Answer 1 is incorrect. 25% chose this answer, “Sit more than eight hours a day and have a sedentary lifestyle”. Although the ADA Standards recommend getting up and moving every half-hour, they don’t specify that eight hours of sitting a day qualifies a person as higher risk to progressing to diabetes. 

Answer 2 is incorrect. 7% of you chose this answer “Have a history of thyroid or celiac disease”.  These autoimmune conditions are more closely associated with immune mediated type 1 diabetes and do not place a person as higher risk for progression to type 2 diabetes.

Answer 3 is incorrect. About 9% of respondents chose this, “Consume a diet with high amounts of simple carbohydrates.” While eating foods rich in fiber and a variety of nutrients is important to decrease risk of diabetes, the ADA does not state that eating simple carbohydrates puts individuals in a higher risk category of progressing to diabetes.

Finally, Answer 4 is correct 60% chose this answer, “Have fasting plasma glucose of 110–125 or A1C ≥6.0%.”  Great job. This is the BEST answer. According to ADA 2025 Standards, “More intensive preventive approaches should be considered in individuals who are at particularly high risk of progression to diabetes, including individuals with BMI ≥35 kg/m2, those at higher glucose levels (e.g., fasting plasma glucose 110–125 mg/dL [6.1–6.9 mmol/L], 2-h post challenge glucose 173–199 mg/dL [9.6–11.0 mmol/L], and A1C ≥6.0% [≥42 mmol/mol]), and individuals with a history of gestational diabetes mellitus.”

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Answer 1 is incorrect. 25% chose this answer: basal insulin doses exceeding 0.5 units/kg/day. This year, the ADA Recommendation was revised to remove consideration of basal insulin doses exceeding 0.5 units/kg/day as evidence of overbasalization. Instead, signs of overbasalization including significant bedtime-to-morning or postprandial-to-preprandial glucose differential, occurrences of hypoglycemia (aware or unaware), and high glycemic variability should be used.

Answer 2 is correct. 52% of you chose this answer: significant bedtime-to-morning or postprandial-to-preprandial glucose differential.  GREAT JOB!  In the 2025 ADA Standards (9), they define overbasalization as significant bedtime-to-morning or postprandial-to-preprandial glucose differential, occurrences of hypoglycemia (aware or unaware), and high glycemic variability.

Answer 3 is incorrect. About 18% of respondents chose this: low glycemic variability, This is a juicy and tempting answer. However, high glycemic variability (lots of ups and downs) is more closely associated with hypoglycemia.

Finally, Answer 4 is incorrect 3% chose this answer: basal insulin dose exceeding 50 units twice per day. Overbasalization is not defined by the amount of insulin used, but by the glucose response including significant bedtime-to-morning or postprandial-to-preprandial glucose differential, occurrences of hypoglycemia (aware or unaware), and high glycemic variability

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!