Diabetes Management Chart Chat Questions

According to the chart, what is the recommended initial drug therapy for type 2 diabetes?
A) Insulin
B) Sulfonylureas (SU)
C) Metformin
D) GLP-1 Receptor Agonist (GLP-1 RA)

C

Which of the following drug combinations has the highest risk of gastrointestinal (GI) side effects?

A) Metformin + DPP4i
B) Metformin + SGLT2i
C) Metformin + GLP-1 RA
D) Metformin + Insulin

C

Which of the following medications is associated with weight gain?
A) Metformin
B) SGLT2 inhibitors
C) GLP-1 Receptor Agonists
D) Sulfonylureas (SU)

D

What is the next step if a patient on dual therapy does not achieve their HbA1c target after about 3 months?
A) Discontinue all medication and start lifestyle modification
B) Proceed to triple therapy
C) Switch to monotherapy
D) Increase physical activity only

B

Which of the following drug classes has a high risk of hypoglycemia?
A) DPP4 inhibitors
B) Sulfonylureas (SU)
C) GLP-1 Receptor Agonists
D) SGLT2 inhibitors

B

Which medication combination is associated with the highest risk of weight loss?
A) Metformin + Sulfonylurea
B) Metformin + GLP-1 RA
C) Metformin + TZD
D) Metformin + Insulin

B

Which of the following drug combinations is associated with an increased risk of edema, heart failure, and bone fractures?
A) Metformin + DPP4i
B) Metformin + Sulfonylurea
C) Metformin + TZD
D) Metformin + SGLT2i

C

What is the recommended next step if HbA1c target is not achieved after ~3 months of triple therapy and the patient is already on oral therapy?
A) Continue the same therapy for 3 more months
B) Move to injectable therapy
C) Stop all medications and focus only on lifestyle changes
D) Replace metformin with insulin

B

Which of the following drug combinations has a high risk of gastrointestinal (GI) side effects and dehydration?
A) Metformin + TZD
B) Metformin + SGLT2i
C) Metformin + DPP4i
D) Metformin + Sulfonylurea

B

Which of the following therapy options is suggested if a patient is on basal insulin but still not achieving their HbA1c goal?
A) Add GLP-1 RA or mealtime insulin
B) Reduce insulin dose and add DPP4i
C) Discontinue basal insulin and switch to sulfonylurea
D) Increase the basal insulin dose indefinitely

A

What is the first-line pharmacologic treatment for most patients with type 2 diabetes?
A) Sulfonylurea (SU)
B) Metformin
C) Insulin
D) GLP-1 Receptor Agonist (GLP-1 RA)

B

If a patient on metformin monotherapy does not reach their HbA1c goal after ~3 months, what is the next recommended step?
A) Continue metformin alone and reassess in another 3 months
B) Add a second medication (dual therapy)
C) Switch from metformin to insulin
D) Stop metformin and start sulfonylurea

B

When adding a second agent to metformin, which of the following should be considered for a patient at high risk of hypoglycemia?
A) Sulfonylurea (SU)
B) Insulin
C) DPP4 inhibitor (DPP4i)
D) TZD

C

A patient on dual therapy with metformin + sulfonylurea still has an elevated HbA1c after 3 months. What is the next step in treatment?
A) Add a third medication (triple therapy)
B) Stop sulfonylurea and switch to insulin
C) Increase sulfonylurea dose indefinitely
D) Stop all medications and recommend only lifestyle modifications

A

Which of the following is a recommended third agent in triple therapy when a patient is already on metformin + sulfonylurea?
A) TZD
B) SGLT2 inhibitor
C) GLP-1 RA
D) Any of the above

D

If a patient fails triple therapy after ~3 months, what is the recommended next step?
A) Move to injectable therapy
B) Replace all medications with insulin
C) Reduce medication doses and continue monitoring
D) Stop all oral medications and rely only on lifestyle changes

A

If a patient on triple therapy is being moved to injectable therapy, which of the following is the preferred first injectable option?
A) Basal insulin
B) GLP-1 Receptor Agonist (GLP-1 RA)
C) Premixed insulin
D) Both A and B are options

