ABFM DIABETES EXAM for 2025
Questions and Verified Answers /A+ Pass
1. True statements regarding nonpharmacologic therapy to reduce insulin resistance
include which of the following? (Mark all that are true.)
A. Decreasing caloric intake will increase insulin sensitivity independent of weight loss
B. Moderate alcohol intake increases insulin resistance
C. Exercise has been shown to enhance insulin action in skeletal muscle A
decrease of as little as 5% in body weight can result in a substantial reduction
in insulin resistance
D. If there are no contraindications, patients with insulin resistance syndrome should be
advised to engage in 30 minutes of modest aerobic exercise at least 4-5 times/week:
A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance syndrome.
Losing even 5% of body weight has been shown to substantially reduce insulin resistance. In
addition, insulin sensitivity can be increased by reducing caloric intake, even if no weight is lost.
Exercise is an important adjunct to weight loss, since it has been shown to enhance insulin
action in skeletal muscle not only during physical activity but for up to a week following exercise.
All patients with insulin resistance syndrome should be advised to engage in 30 minutes of
aerobic exercise at least 4-5 times/week. Moderate alcohol intake lowers insulin resistance.
2. Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
A. Pressure sensation with Semmes-Weinstein monofilament (10 g)
B. Deep tendon reflexes of the ankle
C. Proprioception
D. Vibratory sensation with a 128-mHz tuning fork
E. Light touch with a wisp of cotton:
A
Failure to perceive a pressure sensation produced by Semmes-Weinstein monofilament
indicates a loss of protective sensation in the diabetic foot and is highly predictive of foot
ulceration. Traditional neurologic examination techniques for evaluating reflexes, proprioception,
vibration, or light touch are highly subjective and less predictive of future ulceration.
3. Which of the following lipid-lowering agents can worsen glycemic control? (Mark
all that are true.)
A. Colestipol (Colestid)
,B. Ezetimibe (Zetia)
C. Gemfibrozil (Lopid)
D. Niacin
E. Atorvastatin (Lipitor):
D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an increase of
15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol by 5%-25%.
Hyperglycemia is a side effect of niacin therapy, particularly at high doses. A dosage of 750-2000
mg/day is associated with only moderate rises in blood glucose, and at one time was considered
a treatment option in patients with diabetes, particularly those with low HDL-cholesterol levels.
However, the recommendations for niacin use were changed as a result of the AIM-HIGH trial
(Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact
on Global Health Outcomes), which found no incremental clinical benefit from the addition of
niacin to statin therapy in patients with coronary heart disease and LDL-cholesterol levels >70
mg/dL.Recent studies support a link between statin use and the development of diabetes
mellitus. In a meta-analysis of 13 studies, statin therapy was associated with a 9% increased risk
for incident diabetes. Another meta-analysis corroborated this result and found that intensive-
dose statin therapy was associated with a higher risk of new-onset diabetes compared with
moderate-dose statin therapy. In 2012, the FDA modified the package labeling of statins to
include the risk of increased blood glucose levels and the development of type 2 diabetes. The
benefit of statin therapy, however, outweighs the risk; it was estimated there would be 1
additional case of diabetes for every 498 patients treated for 1 year, compared with 1 less patient
experiencing a cardiovascular event for every 155 patients treated for 1 year.
4. A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon for
his annual physical examination. His current medication regimen consists of insulin
glargine (Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day; metformin
(Glucophage), 1000 mg twice a day; and acarbose (Precose), 100 mg three times a day. He
suddenly becomes shaky, diaphoretic, and pale, and tells you he thinks it is because he
skipped lunch before his appointment.Which of the following would be effective for
managing this episode? (Mark all that are true.)
A. Glucose tablets
B. A sugar cube
C. A banana
D. A soft drink containing sugar
E. Raisins
F. Glucagon:
A AND F
Acarbose, an ±-glucosidase inhibitor, inhibits an enzyme present in the brush border of the
proximal intestinal epithelium that breaks down disaccharides and more complex carbohydrates.
