Calnam Blog

1. According to data from the Diabetes Prevention Program (DPP), which of the following statements regarding racial disparities in A1C among whites vs populations of color (Hispanic, American Indian, Asian, Black) is true?
Racial disparities in A1C among whites vs populations of color do not exist.
They are marginal.
They exist, but are not clinically significant.
They are drivers of poorer outcomes.
They are not a therapeutic issue.
2. Which of the following statements is true about insulin sensitivity among ethnic groups?
It is highest among non-Hispanic whites.
It is highest among African Americans.
It is highest among Asian Americans.
It is highest among Mexican Americans.
Differences have not been found among ethic groups.
3. According to the landmark United Kingdom Prospective Diabetes Study (UKPDS), how much beta-cell function is lost at the time of a type 2 diabetes diagnosis?
10%
25%
50%
75%
100%
4. Racial/ethnic disparities have been found under which of the following parameters?
Across healthcare settings
Across disease areas
Across clinical settings
Across healthcare settings, disease areas, and clinical settings
No racial disparities have been found under these parameters.
5. Which of the following is not considered a diabetes management challenge for the clinician treating the African American population?
Identify the high-risk patients and use preventive strategies, especially in the obese.
Attempt to alter the natural history of disease.
Apply more intensive therapy using the full spectrum of combination treatments.
Reserve the use of insulin therapy for only the most severe of patients.
Employ a more integrative approach to offset impact of cultural barriers.
6. What is the percentage of patients from the UKPDS who required the addition of insulin to control blood glucose to target goal at 5 years post-oral therapy?
10%
20%
30%
40%
100%
7. Which of the following is not true about medical nutrition therapy (MNT)?
MNT outcomes can be seen immediately (within the first 2 weeks).
MNT can result in a 1% to 2% decrease in A1C in type 2 diabetes.
The pleasure of eating must be maintained with MNT.
MNT must be culturally sensitive and individualized.
MNT can reach a point where it is no longer of benefit to the patient.
8. Which of the following insulins has an action profile appropriate for use as a basal insulin?
Aspart
Lispro
Glulisine
NPH
Glargine
9. Which of the following is not considered a barrier to insulin therapy?
Weight gain
Fear of needles
Patient age
Fear of hypoglycemia
Physician’s fear of alienating a patient
10. Which of the following statements accurately describes a main concern about the use of insulin therapy?
It is used too aggressively.
It is used too soon.
It is used too late.
It is used for short periods.
It is used too broadly across groups.

Answers:

According to data from the Diabetes Prevention Program (DPP), which of the following statements regarding racial disparities in A1C among whites vs populations of color (Hispanic, American Indian, Asian, Black) is true?
Answer: They are drivers of poorer outcomes.
The DPP estimated the racial differences in A1C levels compared with the white population. Baseline A1C tended to run higher in the populations of color compared with the white population. This is evidence that, at the start, there are forces at work that are driving poorer outcomes (poor control = poor outcomes) in these communities. In other words, racial disparities in A1C among whites vs populations of color are a driver of poorer outcomes.

Which of the following statements is true about insulin sensitivity among ethnic groups?
Answer: It is highest among non-Hispanic whites.
A study of insulin sensitivity among healthy subjects provides a glimpse of one of the major reasons why there is more diabetes in communities of color. There is less insulin sensitivity in African Americans, Asian Americans, and Mexican Americans compared with non-Hispanic whites; that is, there is more insulin resistance in these communities. As a result, there are more diagnoses of type 2 diabetes in communities of color, in children as well as adults.

According to the landmark United Kingdom Prospective Diabetes Study (UKPDS), how much beta-cell function is lost at the time of a type 2 diabetes diagnosis?
Answer: 50%
According to the landmark UKPDS trial, 50% of beta-cell function is already lost at the time of type 2 diabetes diagnosis. Consequently, it is a challenge to change the natural history of type 2 diabetes, to alter this deterioration of beta-cell function.

Racial/ethnic disparities have been found under which of the following parameters?
Answer: Across healthcare settings, disease areas, and clinical settings
One major problem in the treatment of type 2 diabetes among various racial/ethnic groups is the application of unequal treatment among these groups. Ethnic disparities have been consistently found across a wide range of healthcare settings, disease areas (including diabetes), and clinical services. Countering this unequal treatment can go a long way towards improved control of type 2 diabetes and its complications among ethnic groups.

Which of the following is not considered a diabetes management challenge for the clinician treating the African American population?
Answer: Reserve the use of insulin therapy for only the most severe of patients.
The diabetes management challenges for the African American population include the following:
Identify the high-risk patients and use preventive strategies, especially in the obese.
Apply intensive management strategies to reduce the impact of risk factors.
Attempts to alter the natural history of disease are warranted.
More intensive therapy using the full spectrum of combination treatments is required in African Americans.
Employ a more integrative approach to offset impact of cultural barriers.