D

For patients already on basal insulin but not achieving their HbA1c goal, what is the next step?
A) Add mealtime (bolus) insulin or a GLP-1 RA
B) Discontinue basal insulin and switch to sulfonylurea
C) Increase basal insulin dose indefinitely
D) Stop all medications and rely on diet and exercise alone

A

Which of the following statements is true regarding stepwise treatment intensification for type 2 diabetes?
A) Insulin should always be the second-line therapy after metformin
B) If a patient does not reach their HbA1c goal, therapy should be intensified every ~3 months
C) Dual therapy is only needed for patients with HbA1c >10%
D) Once insulin is started, all other diabetes medications must be discontinued

B

If a patient on basal insulin + mealtime insulin is still not achieving glycemic control, what is a recommended next step?
A) Add an SGLT2 inhibitor or TZD
B) Switch to only metformin
C) Stop insulin completely and restart oral agents
D) Increase carbohydrate intake to balance insulin levels

A

A 55-year-old male with newly diagnosed type 2 diabetes has an HbA1c of 7.8%. He has no history of cardiovascular disease or kidney disease. His BMI is 28 kg/m².

What is the best initial treatment for this patient?

A) Lifestyle modifications only
B) Metformin
C) Insulin
D) Sulfonylurea

B

A 60-year-old female with type 2 diabetes has been on metformin for 3 months, but her HbA1c remains 9.2%. She is concerned about weight gain and has a history of heart failure.

Which of the following would be the best second-line therapy for her?

A) Sulfonylurea
B) SGLT2 inhibitor
C) TZD
D) Insulin

B

A 48-year-old male with type 2 diabetes has been on metformin + sulfonylurea for 3 months. His HbA1c is still 8.9%, and he has frequent hypoglycemia episodes.

Which adjustment is the best next step?

A) Switch sulfonylurea to an SGLT2 inhibitor
B) Add basal insulin
C) Increase sulfonylurea dose
D) Stop metformin

A

A 65-year-old male with type 2 diabetes has been on triple therapy (metformin + GLP-1 RA + SGLT2i) for 3 months, but his HbA1c remains 9.5%. He is not at goal, and his fasting blood glucose is still high.

What is the next step in management?

A) Add basal insulin
B) Switch to sulfonylurea
C) Stop SGLT2i and add DPP4i
D) Continue current therapy and wait another 3 months

A

A 70-year-old female with long-standing diabetes has been on basal insulin for 3 months, but her post-meal blood sugars are still elevated. Her HbA1c is 8.7%.

What is the best next step?

A) Add mealtime (bolus) insulin
B) Increase basal insulin dose
C) Stop insulin and restart oral medications
D) Add sulfonylurea

A

A 45-year-old male with type 2 diabetes is overweight (BMI 32 kg/m²) and has an HbA1c of 8.5% despite taking metformin for 6 months. He wants to lose weight and avoid insulin.

Which medication is the best second-line option?

A) Sulfonylurea
B) TZD
C) GLP-1 RA
D) Insulin

C

A 68-year-old female with chronic kidney disease (CKD, eGFR = 25 mL/min) has type 2 diabetes.

Which medication should be avoided in this patient?

A) SGLT2 inhibitor
B) DPP4 inhibitor
C) Sulfonylurea
D) Metformin

D

A 72-year-old male with a history of heart failure and type 2 diabetes is on metformin but still has an HbA1c of 8.3%. He is concerned about fluid retention.

Which medication should be avoided?

A) GLP-1 RA
B) SGLT2 inhibitor
C) TZD
D) DPP4 inhibitor

C

A 50-year-old female with type 2 diabetes has been on metformin + SGLT2 inhibitor for 3 months. Her HbA1c is still 8.8%, and she experiences frequent gastrointestinal side effects.

Which medication might be worsening her symptoms?

A) Metformin
B) SGLT2 inhibitor
C) Sulfonylurea
D) TZD

A

A 55-year-old male with type 2 diabetes is currently on basal insulin + metformin but still has elevated post-meal blood sugars. He wants to avoid adding mealtime insulin due to concerns about weight gain.

What is an alternative option?

A) Add GLP-1 RA
B) Increase basal insulin dose
C) Add sulfonylurea
D) Stop basal insulin

A