Chronotherapy applications in diabetes management MCQs With Answer

Introduction: Chronotherapy applications in diabetes management MCQs With Answer explores how circadian biology influences drug action and glucose regulation, and how timing medication can optimize efficacy and safety for people with diabetes. This concise quiz-based resource is designed for M.Pharm students to deepen understanding of chronopharmacology principles, clinical strategies for timing antidiabetic agents, formulation approaches (timed-release/chronomodulated systems), and patient-specific considerations such as shift work, nocturnal hypoglycaemia, and biomarkers. Through clinically relevant multiple-choice questions with answers and focused rationale, students will build advanced competence in applying chronotherapy concepts to individualized therapeutic plans, trial design, and pharmacokinetic–pharmacodynamic optimization in diabetes care.

Q1. Which statement best defines chronotherapy in the context of diabetes management?

• Administering medications at random times to observe variable responses
• Timing drug administration to the patient’s circadian rhythms to maximize benefit and minimize adverse effects
• Using the highest tolerated dose at once-daily frequency
• Switching drugs periodically to avoid resistance

Correct Answer: Timing drug administration to the patient’s circadian rhythms to maximize benefit and minimize adverse effects

Q2. The “dawn phenomenon” in diabetes is primarily due to which physiological change occurring overnight?

• Decreased hepatic gluconeogenesis owing to nocturnal insulin surge
• Increased nocturnal growth hormone and cortisol secretion causing enhanced hepatic glucose output
• Enhanced peripheral glucose uptake because of melatonin rise
• Renal glucose reabsorption increase due to nocturnal ADH

Correct Answer: Increased nocturnal growth hormone and cortisol secretion causing enhanced hepatic glucose output

Q3. What is the chronotherapeutic rationale for administering metformin at night in some patients?

• To maximize intestinal absorption during fasting
• To suppress nocturnal hepatic gluconeogenesis and reduce fasting morning glucose
• To minimize interaction with morning statin therapy
• To increase renal clearance of the drug overnight

Correct Answer: To suppress nocturnal hepatic gluconeogenesis and reduce fasting morning glucose

Q4. Which sulfonylurea is most associated with prolonged hypoglycaemia and therefore higher risk of nocturnal hypoglycaemia if taken at night?

• Gliclazide
• Glipizide
• Glibenclamide (glyburide)
• Glimepiride

Correct Answer: Glibenclamide (glyburide)

Q5. Which insulin preparation’s pharmacodynamic profile (pronounced intermediate peak when administered at bedtime) has traditionally been exploited to control the dawn phenomenon?

• Insulin glargine U300
• Detemir
• NPH (Neutral Protamine Hagedorn) insulin
• Ultra‑rapid lispro

Correct Answer: NPH (Neutral Protamine Hagedorn) insulin

Q6. For targeting postprandial glucose excursions using chronotherapy, which class and dosing timing is most appropriate?

• Long‑acting GLP‑1 agonists given once weekly in the morning
• Short‑acting GLP‑1 receptor agonists administered before meals
• SGLT2 inhibitors at bedtime to reduce nocturnal glycaemia
• Basal insulin only, given at any fixed time

Correct Answer: Short‑acting GLP‑1 receptor agonists administered before meals

Q7. Which practical dosing recommendation for SGLT2 inhibitors aligns with chronotherapeutic principles to reduce sleep disturbance from nocturia?

• Administer the drug at bedtime
• Administer the drug in the morning
• Divide the dose twice daily (morning and night)
• Administer only after midnight

Correct Answer: Administer the drug in the morning

Q8. Which pharmacokinetic factor is most influenced by circadian variation and thereby affects the metabolism of several antidiabetic agents?

• Gastric pH remaining constant 24 hours
• Renal tubular secretion that does not vary diurnally
• Hepatic cytochrome P450 enzyme activity exhibiting diurnal fluctuation
• Plasma protein binding that is identical day and night

Correct Answer: Hepatic cytochrome P450 enzyme activity exhibiting diurnal fluctuation

Q9. Which glycemic biomarker is least affected by time-of-day and remains a long‑term integrative measure for assessing chronotherapy outcomes?

• Fasting plasma glucose
• Postprandial glucose at 2 hours
• Continuous glucose monitoring nocturnal nadir
• HbA1c

Correct Answer: HbA1c

Q10. What is the most appropriate chronotherapeutic strategy for a patient who is a permanent night-shift worker?