What is the percentage of patients from the UKPDS who required the addition of insulin to control blood glucose to target goal at 5 years post-oral therapy?
Answer: 40%
In the UKPDS, investigators found that after initiating treatment for diabetes with a sulfonylurea, nearly 10% of patients required the addition of insulin to control blood glucose to the target goal during the first year. By 5 or 6 years, 2 out of 5 patients (40%) needed insulin. UKPDS showed that, rather than positioning insulin as a late tool for diabetes management, the requirement of insulin supplementation was rather early in the course of type 2 diabetes.

Which of the following is not true about medical nutrition therapy (MNT)?
Answer: MNT outcomes can be seen immediately (within the first 2 weeks).
MNT modifies nutrient intake and lifestyle, aiming at normalizing A1C, blood pressure, and cholesterol (the ABCs), in order to prevent or slow the progression of diabetes and its complications. MNT can result in a 1% to 2% decrease in A1C in type 2 diabetes. MNT outcomes can be seen in 6 weeks to 3 months. To be successful, the pleasure of eating must be maintained with MNT, and it must be a culturally sensitive and individualized plan. There does come a time when MNT alone may no longer be of benefit to the patient, at which time adding pharmacologic treatment is necessary.

Which of the following insulins has an action profile appropriate for use as a basal insulin?
Answer: Glargine
Glargine and detemir are basal insulins. Their onset of action is in 1 to 2 hours, they have a flat peak of action and a duration of action of about 24 hours.

Which of the following is not considered a barrier to insulin therapy?
Answer: Patient age
Weight gain, fear of needles, and fear of hypoglycemia, among others, are all patient-related factors that serve as barriers to use of insulin. Physicians themselves may have their own barriers to using insulin in a patient, one of which is a fear of alienating or even losing that patient. Patient age by itself is not a barrier to insulin use.

Which of the following statements accurately describes a main concern about the use of insulin therapy?
Answer: It is used too late.
Insulin is fairly widely used in the United States, but it is considered as not being used early enough. In addition, although insulin is used fairly freely, there may be evidence that it is not intensified with equal opportunity. In a study comparing 3 major ethnic groups in the country, those for whom insulin was intensified to 2 or more injections per day were more likely to be non-Hispanic whites versus non-Hispanic blacks.

1. Which of the following statements about maternal smoking and birthweight is most accurate?
Younger smokers are at the highest risk for intrauterine growth restriction (IUGR)
The effect of smoking in reducing birthweight is not noted among women with a higher body mass index
Cigarette use in the third trimester appears to have the strongest relationship with birthweight
Although smoking increases the risk for IUGR, there is no dose-response relationship between maternal smoking habits and birthweight
2. Maternal smoking is least likely to negatively affect which of the following measures among newborns?
Subcutaneous fat
Head circumference
Limb length
Weight
3. Which of the following statements about fetal ultrasound among women who smoke is most accurate?
Smoking does not appear to affect fetal organ size
Research has yet to demonstrate an effect between maternal smoking and fetal long bone length
Research has yet to demonstrate an effect between maternal smoking and fetal head measurements
Women who smoke during pregnancy should routinely be assessed with ultrasound early in the third trimester
4. Which of the following statements about smoking cessation during pregnancy is most accurate?
Smoking cessation has not been associated with an increase in birthweight
Intervention programs can improve rates of smoking cessation by 50%
Smoking cessation during the first trimester promotes similar neonatal outcomes compared with smoking through the third trimester
Reducing the number of cigarettes consumed appears as effective as smoking cessation in improving birthweight

Answers:

Which of the following statements about maternal smoking and birthweight is most accurate?
Answer: Cigarette use in the third trimester appears to have the strongest relationship with birthweight
There is a synergistic effect between older maternal age and smoking in promoting IUGR. Body mass index does not mitigate the effects of smoking in reducing birthweight, and an inverse dose-response relationship has been demonstrated between maternal smoking habits and birthweight.

Maternal smoking is least likely to negatively affect which of the following measures among newborns?
Answer: Subcutaneous fat
Previous research has found that maternal smoking predominantly lowers newborn weight, limb length, and head circumference. However, maternal smoking appears to leave measures of subcutaneous fat in newborns relatively unchanged.

Which of the following statements about fetal ultrasound among women who smoke is most accurate?
Answer: Women who smoke during pregnancy should routinely be assessed with ultrasound early in the third trimester
Maternal smoking has been associated with reduced renal and cardiac volume, reduced long bone length, and reduced biparietal and occipitofrontal diameters on fetal ultrasound. Therefore, ultrasound should be routinely performed during the early third trimester among women who smoke.

Which of the following statements about smoking cessation during pregnancy is most accurate?
Answer: Intervention programs can improve rates of smoking cessation by 50%
Smoking cessation is associated with improved birthweight, and women who quit smoking cessation during the first trimester have similar anthropometric neonatal outcomes compared with never-smokers. Smoking cessation is more effective than reducing cigarette consumption in improving birthweight.