Prediabetes is a critical high-risk state for the development of type 2 diabetes and its associated cardiovascular complications. While intensive lifestyle modification is the absolute cornerstone of management, pharmacologic therapy with agents like metformin may be considered for certain high-risk individuals. As covered within the broader context of diabetes management in the Patient Care 5 curriculum, pharmacists must understand the evidence and guideline recommendations for diabetes prevention to provide optimal patient care. This quiz will test your knowledge on identifying appropriate candidates and managing pharmacotherapy for prediabetes.
1. Prediabetes is diagnosed with which of the following laboratory values?
- a. A1c < 5.7%
- b. Fasting plasma glucose of 90 mg/dL
- c. A1c between 5.7% and 6.4%
- d. 2-hour OGTT glucose > 200 mg/dL
Answer: c. A1c between 5.7% and 6.4%
2. What is the cornerstone and first-line intervention for all patients with prediabetes?
- a. Immediate initiation of metformin.
- b. Intensive lifestyle modification, including diet and physical activity.
- c. A low-carbohydrate diet only.
- d. Annual A1c monitoring only.
Answer: b. Intensive lifestyle modification, including diet and physical activity.
3. The Diabetes Prevention Program (DPP) trial demonstrated that intensive lifestyle modification was:
- a. Less effective than metformin in preventing the progression to type 2 diabetes.
- b. More effective than metformin in preventing the progression to type 2 diabetes.
- c. Equally as effective as metformin.
- d. Ineffective for diabetes prevention.
Answer: b. More effective than metformin in preventing the progression to type 2 diabetes.
4. According to ADA guidelines, pharmacologic therapy with metformin should be considered for prediabetes in which of the following patients?
- a. All patients diagnosed with prediabetes.
- b. Patients with a BMI ≥ 35 kg/m², those aged < 60 years, or women with a history of gestational diabetes.
- c. Only patients over the age of 70.
- d. Only patients with an A1c between 5.7% and 5.8%.
Answer: b. Patients with a BMI ≥ 35 kg/m², those aged < 60 years, or women with a history of gestational diabetes.
5. What is the only medication recommended by the American Diabetes Association (ADA) for the prevention of type 2 diabetes?
- a. Glipizide
- b. Pioglitazone
- c. Liraglutide
- d. Metformin
Answer: d. Metformin
6. The “Management of Diabetes” is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. What is the primary mechanism of action of metformin?
- a. It stimulates insulin secretion from the pancreas.
- b. It decreases hepatic glucose production.
- c. It inhibits the DPP-4 enzyme.
- d. It blocks the reabsorption of glucose in the kidneys.
Answer: b. It decreases hepatic glucose production.
8. The goal of intensive lifestyle modification for diabetes prevention is a weight loss of at least:
- a. 2%
- b. 5%
- c. 7%
- d. 15%
Answer: c. 7%
9. A common side effect of metformin that requires slow dose titration is:
- a. Hypoglycemia
- b. Weight gain
- c. Gastrointestinal upset (diarrhea, nausea)
- d. Edema
Answer: c. Gastrointestinal upset (diarrhea, nausea)
10. How often should patients with prediabetes be monitored for progression to type 2 diabetes?
- a. Every 5 years
- b. Every 3 years
- c. Annually
- d. Monthly
Answer: c. Annually
11. The introduction to diabetes pathophysiology and management is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. A fasting plasma glucose of 115 mg/dL is classified as:
- a. Normal fasting glucose
- b. Impaired fasting glucose (prediabetes)
- c. Diabetes
- d. Hypoglycemia
Answer: b. Impaired fasting glucose (prediabetes)
13. The goal of pharmacologic therapy in prediabetes is to:
- a. Cure the condition.
- b. Delay or prevent the onset of type 2 diabetes.
- c. Allow the patient to avoid lifestyle changes.
- d. Treat cardiovascular disease.
Answer: b. Delay or prevent the onset of type 2 diabetes.
14. A patient should be counseled to take metformin:
- a. On an empty stomach.
- b. With meals to reduce GI side effects.
- c. Only at bedtime.
- d. 30 minutes before meals.
Answer: b. With meals to reduce GI side effects.
