Recent advances in diabetes mellitus management MCQs With Answer

Recent advances in diabetes mellitus management MCQs With Answer

This quiz set is designed for M.Pharm students specializing in Advanced Pharmacology-II, focusing on contemporary therapeutic developments in diabetes care. It emphasizes mechanistic insights, novel agents, device-based therapies, and safety profiles that are relevant to clinical pharmacology and drug development. Questions cover SGLT2 inhibitors, GLP-1 and dual incretin agonists, oral peptide formulations, closed-loop insulin delivery, renal and cardiovascular outcome evidence, and emerging molecular and cell-based strategies. Each MCQ targets comprehension, application, and critical appraisal skills necessary for postgraduate pharmacology exams and research, helping students synthesize current literature and translate advances into pharmacotherapeutic decisions.

Q1. Which primary mechanism best explains the cardiovascular and renal benefit observed with SGLT2 inhibitors in large outcome trials?

• Enhancement of pancreatic beta cell proliferation
• Reduction of intraglomerular pressure via natriuresis and hemodynamic effects
• Direct GLP-1 receptor activation in cardiac myocytes
• Potent inhibition of hepatic gluconeogenesis

Correct Answer: Reduction of intraglomerular pressure via natriuresis and hemodynamic effects

Q2. Tirzepatide’s superior glycaemic and weight-loss effects compared with single incretin agonists are primarily due to agonism at which receptors?

• GLP-1 and glucagon receptors
• GIP and GLP-1 receptors
• DPP-4 and GLP-1 receptors
• Amylin and GLP-1 receptors

Correct Answer: GIP and GLP-1 receptors

Q3. Which safety concern is most specifically associated with SGLT2 inhibitor use in type 1 diabetes or insulin-treated type 2 diabetes?

• Increased risk of severe hypoglycaemia due to insulin potentiation
• Euglycaemic diabetic ketoacidosis (euDKA)
• Marked elevation of LDL cholesterol causing MI
• Diffuse maculopathy and vision loss

Correct Answer: Euglycaemic diabetic ketoacidosis (euDKA)

Q4. Which formulation breakthrough allowed oral semaglutide to achieve clinically meaningful bioavailability despite peptide degradation in the GI tract?

• Co-formulation with an enteric-coated microcapsule
• Use of an absorption enhancer (SNAC) that increases gastric pH and mucosal permeability
• PEGylation of the peptide backbone to resist proteases
• Conjugation to a bile acid for lymphatic uptake

Correct Answer: Use of an absorption enhancer (SNAC) that increases gastric pH and mucosal permeability

Q5. Which class of novel small molecules directly targets hepatic glucose sensing to stimulate insulin-independent glucose uptake and is under investigation for diabetes?

• Glucokinase activators
• SGLT1 inhibitors
• DPP-4 inhibitors
• PPAR-γ agonists

Correct Answer: Glucokinase activators

Q6. Which mechanistic explanation best describes how GLP-1 receptor agonists reduce cardiovascular risk beyond glycaemic control?

• Direct diuretic action reducing preload
• Promotion of plaque stabilization and anti-inflammatory effects
• Blocking sodium-glucose cotransport in the proximal tubule
• Increasing hepatic glycogenolysis to buffer glucose

Correct Answer: Promotion of plaque stabilization and anti-inflammatory effects

Q7. Sotagliflozin differs from selective SGLT2 inhibitors because it also inhibits which transporter?

• SGLT3
• SGLT1
• GLUT2
• SGLT5

Correct Answer: SGLT1

Q8. Which device-based innovation constitutes a true “closed-loop” insulin delivery system?

• An insulin pump programmed with patient-set basal rates and scheduled boluses
• A continuous glucose monitor linked to an algorithm that automatically adjusts insulin infusion in real time
• A pen device with memory that reminds the user of dosing history
• An implantable long-acting insulin depot requiring monthly refills

Correct Answer: A continuous glucose monitor linked to an algorithm that automatically adjusts insulin infusion in real time

Q9. Which outcome has been consistently improved by SGLT2 inhibitors in trials of patients with chronic kidney disease?

• Reversal of diabetic neuropathy symptoms
• Slowing of estimated glomerular filtration rate (eGFR) decline and reduction in renal endpoints
• Complete remission of albuminuria in all patients
• Normalization of serum potassium levels

Correct Answer: Slowing of estimated glomerular filtration rate (eGFR) decline and reduction in renal endpoints

Q10. Which emerging therapeutic strategy aims to restore endogenous insulin production by replacing or regenerating pancreatic beta cells?

• Long-acting insulin analogues
• Beta-cell replacement with stem cell–derived islet transplants
• SGLT2 inhibition to protect residual beta cells
• GLP-1 receptor agonists for weight loss

Correct Answer: Beta-cell replacement with stem cell–derived islet transplants

Q11. DPP-4 inhibitors primarily exert their glucose-lowering effect by which mechanism?