As a result, if hypoglycemia were to occur in a patient on an ±-glucosidase inhibitor, reversal
requires either the consumption of glucose itself (as opposed to complex carbohydrates) or the
injection of glucagon.
5. Which of the following medications can cause hyperglycemia? (Mark all that are true.)
,A. Niacin
B. Clozapine (Clozaril)
C. Prednisone
D. Spironolactone
E. Ramipril (Altace)
A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in impaired
glucose tolerance and hyperglycemia. Agents associated with the development of hyperglycemia
include pentamidine, niacin, glucocorticoids, thyroid hormone, diazoxide, ²-adrenergic agonists,
thiazide diuretics, phenytoin, and ±-interferon. In addition, second-generation antipsychotic
agents, particularly clozapine and olanzapine, have also been linked to the development of
hyperglycemia and diabetes mellitus. Spironolactone and ramipril have not been linked to the
development of diabetes. In fact, in the HOPE (Heart Outcomes Prevention Evaluation) study,
the use of ramipril, an ACE inhibitor, appeared to reduce the risk for developing type 2 diabetes
mellitus by 20%-35%.
6. A 55-year-old African-American male sees you for a routine visit. His past medical
history is notable for an 8-year history of diabetes mellitus and a past history of
hypercholesterolemia. His current medications are atorvastatin (Lipitor), 20 mg/day, and
extended-release metformin (Glucophage XR), 1000 mg/day. He also reports a history of
peanut allergy manifested by lip angioedema, and carries an epinephrine auto-injector
(EpiPen).On examination he has a blood pressure of 124/80 mm Hg. His hemoglobin A1c
is 6.7%. A spot urine sample contains 40 µg albumin/mg creatinine.You see the patient 6
months later for a follow-up visit, and a spot urine sample has an albumin/creatinine ratio
of 45 µg/mg.Which one of the following would be most appropriate initially?
A. Have the patient return in 6 months for a repeat urine test for albumin and creatinine
B. Order a 24-hour urine collection for creatinine
C. Recommend that the patient reduce his daily protein intake to 1.5 g/kg/day Begin an
ACE inhibitor
D. Begin an angiotensin receptor blocker
E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the leading cause of
end-stage renal disease. Persistent albuminuria in the range of 30-200 mg/24 hr
(microalbuminuria) is the earliest sign of nephropathy in patients with type 1 diabetes, and is a
marker for nephropathy in type 2 diabetes. Patients with microalbuminuria who progress to
macroalbuminuria (>300 mg/24 hr) are likely to progress to end-stage renal disease over a
period of years.Although timed 4- and 24-hour urine collections for creatinine can be used to
screen for microalbuminuria, a random spot urine specimen for measurement of the albumin-to-
creatinine ratio is the preferred method. A minimum of two of three tests showing a urine albumin
level >30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and angiotensin
receptor blockers (ARBs) have been shown to delay the progression from microalbuminuria to
macroalbuminuria in patients with type 1 or type 2 diabetes. Since the antiproteinuric effect is
believed to be independent of blood pressure, current ADA guidelines recommend the use of
ACE inhibitors or ARBs as first-line therapy for both type 1 and type 2 diabetic patients with
microalbuminuria, even if their blood pressure is normal. Some studies, however, have raised
, questions about the value of early renin-angiotensin blockade for preventing microalbuminuria in
normotensive patients with type 1 or type 2 diabetes, and ADA guidelines recommend against
the use of these drugs for patients with normal blood pressure and no albuminuria.Compared to
whites, African-Americans and Asians have a three- to fourfold higher risk of angioedema
associated with the use of ACE inhibitors. The American Heart Association recommends that
ACE inhibitors not be initiated in any patient with a history of angioedema.Reduction of protein
intake to 0.8-1.0 g/kg/day in the early stages of chronic kidney disease, and to 0.8 g/kg/day in
the late stages, may improve renal function and should be considered in patients whose
nephropathy seems to be progressive despite optimal glucose and blood pressure control and
the use of an ACE inhibitor and/or an ARB.
7. True statements regarding carbohydrate intake and diabetes mellitus include which of
the following? (Mark all that are true.)
