WBR1122
| 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 45 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago. She has been following a diet and exercise to control her hyperglycemic state without medication, but so far it has no effect on her blood glucose level. Her recent laboratory test results are shown below:
You decided to start a medical therapy to control her hyperglycemia. Which of the following is the best initial medical therapy for her condition?]] |
| Answer A | AnswerA::Metformin |
| Answer A Explanation | [[AnswerAExp::Incorrect
Metformin is contraindicated in those with renal dysfunction.]] |
| Answer B | AnswerB::Sulfonylureas |
| Answer B Explanation | [[AnswerBExp::Correct
Sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.]] |
| Answer C | AnswerC::Glitazones |
| Answer C Explanation | [[AnswerCExp::Incorrect
Short acting sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.]] |
| Answer D | AnswerD::Insulin |
| Answer D Explanation | [[AnswerDExp::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.]] |
| Answer E | AnswerE::Alpha glucosidase inhibitors |
| Answer E Explanation | [[AnswerEExp::Incorrect
Short acting sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.]] |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::Metformin is contraindicated in those with renal dysfunction because it can accumulate and cause metabolic acidosis. It should not be used among chronic kidney disease(CKD) patients with eGFR <30 mL/min because of an increased risk of lactic acidosis. The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommended that metformin may be used among patients with an estimated GFR >45 mL/min.
The oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting sulfonylureas (eg, glipizide) and repaglinide. |
| Approved | Approved::No |
| Keyword | [[WBRKeyword::Diabetes mellitus type 2]] |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |