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Which of these statements about type 2 diabetes are true?
- It is associated with both insulin resistance and beta-cell dysfunction
- It may be associated with a procoagulant state
- Drug treatment is only indicated to reduce hyperglycaemia
- Beta cell function declines at the rate of 4-5 per cent annually during the 5-6 years after diagnosis
Which of these statements are true?
- Repaglinide reduces plasma glucose by delaying the absorption of carbohydrate after meals
- Sulphonylureas have a duration of action of 6-8 hours
- The maximum effect of postprandial glucose regulators occurs 2-4 hours after administration
- Glipizide is taken once daily
Which of these statements about metformin are true?
- Its principal mechanism of action is to reduce insulin resistance
- It reduces hepatic gluconeogenesis and glycogenolysis
- In UKPDS, it reduced 10-year mortality by 12 per cent
- It is the drug of first choice for type 2 diabetes provided the patient is not overweight
Regarding the thiazolidinediones, which of these statements are true?
- Their full effect on plasma glucose levels may not be seen for 6-8 weeks
- They reduce HDL-cholesterol
- They reduce LDL-cholesterol
- Pioglitazone reduces plasma triglycerides but rosiglitazone does not
Which of these statements are true?
- DPP-4 is an enzyme that enhances the effects of glucagon-like peptide-1 (GLP-1)
- DPP-4 inhibitors do not increase pancreatic insulin output
- DPP-4 inhibitors suppress glucagon secretion by alpha cells
- Acarbose lowers postprandial plasma glucose by competing with dietary carbohydrate for alpha-glucosidase enzymes
Regarding the effects of oral antidiabetic drugs (OADs) on glycaemic control, some of these statements are true. Which are they?
- The higher the plasma glucose concentration at diagnosis, the greater the improvement in plasma glucose with OAD treatment
- Treatment with an OAD typically reduces fasting plasma glucose by 4-5mmol per litre 2-3 years after diagnosis
- Treatment with an OAD typically reduces HbA_1c by 4-5 per cent 2-3 years after diagnosis
- Provided OAD treatment is optimised, no patient with type 2 diabetes should need treatment with insulin
Which of these statements about the adverse effects of sulphonylureas are true?
- Hypoglycaemia is an unlikely cause of altered behaviour in someone taking a sulphonylurea
- The action of sulphonylureas may be prolonged in patients with liver or renal impairment
- Glibenclamide is the sulphonylurea of choice for older people because of its short duration of action
- Sulphonylureas commonly cause weight gain
Which of these statements about the adverse effects of metformin are true?
- Metformin is concentrated in the salivary glands
- A modified-release formulation of metformin reduces the incidence of adverse gastrointestinal effects by 20 per cent compared with the immediate-release formulation
- The optimal starting dose of metformin is 500mg per day
- Metformin is contraindicated in older people because of the risk of lactic acidosis
Which of these statements about the adverse effects of thiazolidinediones are true?
- Liver function tests should be carried out when treatment is started and annually thereafter
- They may increase weight by 3-4kg in the first six months of treatment
- Rosiglitazone should not be prescribed for patients with ischaemic heart disease
- They increase the risk of hip fracture in postmenopausal women
Which of these statements about the adverse effects of DPP-4 inhibitors are true?
- They cause a mean weight loss of about 2kg in the first six months of treatment
- Sitagliptin and vildagliptin can be used in patients with mild renal impairment
- Sitagliptin has been associated with cases of pancreatitis in postmarketing surveillance
- Vildagliptin is the DPP-4 inhibitor of choice for patients with hepatic impairment
Regarding the management of type 2 diabetes, which of these statements are true?
- Good glucose control from the time of diagnosis is important for reducing the rate of complications
- Exenatide is recommended as third-line therapy when weight loss is particularly desirable
- Pioglitazone can be co-prescribed with insulin
- Dual therapy (metformin/sulphonylurea) is associated with a two-fold higher risk of progression to insulin therapy over three years compared with triple therapy (metformin/sulphonylurea/pioglitazone)
Which of these statements about achieving best practice are true?
- In the ACCORD trial intensive glycaemic control was associated with reduced total and cardiovascular mortality
- For practical purposes the aim in clinical practice when treating type 2 diabetes patients is to achieve an HbA_1c of 6.5 per cent or less
- Intensive blood glucose control probably has no major benefit with regard to macrovascular disease in patients with type 2 diabetes of greater than 10 years’ duration who have established cardiovascular disease
- In older patients or those with severe co-morbidities, acceptable control means simply keeping the patient free of hyperglycaemic symptoms and ignoring tight HbA_1c targets

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