• Preventing renal glucose reabsorption
• Prolonging endogenous incretin hormone activity (GLP-1 and GIP)
• Directly stimulating insulin release via sulfonylurea receptor binding
• Increasing insulin sensitivity in peripheral muscle through AMPK activation

Correct Answer: Prolonging endogenous incretin hormone activity (GLP-1 and GIP)

Q12. Which adverse event is most commonly associated with GLP-1 receptor agonists and often limits dose escalation?

• Severe neutropenia
• Gastrointestinal symptoms such as nausea and vomiting
• Hypertensive crises
• Diffuse alopecia

Correct Answer: Gastrointestinal symptoms such as nausea and vomiting

Q13. Precision medicine in diabetes aims to tailor therapy based on which of the following patient-specific data?

• Only fasting blood glucose values
• Genetic markers, phenotypic traits, and biomarkers predicting drug response and risk
• Universal therapy based on body weight alone
• Random allocation to newest available drug classes

Correct Answer: Genetic markers, phenotypic traits, and biomarkers predicting drug response and risk

Q14. Amylin analogues (e.g., pramlintide) improve glycaemic control primarily by which actions?

• Increasing renal glucose excretion via SGLT2 blockade
• Slowing gastric emptying, suppressing glucagon, and decreasing postprandial glucose excursions
• Stimulating hepatic glycogenolysis to prevent hypoglycaemia
• Enhancing peripheral glucose uptake by upregulating GLUT4 transcription

Correct Answer: Slowing gastric emptying, suppressing glucagon, and decreasing postprandial glucose excursions

Q15. Which of the following best describes the mechanism by which bariatric surgery improves type 2 diabetes in many patients?

• Permanent inhibition of DPP-4 activity by surgical alteration of the gut
• Weight-independent changes in gut hormones, bile acid metabolism, and nutrient sensing that improve insulin sensitivity and secretion
• Direct pancreatic resection removing insulin-resistant islets
• Exclusive reduction of hepatic gluconeogenesis due to caloric restriction

Correct Answer: Weight-independent changes in gut hormones, bile acid metabolism, and nutrient sensing that improve insulin sensitivity and secretion

Q16. Which investigational approach uses patient-specific induced pluripotent stem cells (iPSCs) to generate insulin-producing cells with reduced immunogenicity?

• Allogeneic cadaveric islet transplantation without immunosuppression
• Autologous iPSC-derived beta-like cell transplantation with genome editing to reduce rejection
• Oral peptide vaccines to stimulate native beta-cell replication
• SGLT2 inhibitor therapy combined with metformin

Correct Answer: Autologous iPSC-derived beta-like cell transplantation with genome editing to reduce rejection

Q17. Which pharmacologic strategy is under investigation to harness the incretin axis but without injectable administration besides oral semaglutide?

• Inhaled insulin formulations only
• Orally bioavailable small-molecule GLP-1 receptor agonists and peptide oral delivery technologies
• Sublingual DPP-4 inhibitors for daily use
• Topical transdermal incretin patches releasing GLP-1 analogues

Correct Answer: Orally bioavailable small-molecule GLP-1 receptor agonists and peptide oral delivery technologies

Q18. In interpreting cardiovascular outcome trials (CVOTs) for newer antidiabetic drugs, which endpoint is most commonly used as the primary composite outcome?

• Three-point major adverse cardiovascular events (3P-MACE): CV death, nonfatal MI, nonfatal stroke
• All-cause mortality only
• Change in HbA1c at 12 weeks
• Serial measures of ankle-brachial index

Correct Answer: Three-point major adverse cardiovascular events (3P-MACE): CV death, nonfatal MI, nonfatal stroke

Q19. Which mechanism is proposed to explain renal protection by SGLT2 inhibitors beyond glucose lowering?

• Upregulation of renal gluconeogenesis
• Reduction in tubular workload and intraglomerular pressure plus reduced hypoxia and inflammation
• Direct blockade of aldosterone receptors in the collecting duct
• Enhancement of proximal tubular sodium reabsorption to preserve volume

Correct Answer: Reduction in tubular workload and intraglomerular pressure plus reduced hypoxia and inflammation

Q20. Which newer therapeutic target focuses on modulating microRNAs or long non-coding RNAs (lncRNAs) in diabetes research?

• Small-molecule insulin sensitisers acting on GLUT4 exclusively
• RNA-based therapies to alter gene expression involved in beta-cell survival and insulin signalling
• Monoclonal antibodies targeting SGLT2
• Topical agents modifying skin glucose transport

Correct Answer: RNA-based therapies to alter gene expression involved in beta-cell survival and insulin signalling

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