. A physician who chooses to administer a sulfonylurea drug in an attempt to enhance insulin secretion by the pancreatic islet beta cells should be aware that: a. first-generation sulfonylurea drugs such as tolbutamide or tolazamide are less likely to cause hypoglycemia than are second-generation drugs such as glyburide or glipizide. b. sulfonylurea drugs commonly are associated with weight loss. c. chlorpropamide should not be prescribed for elderly patients. d. first-generation sulfonylurea drugs are preferable for patients with kidney or liver disease. 13. Alpha-glucosidase inhibitors, which slow the digestion of carbohydrates, thereby allowing time for increased insulin secretion, are either sulfonylurea drugs or biguanides to cause hypoglycemia. a. more likely than b. less likely than
AMDA Test on Diabetes Mellitus CPG page 3 14. Which of these statements about the thiazolidinedione class of oral antidiabetic agents is NOT accurate? a. These drugs reduce insulin resistance by promoting insulin-mediated glucose uptake in muscle, fat tissue, and the liver, and by lowering hepatic glucose output. b. They may cause severe liver toxicity. c. They are contraindicated in patients with mild congestive heart failure. d. They have only a modest effect on blood glucose levels. 15. The meglitinides are relatively short-acting insulin secretagogues distinct from the sulfonylurea drugs that act by stimulating insulin secretion. These drugs: a. effectively lower blood glucose levels. b. elevate blood lipid levels. c. do not alter body weight. d. may pose a greater risk of hypoglycemia than do the sulfonylurea drugs. 16. The biguanides such as metformin do NOT: a. suppress hepatic glucose production. b. make muscle tissue more sensitive to insulin. c. increase blood levels of triglyceride and low-density-lipoprotein cholesterol. d. constitute a contraindication for diabetic patients whose renal function is impaired. 17. Indications for the immediate use of insulin include: a. significant weight loss. b. a hyperosmolar state. c. surgery. d. any of these conditions. e. none of these conditions. 18. An expressed wish of a patient with type 2 diabetes to receive insulin as a part of initial treatment a legitimate reason to add insulin to a regimen of diet, exercise, and oral antidiabetic medication. a. is b. is not 19. Even if there are no symptoms or signs of hypoglycemia, immediate attention by a physician is warranted if a patient s blood glucose is lower than mg/dl. a. 50 b. 60 c. 75 d. 90 20. At present, the preferred initial type of drug for use in a patient with type 2 diabetes who is hypertensive and has either microalbuminuria or clinical albuminuria is: a. a diuretic. b. a beta-blocker. c. an angiotensin-converting enzyme (ACE) inhibitor. d. an angiotensin II-receptor blocker.
AMDA Test on Diabetes Mellitus page 4 21. Neuropathic complications of type 2 diabetes may include: a. chronic constipation. b. diarrhea. c. either of these conditions. d. neither of these conditions. 22. Measures to lower elevated blood lipid levels in long-term care patients with type 2 diabetes: a. are mandatory. b. may be unnecessary when hyperlipidemia is reversed by better glycemic control. c. have proved in large-scale randomized trials to lower the risk of heart attacks and strokes. d. entail virtually no risk of causing undernutrition. 23. Annual vaccination against influenza is advisable in long-term care patients who are diabetic. In addition, pneumococcal vaccine is recommended: a. if it is not clear whether the patient has previously been vaccinated. b. if fewer than 5 years have elapsed since the last vaccination in a patient less than 65 years of age. c. if the patient was aged 65 or older when last vaccinated. 24. The minimum interval for monitoring blood glucose in diabetic patients who are well controlled while taking an oral antidiabetic drug or drugs, assuming no change in type of drug or dosage, is: a. once a day. b. every other day. c. twice a week. d. once a week. Part II: Effectiveness of Activity: 1. This activity reinforced my current practice. Yes No 2. This activity made me look at the treatment of diabetes in new ways. Yes No 3. I will implement the following new practices into my treatment plans: 4. This CPG activity has been a good educational (circle one): review intervention. 5. Please provide a follow-up activity on implementation with the interdisciplinary team. Yes No
Part III: Request for CME Certificate: I attest to having completed the self-directed study on the CPG Diabetes Mellitus and request 2 credit hours in category 1 toward the AMA PRA. Signature Date Credit certificate will be sent by e-mail unless you indicate preference for using fax. PRINT legibly or type: Name Address Telephone number FAX number E-mail Return this CME Post-Test with the $14 fee to AMDA Education via e-mail to education@amda.com, by fax to (410) 740-4572; or by mail to AMDA, Education Department, 11000 Broken Land Parkway, Suite 400, Columbia, MD 21044. Please allow 4 weeks for processing your certificate. If you choose to e-mail or to print and fax your test, please provide credit card payment: Type of Card: MasterCard Visa American Express Card # Security Code Expiration Date Cardholder Name Cardholder s Signature IF YOU FAX YOUR TEST, PLEASE BE SURE TOFAX ALL FIVE PAGES.