Answer A is incorrect: 0% chose this answer, “Reassure Kyle that retinopathy is very common with type 2 diabetes. Encourage him to verify the CGM with his glucometer more frequently if that helps make him feel less anxious.” This is incorrect. Although diabetes retinopathy is a common complication of diabetes, it is not inevitable, and the risk can be reduced by maintaining optimal glycemic control. Additionally, verifying blood glucose levels with a glucometer when there appears to be no issue with his CGM will not alleviate his anxiety.

Answer B is incorrect: 0% chose this answer, “Educate Kyle that the CGM he is using cannot be calibrated and instruct him to stop using his glucometer, since the CGM is accurate.” This is incorrect. Though his particular CGM cannot be calibrated, fingerstick blood glucose readings are the gold standard when CGM readings are unexpectedly out of range.

Answer C is correct: 99.36% chose this answer, “Acknowledge Kyle’s fears about vision loss, screen for diabetes distress, and collaborate on strategies to reduce the emotional burden of CGM use, including referral to a behavioral health provider if indicated.” This is correct. Kyle is demonstrating symptoms of diabetes distress due to fear of ocular complications, perfectionism, and technology overwhelm. The ADA Standards of Care 2025 recommend routine screening for diabetes distress and other psychosocial concerns at least annually or when complications arise.

Answer D is incorrect: 0.64% chose this answer, “Adjust Kyle’s time in range target goal to >90% to meet his expectations and reduce his worry about complications.” This is incorrect: The time in range goal for most adults living with diabetes is >70%. Adjusting his time-in-range goal to >90% will not work to reduce his obsessive behavior.

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 A is incorrect: 18.4% chose this answer, “Start AR on pioglitazone and recheck FIB-4 in 3 months.” Although pioglitazone is a recommended treatment for steatosis, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer B is incorrect: 15.11% chose this answer, “Encourage AR to see a RDN and stop consumption of alcohol immediately.” Seeing a RDN is very important for AR to evaluate and customize an eating plan to address their steatosis and support quality of life. However, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer C is incorrect: 18.4% chose this answer, “Suggest increased high intensity activity coupled with a GLP-1 to reduce body weight.” Strength training and activity, coupled with a GLP-1 for GLP-1/GIP are important strategies to address steatosis. However, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer D is correct: 48.09% chose this answer, “Refer AR to liver specialist for further evaluation.” Great job! AR will require intensive intervention to decrease their risk of worsening steatosis, including MNT, targeted activities, and a referral to a liver specialist to determine the best treatment approach.

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 A is incorrect: 24.19% chose this answer, “Semaglutide (Ozempic).” The diabetes approved version of semaglutide (Ozempic) does not yet have FDA approval as a medication that is used for treatment of MASH.

Answer B is incorrect: 18.77% chose this answer, “Empagliflozin (Jardiance).” Although empagliflozin will reduce blood glucose and can help with weight loss, it is not FDA approved for treatment of MASH.

Answer C is incorrect: 23.29% chose this answer, “Tirzepatide (Mounjaro).” Tirzepatide (Mounjaro) is approved for treatment of diabetes, helps with weight loss and is FDA approved for sleep apnea. However it is not FDA approved for treatment of MASH.

Answer D is correct: 33.75% chose this answer, “Semaglutide (Wegovy).” The weight loss approved version of semaglutide (Wegovy) has FDA approval as a medication that is used for treatment of MASH.

Please see our new “Indications for GLP-1/GIP” Cheat Sheet for a complete run down.  

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Answer A is incorrect: 6.35% chose this answer, “No changes are needed because kidney function is within normal range.” A is incorrect. Although eGFR indicates stage 2 kidney disease, the elevated UACR, ≥30 mg/g, confirms moderately increased risk and recommendation to treat. Additionally, PJ’s blood pressure is also above the target. Intervention is needed to protect kidney and cardiovascular health.

Answer B is correct: 83% chose this answer, “Initiate an ACE inhibitor or ARB to reduce progression the of diabetic kidney disease.” PJ has a mildly decreased eGFR, but UACR is elevated above 30 mg/g, indicating a recommendation to treat. Additionally, intervention is needed to optimize blood pressure. According to the ADA Standards of Care in Diabetes, individuals with diabetes, hypertension, and moderately increased albuminuria should be treated with an ACE inhibitor or angiotensin receptor blocker. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 agonists (GLP1-RA), with demonstrated benefits, could also be considered to reduce CKD progression.

Answer C is incorrect: 5.25% chose this answer, “Discontinue metformin due to the risk of kidney injury with reduced eGFR.” Metformin is safe to continue unless eGFR falls below 30 30 mL/min/1.73m². PJ’s kidney function is adequate for continued use. However, consideration to add a change to SGLT2 or GLP1 with kidney benefit could also promote additional A1c reduction.