15. Educating a patient on how to monitor a health condition like blood glucose is a key objective for student pharmacists.
- a. True
- b. False
Answer: a. True
16. Which of the following agents is NOT typically considered for prediabetes management due to its risk of hypoglycemia and weight gain?
- a. Metformin
- b. A sulfonylurea like glyburide
- c. A TZD like pioglitazone
- d. An alpha-glucosidase inhibitor like acarbose
Answer: b. A sulfonylurea like glyburide
17. The pharmacology of oral diabetes medications is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
18. The recommended amount of physical activity for diabetes prevention is:
- a. 30 minutes per week.
- b. 60 minutes per week.
- c. 100 minutes per week.
- d. At least 150 minutes per week of moderate-intensity activity.
Answer: d. At least 150 minutes per week of moderate-intensity activity.
19. A pharmacist’s role in prediabetes management includes:
- a. Identifying at-risk patients.
- b. Providing intensive counseling on lifestyle modifications.
- c. Recommending metformin in appropriate candidates.
- d. All of the above.
Answer: d. All of the above.
20. An active learning session on diabetes is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A patient with an A1c of 6.2% is diagnosed with:
- a. Normal glucose tolerance
- b. Type 2 Diabetes
- c. Prediabetes
- d. Type 1 Diabetes
Answer: c. Prediabetes
22. Which of the following is NOT a risk factor for developing prediabetes and type 2 diabetes?
- a. Obesity
- b. Family history
- c. Regular physical activity
- d. Age ≥ 45 years
Answer: c. Regular physical activity
23. Long-term use of metformin can be associated with a deficiency in:
- a. Vitamin C
- b. Vitamin B12
- c. Iron
- d. Calcium
Answer: b. Vitamin B12
24. An active learning session on diabetes is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. Although not FDA-approved for prediabetes, which weight loss medication class has been shown to reduce the incidence of T2DM?
- a. GLP-1 receptor agonists
- b. Orlistat
- c. Both a and b
- d. Neither a nor b
Answer: c. Both a and b
26. The primary benefit of treating prediabetes is:
- a. It allows the patient to eat whatever they want.
- b. It reduces the risk of progressing to type 2 diabetes and its associated complications.
- c. It guarantees weight loss.
- d. It is cost-effective in the short term.
Answer: b. It reduces the risk of progressing to type 2 diabetes and its associated complications.
27. Before recommending metformin, a pharmacist should ensure the patient does not have a contraindication, such as:
- a. Hypertension
- b. Severe renal impairment (e.g., eGFR < 30).
- c. High cholesterol
- d. A history of smoking.
Answer: b. Severe renal impairment (e.g., eGFR < 30).
28. An active learning session on diabetes is part of which course module?
- a. Module 1: Diabetes Mellitus
- b. Module 3: Women’s Health
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 1: Diabetes Mellitus
29. The Diabetes Prevention Program (DPP) was a major landmark trial that established the effectiveness of:
- a. Insulin for prediabetes.
- b. Lifestyle modification and metformin for diabetes prevention.
- c. Bariatric surgery for prediabetes.
- d. A low-fat diet only.
Answer: b. Lifestyle modification and metformin for diabetes prevention.
30. The management of diabetes is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. The focus of nutritional counseling for prediabetes is on:
- a. Portion control.
- b. The quality of food choices (e.g., whole grains, lean proteins).
- c. Reducing intake of sugar-sweetened beverages.
- d. All of the above.
Answer: d. All of the above.
32. A 55-year-old male with a BMI of 36 kg/m² and an A1c of 6.1% is a candidate for which pharmacologic therapy?
- a. Glipizide
- b. Insulin
- c. Metformin
- d. None, he is not a candidate for pharmacotherapy.
Answer: c. Metformin
33. What is the best way a pharmacist can support a patient trying to make lifestyle changes for prediabetes?
- a. By providing regular follow-up, encouragement, and education.
- b. By telling them what to do without discussion.
- c. By focusing only on their A1c value.
- d. By only discussing medication.
Answer: a. By providing regular follow-up, encouragement, and education.