• Require all antidiabetic drugs be taken strictly at 0800 daily
• Individualize dosing and monitoring to align with the patient’s sleep–wake and meal schedule
• Stop all oral agents and use only insulin
• Administer all drugs only at bedtime irrespective of shift timing

Correct Answer: Individualize dosing and monitoring to align with the patient’s sleep–wake and meal schedule

Q11. For chronotherapy studies comparing morning versus evening dosing within the same patients, which clinical trial design is most efficient to control inter-individual variability?

• Parallel group randomized design
• Crossover randomized design
• Open-label case series
• Non-randomized observational cohort

Correct Answer: Crossover randomized design

Q12. Which drug delivery approach is most specifically described as “chronomodulated” to release antidiabetic drug at preprogrammed times, e.g., overnight to target dawn hyperglycaemia?

• Immediate-release tablets taken with breakfast
• Continuous infusion without variation
• Pulsatile or delayed/ timed‑release formulations that release drug after a lag time
• Enteric-coated formulations solely to prevent gastric irritation

Correct Answer: Pulsatile or delayed/ timed‑release formulations that release drug after a lag time

Q13. How does melatonin generally influence pancreatic beta‑cell function in the context of circadian regulation?

• Melatonin enhances insulin secretion through MT1 receptor activation
• Melatonin suppresses insulin secretion and modulates circadian insulin release
• Melatonin increases beta‑cell proliferation acutely
• Melatonin has no known effect on insulin physiology

Correct Answer: Melatonin suppresses insulin secretion and modulates circadian insulin release

Q14. The early morning cortisol surge contributes to which chronotherapeutic concern in people with diabetes?

• Reduced nocturnal hepatic glucose output
• Night‑time hypoglycaemia common after midnight snacks
• Morning hyperglycaemia due to increased gluconeogenesis and insulin resistance
• Increased insulin sensitivity at dawn

Correct Answer: Morning hyperglycaemia due to increased gluconeogenesis and insulin resistance

Q15. Which monitoring tool is most valuable to detect and quantify nocturnal hypoglycaemia when applying chronotherapeutic insulin strategies?

• Once‑monthly HbA1c measurement
• Intermittent finger‑stick checks at noon
• Continuous glucose monitoring (CGM) with nocturnal profiling
• Lipid profile testing

Correct Answer: Continuous glucose monitoring (CGM) with nocturnal profiling

Q16. To align insulin action with anticipated postprandial glucose peaks in a chronotherapeutic regimen, how should rapid‑acting insulin analogues generally be administered?

• 5–15 minutes before meals to match glucose absorption
• Only at bedtime to cover all meals
• Randomly during the day without relation to meals
• Once weekly as a bolus injection

Correct Answer: 5–15 minutes before meals to match glucose absorption

Q17. Which statin is classically recommended for nighttime dosing because endogenous cholesterol synthesis peaks nocturnally, and is therefore relevant in diabetic patients on combination therapy?

• Atorvastatin (long half‑life) exclusively in the morning
• Rosuvastatin at bedtime to reduce nocturnal synthesis
• Simvastatin administered at night to align with nocturnal cholesterol synthesis
• Pravastatin requiring twice‑daily dosing at midday and midnight

Correct Answer: Simvastatin administered at night to align with nocturnal cholesterol synthesis

Q18. Variants in which circadian regulatory gene family have been implicated in altered glycaemic responses and may affect chronotherapeutic outcomes?

• HMG‑CoA reductase gene family
• CLOCK and BMAL1 circadian clock genes
• CYP450 mitochondrial genes exclusively
• Insulin gene family with no circadian role

Correct Answer: CLOCK and BMAL1 circadian clock genes

Q19. Bedtime dosing of certain antihypertensives in diabetic patients is a chronotherapeutic strategy intended primarily to:

• Increase daytime blood pressure to improve perfusion
• Reduce nocturnal hypertension and attenuate the morning blood pressure surge, lowering CV risk
• Eliminate the need for glucose monitoring
• Enhance drug absorption by fasting state

Correct Answer: Reduce nocturnal hypertension and attenuate the morning blood pressure surge, lowering CV risk

Q20. Which practical prescribing caution reflects chronotherapeutic principles for patients with highly irregular meals or shift work?

• Prefer long‑acting sulfonylureas and fixed nighttime dosing
• Avoid long‑acting sulfonylureas (e.g., glibenclamide) because of unpredictable nocturnal hypoglycaemia risk
• Use bedtime immediate‑release insulin secretagogues only
• Discontinue all antidiabetic medications during night shifts

Correct Answer: Avoid long‑acting sulfonylureas (e.g., glibenclamide) because of unpredictable nocturnal hypoglycaemia risk

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