Inc Re 1

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   A 45-year-old male presents to your office for a 3-month recheck on the status of his T2DM, hypertension, and hyperlipidemia. He was diagnosed with T2DM 3 years ago. He denies any episodes of hypoglycemia; however, his glucose readings have been higher recently, especially after meals. Exercise is difficult due to a bad knee. He denies any other medical conditions.

According to the American Diabetes Association (ADA) guidelines, what is an appropriate A1C goal for this patient? a) < 6.0% b) < 6.5% c) < 7.0% d) Any of the above

ßital signs: weight = 210 lb; height = 70 in; body mass index (BMI) = 30.1 kg/m2; blood pressure = 118/78; pulse = 74. Current meds: metformin 1000 mg twice daily for the past year, simvastatin 20 mg daily, aspirin 81 mg daily. The patient's A1C in your office today is 7.6%. Three months ago, it was 7.1% and has been rising for the past year despite the initiation of metformin. His weight has increased slightly and his selfmonitoring blood glucose log shows average fasting readings of approximately 110 mg/dL, with postprandial plasma glucose (PPG) readings (1- to 2-hour values) ranging from 130 to 200 mg/dL. He has been to a dietitian and diabetes educator and states he is frustrated with the results of his careful calorie and carbohydrate counting. He has read about incretin mimetics on the Internet and would like to know if he is a candidate Which of the following mechanisms contribute to the glucose-lowering abilities of incretin mimetics? a) Enhanced postprandial insulin secretion b) Increased glucagon secretion c) Increased gastric emptying d) Weight loss e) Continuous pancreatic ɴ-cell stimulation f) Both Enhanced postprandial insulin secretion and Weight loss