Answer D is incorrect: 5.52% chose this answer, “Increase statin therapy to target albuminuria reduction.” Statins are recommended for ASCVD prevention, but they do not reduce albuminuria. Lipids are within normal range, and albuminuria should be addressed with an ACE inhibitor/ARB or potentially a SGLT2 inhibitor or GLP-1 RA.

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 A is incorrect: 1% chose this answer, “Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.” R.S. is aware that his glycemic control is important, and he is already aware of the risk of diabetes-related complications. Counseling him on this would not help him be successful with his insulin management.  

Answer B is correct: 96% chose this answer, “Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.” R.S. is struggling with barriers to successful insulin management.  A holistic approach would be to ask open-ended questions about his current routine, stressors, and support systems to gain a better understanding of these barriers. This information can lead to a personalized plan of care to help improve glycemic control. 

Answer C is incorrect: 2% chose this answer, “Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.” He has already attempted other non-insulin therapies, and these were either ineffective or not tolerated. Changing his regimen would not be successful at improving his glycemic control and quality of life.

Answer D is incorrect: 1% chose this answer, “Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.” R.S. appears to understand how to take his insulin lispro at meals. Writing out the instructions would not improve his situation. It is not a lack of knowledge, but the multiple barriers in his life that are keeping him from being able to implement this new medication regimen.  

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Answer A is incorrect: % chose this answer, “Discuss the insulin pump options that connect with the Dexcom G7 CGM. This will help simplify her transition to pump therapy by minimizing the learning curve when starting an AID system.” Although some insulin pumps are compatible with the Dexcom CGM, switching to a different CGM supplier should not restrict clients from selecting the insulin pump that best suits their needs.

Answer B is incorrect: % chose this answer, “Acknowledge Grace’s interest in insulin pump technology and recommend that she wait until more advanced insulin pump algorithms are available that are easier to use.” Automated insulin delivery systems offer advanced automation. Waiting for future technology will not help Grace improve glycemic control now.

Answer C is incorrect: % chose this answer, “Recommend that Grace use a tubeless pump as it will suit her better due to her work as a nurse and active lifestyle. This will help to avoid tubing issues or the insertion site becoming dislodged.” The type of pump, with or without tubing, is a personal decision and is not based solely on occupation.

Answer D is correct: % chose this answer, “Review with Grace the details of all the available insulin pumps, algorithms, and compatible CGMs so she can make a personalized decision based on her preferences and lifestyle.” Choosing the right insulin pump is a highly personalized decision. Each insulin pump has different variables and CGM connectivity that must be considered. Grace will need to be educated on the available options so she can determine which insulin pump will work best for her.

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Answer A is incorrect: % chose this answer, “Drink sugar-free cranberry juice a few times a week.” Scientific studies have yielded mixed and inconsistent results regarding the effectiveness of cranberry juice for prevention. MS needs an intervention that will provide ongoing relief.

Answer B is correct: % chose this answer, “Apply topical vaginal estrogen cream.” Vaginal estrogen cream can help prevent recurrent urinary tract infections (UTIs) in postmenopausal women by restoring the health of vaginal and urinary tissues. Estrogen helps restore a healthy vaginal pH, increases beneficial bacteria, and improves circulation, creating an environment that is less hospitable to uropathogens. It is a non-antibiotic option recommended by medical societies and is associated with a significant reduction in rUTIs.

Answer C is incorrect: % chose this answer, “Get A1C below 7% by adding basal insulin.” Getting A1C to target can reduce risk of infections, but MS A1C is already close to target. They need an effective treatment for their frequent UTI’s.

Answer D is incorrect: % chose this answer, “Evaluate MS for autoimmune conditions.” Frequent UTIs are not usually associated with autoimmune conditions. MS needs an effective treatment for their frequent UTI’s.

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Learn more about HRT and UTIs in our blog “Hormone Replacement Therapy (HRT) – What You Need to Know”

Answer 1 is incorrect. 25.14% chose this answer, “It decreases cortisol synthesis in the adrenal cortex, lowering circulating cortisol levels.” As tempting as this answer is, mifepristone does not inhibit cortisol synthesis.

Answer 2 is incorrect. 15.21% of you chose this answer, “It reduces ACTH release from the pituitary, leading to decreased adrenal stimulation.” This medication does not directly reduce ACTH release from the pituatary.

Answer 3 is correct. About 48.73% of respondents chose this, “It blocks glucocorticoid receptors, preventing cortisol from exerting metabolic effects.” Mifepristone is a glucocorticoid receptor antagonist. By competitively binding to glucocorticoid receptors, it prevents cortisol from exerting downstream effects, including increased hepatic gluconeogenesis, peripheral insulin resistance, and lipolysis. This mechanism is particularly useful in people with hypercortisolism and concurrent type 2 diabetes, as it improves insulin sensitivity and lowers blood glucose without lowering circulating cortisol levels.

Finally, Answer 4 is incorrect. 10.99% chose this answer, “It directly enhances insulin secretion and sensitivity, independent of cortisol pathways.” This medication does not act directly on pancreatic β-cells or insulin receptors.

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!