CDCES EXAM QUESTIONS WITH
100% CORRECT ANSWERS 2024
LATEST UPDATE
How long does it take to see the maximal effect of a TZD?
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. ≥8 weeks - Answer- D.
TZDs and CHF - Answer- TZDs are known for their association with fluid accumulation,
which results in weight gain, potentially caused by an increase in subcutaneous adipose
tissue and concomitant disease in visceral fat, as well as an increase in leptin levels
resulting in increased appetite. Furthermore, fluid retention is not only a contributor to
weight gain, but also a precipitator of CHF exacerbation. Both available TZDs,
pioglitazone and rosiglitazone, carry a black-box warning about their potential to cause
or exacerbate CHF. The weight gain and fluid accumulation seen with TZDs are dose-
dependent; therefore, when there is concern about potential fluid accumulation and
CHF exacerbation, lower doses should be used.
TZDs and CV outcomes - Answer- pioglitazone can offer improved CV outcomes in
patients with type 2 diabetes who are at high CV risk.
Sulfonylurea side effects - Answer- Sulfonylureas are known for increasing the risks of
weight gain and hypoglycemia and for being associated with a theoretical concern
regarding potential increased CV risk.
Sulfonylureas method of action - Answer- Sulfonylureas stimulate insulin secretion from
pancreatic β-cells. Because this effect does not occur in a glucose-dependent manner,
these agents can cause hypoglycemia, especially in patients with erratic eating
schedules.
iGlarLixi Dosing - Answer- The recommended starting dose of iGlarLixi is insulin
glargine/lixisenatide 15 units/5 μg once daily for patients who are naive to basal insulin
or GLP-1 receptor agonists, currently on a GLP-1 receptor agonist, or currently on <30
units of basal insulin daily. For patients on 30-60 units of basal insulin daily with or
without a GLP-1 receptor agonist, the recommended starting dose is insulin
glargine/lixisenatide 30 units/10 μg once daily. The iGlarLixi pen is designed for dialing
, up doses based on the insulin units. Every 1 unit of iGlarLixi 100/33 contains 1 unit of
insulin glargine and 0.33 μg of lixisenatide. Doses should be titrated by 2-4 units weekly
based on the degree to which the patient' FPG is above or below the target range. The
maximum recommended dose of iGlarLixi is insulin glargine/ lixisenatide 60 units/20 μg
once daily.
pre-recs for CGM - Answer- -The patient has a documented diagnosis of diabetes
-The patient has been performing frequent SMBG (at least four times daily)
-The patient is on insulin therapy with at least three daily injections or uses an insulin
pump
-The insulin regimen requires frequent adjustment based on therapeutic CGM testing
results
-Within 6 months before ordering the CGM device, the patient had an in-person visit
with the treating practitioner to evaluate diabetes control and determine whether the
above criteria had been met
-Every 6 months after the initial CGM prescription, the patient has an in-person visit with
the treating practitioner to assess adherence to the CGM regimen and diabetes
treatment plan
Trulicity - Answer- Dulaglutide
GLP-1 Receptor Antagonist
enhances glucose-dependent insulin secretion
suppresses PP glucagon
slows gastric emptying
increases satiety
Glucotrol (XL) - Answer- Glipizide
partially blocks potassium channels among beta cells of pancreatic islets of
Langerhans. This causes the cell to depolarize, causing opening of voltage-gated
calcium channels. Calcium influx encourages insulin release from beta cells.
Invokana - Answer- Canagliflozin
SGLT-2 inhibitor
inhibits sodium-glucose co-transporter 2 in the kidney to reduce glucose reabsorption,
resulting in increased glucose excretion & lower plasma glucose
Metformin - Answer- Glucophage
biguanide
100% CORRECT ANSWERS 2024
LATEST UPDATE
How long does it take to see the maximal effect of a TZD?
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. ≥8 weeks - Answer- D.
TZDs and CHF - Answer- TZDs are known for their association with fluid accumulation,
which results in weight gain, potentially caused by an increase in subcutaneous adipose
tissue and concomitant disease in visceral fat, as well as an increase in leptin levels
resulting in increased appetite. Furthermore, fluid retention is not only a contributor to
weight gain, but also a precipitator of CHF exacerbation. Both available TZDs,
pioglitazone and rosiglitazone, carry a black-box warning about their potential to cause
or exacerbate CHF. The weight gain and fluid accumulation seen with TZDs are dose-
dependent; therefore, when there is concern about potential fluid accumulation and
CHF exacerbation, lower doses should be used.
TZDs and CV outcomes - Answer- pioglitazone can offer improved CV outcomes in
patients with type 2 diabetes who are at high CV risk.
Sulfonylurea side effects - Answer- Sulfonylureas are known for increasing the risks of
weight gain and hypoglycemia and for being associated with a theoretical concern
regarding potential increased CV risk.
Sulfonylureas method of action - Answer- Sulfonylureas stimulate insulin secretion from
pancreatic β-cells. Because this effect does not occur in a glucose-dependent manner,
these agents can cause hypoglycemia, especially in patients with erratic eating
schedules.
iGlarLixi Dosing - Answer- The recommended starting dose of iGlarLixi is insulin
glargine/lixisenatide 15 units/5 μg once daily for patients who are naive to basal insulin
or GLP-1 receptor agonists, currently on a GLP-1 receptor agonist, or currently on <30
units of basal insulin daily. For patients on 30-60 units of basal insulin daily with or
without a GLP-1 receptor agonist, the recommended starting dose is insulin
glargine/lixisenatide 30 units/10 μg once daily. The iGlarLixi pen is designed for dialing
, up doses based on the insulin units. Every 1 unit of iGlarLixi 100/33 contains 1 unit of
insulin glargine and 0.33 μg of lixisenatide. Doses should be titrated by 2-4 units weekly
based on the degree to which the patient' FPG is above or below the target range. The
maximum recommended dose of iGlarLixi is insulin glargine/ lixisenatide 60 units/20 μg
once daily.
pre-recs for CGM - Answer- -The patient has a documented diagnosis of diabetes
-The patient has been performing frequent SMBG (at least four times daily)
-The patient is on insulin therapy with at least three daily injections or uses an insulin
pump
-The insulin regimen requires frequent adjustment based on therapeutic CGM testing
results
-Within 6 months before ordering the CGM device, the patient had an in-person visit
with the treating practitioner to evaluate diabetes control and determine whether the
above criteria had been met
-Every 6 months after the initial CGM prescription, the patient has an in-person visit with
the treating practitioner to assess adherence to the CGM regimen and diabetes
treatment plan
Trulicity - Answer- Dulaglutide
GLP-1 Receptor Antagonist
enhances glucose-dependent insulin secretion
suppresses PP glucagon
slows gastric emptying
increases satiety
Glucotrol (XL) - Answer- Glipizide
partially blocks potassium channels among beta cells of pancreatic islets of
Langerhans. This causes the cell to depolarize, causing opening of voltage-gated
calcium channels. Calcium influx encourages insulin release from beta cells.
Invokana - Answer- Canagliflozin
SGLT-2 inhibitor
inhibits sodium-glucose co-transporter 2 in the kidney to reduce glucose reabsorption,
resulting in increased glucose excretion & lower plasma glucose
Metformin - Answer- Glucophage
biguanide
