ABFM DIABETES EXAM 2025 WITH
100% CORRECT ANSWERS
True statements regarding nonpharmacologic therapy to reduce insulin resistance include which
of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
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
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 - CORRECT
ANSWER✔✔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.
Which one of the following neurologic tests is most useful for predicting the future occurrence
of a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
,Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton - CORRECT ANSWER✔✔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.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all that are
true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) - CORRECT ANSWER✔✔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.
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.)
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon - CORRECT ANSWER✔✔A AND F
Acarbose, an α-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 α-glucosidase
inhibitor, reversal requires either the consumption of glucose itself (as opposed to complex
carbohydrates) or the injection of glucagon.
Which of the following medications can cause hyperglycemia? (Mark all that are true.)
Niacin
Clozapine (Clozaril)
, Prednisone
Spironolactone
Ramipril (Altace) - CORRECT ANSWER✔✔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, β-
adrenergic agonists, thiazide diuretics, phenytoin, and α-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%.
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?
Have the patient return in 6 months for a repeat urine test for albumin and creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient - CORRECT ANSWER✔✔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
100% CORRECT ANSWERS
True statements regarding nonpharmacologic therapy to reduce insulin resistance include which
of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
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
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 - CORRECT
ANSWER✔✔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.
Which one of the following neurologic tests is most useful for predicting the future occurrence
of a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
,Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton - CORRECT ANSWER✔✔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.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all that are
true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) - CORRECT ANSWER✔✔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.
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.)
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon - CORRECT ANSWER✔✔A AND F
Acarbose, an α-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 α-glucosidase
inhibitor, reversal requires either the consumption of glucose itself (as opposed to complex
carbohydrates) or the injection of glucagon.
Which of the following medications can cause hyperglycemia? (Mark all that are true.)
Niacin
Clozapine (Clozaril)
, Prednisone
Spironolactone
Ramipril (Altace) - CORRECT ANSWER✔✔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, β-
adrenergic agonists, thiazide diuretics, phenytoin, and α-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%.
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?
Have the patient return in 6 months for a repeat urine test for albumin and creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient - CORRECT ANSWER✔✔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
