Endocrine

Endocrine

Which hypoglycemic agent should be avoided in patients with a glomerular filtration rate (GFR) less than 25 mL/min/1.73 m²?

A. Metformin

B. Glyburide

C. Insulin

D. Acarbose

Answer: A

In general, metformin should be avoided in patients with chronic kidney disease (CKD), although observational data suggests that it may be safe to use in patient with GFR less than 30 mL/min/1.73 m². If it is used at lower GFRs, the dose should be decreased and patients should be counseled to stop metformin when they have a high likelihood of volume depletion, such as if they are vomiting or have diarrhea. Glyburide is a sulfonylurea and may be used in CKD, as can insulin. Acarbose is an alpha-glucosidase inhibitor and can be used in patients with CKD.

Reference:

American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes – 2020. Diabetes Care. 2020;43(1): S98-110.

According to the American Diabetes Association (ADA), which of the following criteria can be used in the diagnosis of diabetes in nonpregnant adults?

A. A_1c greater than or equal to 7.0

B. Fasting plasma glucose (FPG) of greater than or equal to 126

C. Oral glucose tolerance test (OGTT) with 2-hour plasma glucose greater than or equal to 180

D. Classic symptoms of hyperglycemia and random glucose of greater than or equal to 180

Answer: B

According to the ADA guidelines, the diagnosis of diabetes in nonpregnant adults can be made by any of the following:

• A_1c greater than or equal to 6.5%

• Fasting plasma glucose (FPG) greater than or equal to 126 mg/dL (7.0 mmol/L); fasting is defined as no caloric intake for at least 8 hours.

• Oral glucose tolerance test (OGTT, 75-gram anhydrous glucose) with measured plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L) at 2 hours (after the glucose load)

• Classic symptoms of hyperglycemia (polyuria, polydipsia, and unexplained weight loss) and random glucose greater than or equal to 200 mg/dL (11.1 mmol/L)

Reference:

American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020; 43(1):S14-S31.

With what condition is prediabetes most commonly associated?

A. Chronic pancreatitis

B. Hyperlipidemia