Abstract
1 Which of the following islet cell antibodies is the best immunologic predictor of type 1 diabetes?
A. Glutamic acid decarboxylase (GAD)
B. Heat shock protein 65
C. Peripherin
D. Endocrine cell antigens
2 A thin 38-year-old white female presents to the clinic for evaluation of her glycemic control. She was diagnosed with diabetes 9 months ago with an A1C of 13% and started on metformin and glipizide. Three months later her glycemic control was much improved (A1C of 7.4%), but today she reports increased thirst and urination. Her A1C today is 11.2% despite confirmed adherence with her medications and a negative pregnancy test. Which of the following is the MOST likely diagnosis?
A. Type 1 diabetes (T1DM)
B. Type 2 diabetes (T2DM)
C. Latent autoimmune diabetes of adults (LADA)
D. Gestational diabetes (GDM)
3 JT, a 34-year-old male with newly diagnosed type 1 diabetes and hypertension, states that he has an occasional alcoholic drink and wants to know if alcohol is allowed. Which of the following is the MOST appropriate response?
A. Yes, but always consume alcohol with food to minimize the risk of nocturnal hypoglycemia.
B. It is recommended to drink 2 glasses of red wine every day to reduce the risk of cardiovascular disease.
C. Yes, substitute an alcoholic drink for 1 carb serving.
D. No, alcoholic beverages should be avoided in persons with hypertension due to the impact on blood pressure.
4 According to the Diabetes Prevention Program (DPP), which of the following was the MOST effective for preventing diabetes?
A. Intensive lifestyle modifications
B. Metformin
C. Acarbose
D. Rosiglitizone
Test Your Knowledge Answers
A: Although the other choices (B, C, D) do play a pathologic role in the causation of type 1 diabetes, GAD has been shown to be the best predictor for the future development of type 1 diabetes.
C: Latent autoimmune diabetes of adults (LADA) is the correct answer (C). Patients with LADA are typically less than 40 years old and often misdiagnosed with type 2 diabetes at presentation (B). Because these patients initially respond to oral agents and do not require insulin, they are usually not diagnosed with type 1 diabetes (A). However, these patients usually progress to insulin requirement over a period of several months, leading some experts to consider LADA related to type 1 diabetes. This patient would not be diagnosed with gestational diabetes because she is not pregnant (D).
A: Although 1 to 2 drinks/day may reduce the risk of cardiovascular (CV) disease, nondrinkers should not be advised to start drinking alcoholic beverages or to drink more often (B). Carbohydrates should not be omitted when drinking alcoholic beverages for persons taking insulin due to the risk of hypoglycemia (C). Studies show that light to moderate drinking reduces blood pressure in both women and men, but chronic, excessive drinking (ie, more than 3 drinks/day) appears to increase blood pressure.
A: Intensive lifestyle modifications (A) is correct. The Diabetes Prevention Program (DPP) enrolled patients at high risk to develop diabetes and randomized them to usual care, intensive lifestyle modification, or metformin. The group that engaged in intensive lifestyle modifications, including loss of 7% of body weight and 150 minutes of exercise each week, was least likely to develop diabetes.
Note: Adapted from Review Guide for the Certified Diabetes Educators Exam. 4th ed. 2017 Chicago: American Association of Diabetes Educators. Reprinted with permission.