a. True
b. False

2. True or False: Weight gain, although well-recognized to be associated with insulin treatment, is of little consequence given the overall improvement in outcome seen with reduction in glycemia.

a. True
b. False

3. Glycemic therapies which may ameliorate the weight gain associated with insulin treatment include all of the following EXCEPT:

1. Metformin combination with insulin
2. Use of insulin detemir as a basal insulin
3. Thiazolidinedione combination with insulin
4. Administration of insulin with pramlintide, or possibly with exenatide

4. Pharmacologic and surgical approaches specifically addressing weight loss may also be useful in the treatment of diabetic patients. Which of the following are associated with the lowest risk of side effects?

1. Orlistat
2. Sibutramine
3. Rimonabant
4. Laparoscopic adjustable gastric band placement
5. Lifestyle modification

5. Obstructive sleep apnea has been shown to be associated with all of the following EXCEPT:

1. Diabetes
2. Insulin resistance
3. Hypertension
4. Impaired fasting glucose / impaired glucose tolerance
5. Cardiac arrhythmias
6. Stroke

6. Nonalcoholic fatty liver disease is strongly associated with obesity. Current theories of pathogenesis include the concepts that:

1. Obesity, via increased adipocyte cytokine production and/or increased fatty acid release, leads to hepatic fat deposition.
2. Hepatic cytokine overproduction in obesity is associated with increased fat deposition.
3. Both (a) and (b)

7.  True or False: Non-diabetic children with body mass index above the 98th percentile have higher than expected prevalence of positive glutamic acid dehydroxylase-65 and islet cell associated antibodies.

a. True
b. False

8. True or False: During the period prior to the development of diabetes, studies carried out over periods up to 30 years suggest that 2-hour post glucose load blood glucose levels show steady and progressive increase.

a. True
b. False

9. The prevalence of diabetes increased by almost three quarters in the United States from 1976 to 2004. This period also saw an increasing prevalence of obesity. Numerically, the greatest amount of increase in diabetes was due to:

1. an increase in overweight (BMI >25, <30 kg/m2)
2. an increase in class I obesity (BMI >30, <35 kg/m2)
3. an increase in severe obesity (BMI >35)

10. The concept of metabolic syndrome has been criticized as not adding to risk prognostication beyond the risks due to the component factors. Studies presented at the ADA meeting contradict this by suggesting:

1. Persons with metabolic syndrome show similar frequency of development of diabetes with fasting glucose 100-125 and 110-125, suggesting an additive effect of the syndrome to diabetes risk.

2. Persons with normal waist circumference are at lower risk of other syndrome components, while there is greater-than-expected clustering of all five and of four of the five components.

3. Both (a) and (b)

4. Neither (a) nor (b)