A. The glycemic index is not useful in the management of diabetes mellitus
B. Carbohydrate sources high in protein are effective for treating hypoglycemia
C. Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets
(<130 g/day)
D. Excessive intake of sugar-sweetened beverages has been shown to increase the risk
for diabetes mellitus
E. Carbohydrates have fewer calories per gram than alcohol
D AND E
Weight loss is an important therapeutic objective in overweight or obese individuals with
prediabetes or diabetes mellitus. Although low-fat diets have traditionally been promoted for
weight loss, studies indicate that diets that provide the same caloric restriction but differ in
protein, carbohydrate, or fat content are equally effective (SOR A). Both the amount and type of
carbohydrates in food influence blood glucose levels. Monitoring the total grams of
carbohydrates and using the glycemic index are both regarded as helpful strategies for achieving
glycemic control. Dietary sucrose does not increase glycemia more than isocaloric amounts of
starch, and intake of sucrose and sucrose-containing foods does not need to be restricted
because of concerns about aggravating hyperglycemia in patients with diabetes mellitus. The
use of nonnutritive sweeteners in place of caloric sweeteners has the potential to reduce
carbohydrate intake. However, it has been shown that consumption of excessive amounts of
sugar-sweetened beverages by nondiabetic persons is associated with a greater risk of
developing type 2 diabetes. Although the energy content of alcohol is approximately 7 kcal/g,
compared to 4 kcal/g for carbohydrates, alcohol consumption may place patients with diabetes
at higher risk for hypoglycemia, especially if they are on insulin or insulin secretagogues.
8. A 51-year-old male with type 2 diabetes mellitus controlled with diet is found to
have a serum triglyceride level of 350 mg/dL, an LDL-cholesterol level of 101 mg/dL, and
an HDL-cholesterol level of 45 mg/dL.Which one of the following supplements would
most likely reduce his serum triglyceride levels?
A. Vitamin E
B. Vitamin C
C. Omega-3 fatty acids
D. Folate
E. Chromium
Questions and Verified Answers /A+ Pass
1. True statements regarding nonpharmacologic therapy to reduce insulin resistance
include which of the following? (Mark all that are true.)
A. Decreasing caloric intake will increase insulin sensitivity independent of weight loss
B. Moderate alcohol intake increases insulin resistance
C. Exercise has been shown to enhance insulin action in skeletal muscle A
decrease of as little as 5% in body weight can result in a substantial reduction
in insulin resistance
D. If there are no contraindications, patients with insulin resistance syndrome should be
advised to engage in 30 minutes of modest aerobic exercise at least 4-5 times/week:
A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance syndrome.
Losing even 5% of body weight has been shown to substantially reduce insulin resistance. In
addition, insulin sensitivity can be increased by reducing caloric intake, even if no weight is lost.
Exercise is an important adjunct to weight loss, since it has been shown to enhance insulin
action in skeletal muscle not only during physical activity but for up to a week following exercise.
All patients with insulin resistance syndrome should be advised to engage in 30 minutes of
aerobic exercise at least 4-5 times/week. Moderate alcohol intake lowers insulin resistance.
2. Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
A. Pressure sensation with Semmes-Weinstein monofilament (10 g)
B. Deep tendon reflexes of the ankle
C. Proprioception
D. Vibratory sensation with a 128-mHz tuning fork
E. Light touch with a wisp of cotton:
A
Failure to perceive a pressure sensation produced by Semmes-Weinstein monofilament
indicates a loss of protective sensation in the diabetic foot and is highly predictive of foot
ulceration. Traditional neurologic examination techniques for evaluating reflexes, proprioception,
vibration, or light touch are highly subjective and less predictive of future ulceration.
3. Which of the following lipid-lowering agents can worsen glycemic control? (Mark
all that are true.)
A. Colestipol (Colestid)
,B. Ezetimibe (Zetia)
C. Gemfibrozil (Lopid)
D. Niacin
E. Atorvastatin (Lipitor):
D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an increase of
15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol by 5%-25%.
