a. 70%, 60%, and 50%
b. 50%, 45%, and 40%
c. 30%, 20%, and 25%
d. 40%, 30%, and 35%

2. A Diabetes Outcome Progression Trial (ADOPT) compared the durability of glycemic control in 4360 persons with newly diagnosed diabetes receiving rosiglitazone, at a maximal dose of 8 mg/day; metformin, a maximal dose of 2000 mg/day; and glyburide, at a maximal dose of 15 mg/day. Fasting glucose levels remained below 180 mg/dl:

a. For the longest time with rosiglitazone, and for the shortest time with glyburide
b. For the longest time with metformin, and for the shortest time with glyburide
c. For the longest time with rosiglitazone, and for the shortest time with metformin
d. For the longest time with glyburide, and for the shortest time with rosiglitazone

3. Combination hypoglycemic agent therapy approaches most frequently use metformin with a sulfonylurea. When three agents are used, choices may include which of the following:

i. Addition of a thiazolidinedione
ii. Addition of insulin
iii. Addition of a DPP-4 inhibitor
iv. Addition of exenatide
v. Addition of an alpha-glucosidease inhibitor

The most appropriate response is:

a. i and ii are most common, but all are reasonable approaches
b. ii is the only acceptable approach
c. i or ii are the only acceptable approaches
d. iv is the most logical approach

4. More than one quarter of persons with diabetes in the United States receive insulin, usually in combination with one or more oral hypoglycemic agents. The prevalence of psychological unwillingness to take insulin is closest to:

a. 75-90%
b. 15-30%
c. 45-60%

5. Adverse consequences of insulin treatment of type 2 diabetic persons include weight gain and hypoglycemia.

a. Average weight gain is approximately 6 pounds, and hypoglycemia occurs in approximately 15% and is severe in approximately 1% of treated patients
b. Average weight gain is approximately 10 pounds, and hypoglycemia occurs in approximately 35% and is severe in approximately 3% of treated patients
c. Average weight gain is approximately 14 pounds, and hypoglycemia occurs in approximately 45% and is severe in approximately 5% of treated patients
d. Average weight gain is approximately 18 pounds, and hypoglycemia occurs in approximately 60% and is severe in approximately 7% of treated patients

6. Define the incretin effect:

a. Ingested nutrient increases gastric emptying and hence is associated with greater increase in glucose than equivalent parenterally administered nutrient.
b. Ingested nutrient causes a greater degree of satiety than equivalent parenterally administered nutrient.
c. Ingested nutrient increases insulin levels to a greater extent than equivalent parenterally administered nutrient.

7. A concern in use of incretin-based therapy for type 2 diabetes has been the relative resistance to glucose-dependent insulinotropic peptide (GIP). When insulin is administered for one month to type 2 diabetic persons, achieving relative normalization of glucose levels, the insulin secretory responses to hyperglycemia with infusion of GIP, to hyperglycemia with infusion of glucagon-like peptide (GLP)-1, and to hyperglycemia alone are:

a. Increased 2-3-fold
b. Unchanged
c. Decreased 2-3-fold

8. Exenatide and liraglutide are treatments for type 2 diabetes associated with which of the following?

i. Weight loss
ii. Gastrointestinal side effects
iii. Increased GLP-1 and GIP levels
iv. Increased insulin secretion
v. Hypoglycemia

a. All of these
b. i, ii, and iii
c. i,iii, and v
d. iii and iv
e. i, ii, and iv

9. Vildagliptin and sitagliptin are treatments for type 2 diabetes associated with which of the following?

i. Weight loss
ii. Gastrointestinal side effects
iii. Increased GLP-1 and GIP levels
iv. Increased insulin secretion
v. Hypoglycemia

a. All of these
b. i, ii, and iii
c. i, iii, and v
d. iii and iv
e. i, ii, and iv