34. Prediabetes is considered a reversible condition for many patients.
- a. True
- b. False
Answer: a. True
35. A pharmacist counseling a patient on lifestyle changes is fulfilling which course objective?
- a. Objective 11 from PHA5161L: “…counsel the patient on lifestyle modifications.”
- b. Objective 4 from PHA5784C: “Administer Medications Through Enteral Tubes”
- c. Objective 2 from PHA5104: “Aseptic Technique”
- d. None of the above
Answer: a. Objective 11 from PHA5161L: “…counsel the patient on lifestyle modifications.”
36. While thiazolidinediones (TZDs) have shown efficacy in preventing T2DM, their use is limited due to concerns about:
- a. Hypoglycemia
- b. Lactic acidosis
- c. Weight gain, edema, and heart failure risk.
- d. Nausea and vomiting.
Answer: c. Weight gain, edema, and heart failure risk.
37. The initial starting dose of metformin for prediabetes or diabetes is typically:
- a. 2000 mg twice daily
- b. 500 mg once or twice daily with meals
- c. 1000 mg twice daily
- d. 850 mg three times a day
Answer: b. 500 mg once or twice daily with meals
38. The medicinal chemistry of diabetes medications is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
39. The most impactful intervention for preventing the progression of prediabetes to type 2 diabetes is:
- a. Metformin
- b. Acarbose
- c. Weight loss through intensive lifestyle modification.
- d. A vitamin supplement.
Answer: c. Weight loss through intensive lifestyle modification.
40. An active learning session covering diabetes management is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. Why are sulfonylureas not recommended for prediabetes?
- a. They are not effective at lowering blood glucose.
- b. They can cause hypoglycemia and weight gain, which are undesirable in this population.
- c. They are too expensive.
- d. They are only available as injections.
Answer: b. They can cause hypoglycemia and weight gain, which are undesirable in this population.
42. A key role for the pharmacist is to identify patients taking medications that can increase blood glucose and worsen prediabetes, such as:
- a. ACE inhibitors
- b. Statins
- c. Systemic corticosteroids
- d. Metformin
Answer: c. Systemic corticosteroids
43. A patient’s 2-hour oral glucose tolerance test result is 175 mg/dL. This is diagnostic for:
- a. Normal glucose tolerance
- b. Impaired glucose tolerance (prediabetes)
- c. Diabetes
- d. Reactive hypoglycemia
Answer: b. Impaired glucose tolerance (prediabetes)
44. The pathophysiology of prediabetes is characterized by:
- a. Absolute insulin deficiency.
- b. Normal insulin sensitivity.
- c. The beginning stages of insulin resistance and beta-cell dysfunction.
- d. Autoimmune destruction of the pancreas.
Answer: c. The beginning stages of insulin resistance and beta-cell dysfunction.
45. Screening for prediabetes and type 2 diabetes should begin at age 35 for all adults.
- a. True
- b. False
Answer: a. True
46. Which of the following is NOT a goal of prediabetes management?
- a. To achieve and maintain 7% weight loss.
- b. To increase physical activity to 150 min/week.
- c. To normalize glucose levels.
- d. To start insulin therapy immediately.
Answer: d. To start insulin therapy immediately.
47. A pharmacist can promote public health by:
- a. Offering prediabetes screening services or awareness campaigns.
- b. Counseling patients on risk factors.
- c. Providing group classes on healthy eating.
- d. All of the above.
Answer: d. All of the above.
48. An active learning session on diabetes is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
49. The overall management of prediabetes is focused on:
- a. High-intensity pharmacotherapy.
- b. Risk reduction through lifestyle changes, with pharmacotherapy as a secondary option for high-risk individuals.
- c. A watch-and-wait approach.
- d. Bariatric surgery.
Answer: b. Risk reduction through lifestyle changes, with pharmacotherapy as a secondary option for high-risk individuals.
50. The ultimate goal of managing prediabetes is to:
- a. Sell more metformin.
- b. Prevent or delay the onset of type 2 diabetes and its associated cardiovascular and microvascular complications.
- c. Ensure every patient knows their A1c value.
- d. Have the patient lose as much weight as possible.
Answer: b. Prevent or delay the onset of type 2 diabetes and its associated cardiovascular and microvascular complications.