Hyperglycemia is a side effect of niacin therapy, particularly at high doses. A dosage of 750-2000
mg/day is associated with only moderate rises in blood glucose, and at one time was considered
a treatment option in patients with diabetes, particularly those with low HDL-cholesterol levels.
However, the recommendations for niacin use were changed as a result of the AIM-HIGH trial
(Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact
on Global Health Outcomes), which found no incremental clinical benefit from the addition of
niacin to statin therapy in patients with coronary heart disease and LDL-cholesterol levels >70
mg/dL.Recent studies support a link between statin use and the development of diabetes
mellitus. In a meta-analysis of 13 studies, statin therapy was associated with a 9% increased risk
for incident diabetes. Another meta-analysis corroborated this result and found that intensive-
dose statin therapy was associated with a higher risk of new-onset diabetes compared with
moderate-dose statin therapy. In 2012, the FDA modified the package labeling of statins to
include the risk of increased blood glucose levels and the development of type 2 diabetes. The
benefit of statin therapy, however, outweighs the risk; it was estimated there would be 1
additional case of diabetes for every 498 patients treated for 1 year, compared with 1 less patient
experiencing a cardiovascular event for every 155 patients treated for 1 year.
4. A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon for
his annual physical examination. His current medication regimen consists of insulin
glargine (Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day; metformin
(Glucophage), 1000 mg twice a day; and acarbose (Precose), 100 mg three times a day. He
suddenly becomes shaky, diaphoretic, and pale, and tells you he thinks it is because he
skipped lunch before his appointment.Which of the following would be effective for
managing this episode? (Mark all that are true.)
A. Glucose tablets
B. A sugar cube
C. A banana
D. A soft drink containing sugar
E. Raisins
F. Glucagon:
A AND F
Acarbose, an ±-glucosidase inhibitor, inhibits an enzyme present in the brush border of the
proximal intestinal epithelium that breaks down disaccharides and more complex carbohydrates.
As a result, if hypoglycemia were to occur in a patient on an ±-glucosidase inhibitor, reversal
requires either the consumption of glucose itself (as opposed to complex carbohydrates) or the
injection of glucagon.
5. Which of the following medications can cause hyperglycemia? (Mark all that are true.)
,A. Niacin
B. Clozapine (Clozaril)
C. Prednisone
D. Spironolactone
E. Ramipril (Altace)
A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in impaired
glucose tolerance and hyperglycemia. Agents associated with the development of hyperglycemia
include pentamidine, niacin, glucocorticoids, thyroid hormone, diazoxide, ²-adrenergic agonists,
thiazide diuretics, phenytoin, and ±-interferon. In addition, second-generation antipsychotic
agents, particularly clozapine and olanzapine, have also been linked to the development of
hyperglycemia and diabetes mellitus. Spironolactone and ramipril have not been linked to the
development of diabetes. In fact, in the HOPE (Heart Outcomes Prevention Evaluation) study,
the use of ramipril, an ACE inhibitor, appeared to reduce the risk for developing type 2 diabetes
mellitus by 20%-35%.
6. A 55-year-old African-American male sees you for a routine visit. His past medical
history is notable for an 8-year history of diabetes mellitus and a past history of
hypercholesterolemia. His current medications are atorvastatin (Lipitor), 20 mg/day, and
extended-release metformin (Glucophage XR), 1000 mg/day. He also reports a history of
peanut allergy manifested by lip angioedema, and carries an epinephrine auto-injector
(EpiPen).On examination he has a blood pressure of 124/80 mm Hg. His hemoglobin A1c
is 6.7%. A spot urine sample contains 40 µg albumin/mg creatinine.You see the patient 6
months later for a follow-up visit, and a spot urine sample has an albumin/creatinine ratio
of 45 µg/mg.Which one of the following would be most appropriate initially?
