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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. A1c 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:

  • A1c 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

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