WBR1121

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A 40 year-old female presents to your office complaining of frequent urination and feeling thirsty all the time, started gradually over the last 6 months, when she also noticed her increased appetite, and weight gain. She has moved to United States three months ago with her husband. The patient has insignificant past medical history. On examination, she has normal vital signs. She is obese, no lower limb edema. She has insignificant chest and abdominal examination. Which of the following is the best initial therapy for her condition?]]
Answer A	AnswerA::Metformin
Answer A Explanation	[[AnswerAExp::Incorrect Metformin is used when the first line in diabetes mellitus treatment (diet, exercise, and weight loss) is failed to control blood glucose levels.]]
Answer B	AnswerB::Sulfonylureas
Answer B Explanation	[[AnswerBExp::Incorrect Oral hypoglycemic drugs should be used when the first line in diabetes mellitus treatment (diet, exercise, and weight loss) is failed to control blood glucose levels]]
Answer C	AnswerC::Diet, exercise, and weight Loss
Answer C Explanation	[[AnswerCExp::Correct Diet, exercise, and weight loss can restore insulin sensitivity even when the weight loss is modest.]]
Answer D	AnswerD::Glitazones
Answer D Explanation	[[AnswerDExp::Incorrect Glitazones are not used as the first line of treatment. If diet, exercise, and weight loss fail to control blood glucose level, we should start with metformin, as glitazones cause more weight gain and edema.]]
Answer E	AnswerE::Insulin
Answer E Explanation	[[AnswerEExp::Incorrect If oral hypoglycemic drugs fail (or stop helping), insulin therapy may be necessary, usually in addition to oral medication therapy, to maintain normal glucose levels.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Diabetes mellitus type 2 (formerly called non insulin-dependent diabetes (NIDDM), obesity related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance. Diet, exercise, and weight loss can restore insulin sensitivity even when the weight loss is modest. Weight loss can control as much as 25% of cases of type 2 diabetes mellitus without the need for medications, since decreasing the amount of adipose tissue helps to decrease insulin resistance. Educational Objective: Diet, exercise, and weight loss are the first line in diabetes mellitus treatment. References: http://www.wikidoc.org/index.php/Diabetes_mellitus_type_2]]
Approved	Approved::No
Keyword	[[WBRKeyword::Diabetes mellitus type 2]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::