A. Have the patient return in 6 months for a repeat urine test for albumin and creatinine
B. Order a 24-hour urine collection for creatinine
C. Recommend that the patient reduce his daily protein intake to 1.5 g/kg/day Begin an
ACE inhibitor
D. Begin an angiotensin receptor blocker
E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the leading cause of
end-stage renal disease. Persistent albuminuria in the range of 30-200 mg/24 hr
(microalbuminuria) is the earliest sign of nephropathy in patients with type 1 diabetes, and is a
marker for nephropathy in type 2 diabetes. Patients with microalbuminuria who progress to
macroalbuminuria (>300 mg/24 hr) are likely to progress to end-stage renal disease over a
period of years.Although timed 4- and 24-hour urine collections for creatinine can be used to
screen for microalbuminuria, a random spot urine specimen for measurement of the albumin-to-
creatinine ratio is the preferred method. A minimum of two of three tests showing a urine albumin
level >30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and angiotensin
receptor blockers (ARBs) have been shown to delay the progression from microalbuminuria to
macroalbuminuria in patients with type 1 or type 2 diabetes. Since the antiproteinuric effect is
believed to be independent of blood pressure, current ADA guidelines recommend the use of
ACE inhibitors or ARBs as first-line therapy for both type 1 and type 2 diabetic patients with
microalbuminuria, even if their blood pressure is normal. Some studies, however, have raised
, questions about the value of early renin-angiotensin blockade for preventing microalbuminuria in
normotensive patients with type 1 or type 2 diabetes, and ADA guidelines recommend against
the use of these drugs for patients with normal blood pressure and no albuminuria.Compared to
whites, African-Americans and Asians have a three- to fourfold higher risk of angioedema
associated with the use of ACE inhibitors. The American Heart Association recommends that
ACE inhibitors not be initiated in any patient with a history of angioedema.Reduction of protein
intake to 0.8-1.0 g/kg/day in the early stages of chronic kidney disease, and to 0.8 g/kg/day in
the late stages, may improve renal function and should be considered in patients whose
nephropathy seems to be progressive despite optimal glucose and blood pressure control and
the use of an ACE inhibitor and/or an ARB.
7. True statements regarding carbohydrate intake and diabetes mellitus include which of
the following? (Mark all that are true.)
A. The glycemic index is not useful in the management of diabetes mellitus
B. Carbohydrate sources high in protein are effective for treating hypoglycemia
C. Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets
(<130 g/day)
D. Excessive intake of sugar-sweetened beverages has been shown to increase the risk
for diabetes mellitus
E. Carbohydrates have fewer calories per gram than alcohol
D AND E
Weight loss is an important therapeutic objective in overweight or obese individuals with
prediabetes or diabetes mellitus. Although low-fat diets have traditionally been promoted for
weight loss, studies indicate that diets that provide the same caloric restriction but differ in
protein, carbohydrate, or fat content are equally effective (SOR A). Both the amount and type of
carbohydrates in food influence blood glucose levels. Monitoring the total grams of
carbohydrates and using the glycemic index are both regarded as helpful strategies for achieving
glycemic control. Dietary sucrose does not increase glycemia more than isocaloric amounts of
starch, and intake of sucrose and sucrose-containing foods does not need to be restricted
because of concerns about aggravating hyperglycemia in patients with diabetes mellitus. The
use of nonnutritive sweeteners in place of caloric sweeteners has the potential to reduce
carbohydrate intake. However, it has been shown that consumption of excessive amounts of
sugar-sweetened beverages by nondiabetic persons is associated with a greater risk of
developing type 2 diabetes. Although the energy content of alcohol is approximately 7 kcal/g,
compared to 4 kcal/g for carbohydrates, alcohol consumption may place patients with diabetes
at higher risk for hypoglycemia, especially if they are on insulin or insulin secretagogues.
8. A 51-year-old male with type 2 diabetes mellitus controlled with diet is found to
have a serum triglyceride level of 350 mg/dL, an LDL-cholesterol level of 101 mg/dL, and
an HDL-cholesterol level of 45 mg/dL.Which one of the following supplements would
most likely reduce his serum triglyceride levels?
A. Vitamin E
B. Vitamin C
C. Omega-3 fatty acids
D. Folate
E. Chromium
