Answer A is correct: % chose this answer, “It sounds like you are worried about a parasite infection. Tell me more about what you’ve read.” Great job. A is the best answer because it uses person-centered, nonjudgmental communication, as recommended by the ADA. It avoids dismissive language and explores misinformation respectfully. It preserves the therapeutic alliance.

Answer B is incorrect: % chose this answer, “Yes. We will be treating that issue soon, but first we need to focus on your insulin doses.” Option B offers a false narrative saying that they are going to treat the parasitic infection then shifts focus to the blood glucose, without recognizing JR’s emotional distress.

Answer C is incorrect: % chose this answer, “I can see how you would be concerned, but here is no such thing as pancreatic parasites.” Option C does initially recognize the emotions but then ends with a dismissive tone, that may make JR feel defensive and unheard.

Answer D is incorrect: % chose this answer, “Sadly, prediabetes always progresses to diabetes when people are acutely ill, and you will probably be discharged on insulin therapy.” Option D completely ignores the emotional distress in addition to making assumptions that may not be true.

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 correct: 80.92% chose this answer, “Stage 1 Type 1 diabetes.” J.C. has stage 1 type 1 diabetes. She has two positive autoantibodies and normoglycemia.

Answer B is incorrect: 13.36% chose this answer, “Stage 2 Type 1 diabetes.” J.C. still has normoglycemia. Stage 2 type 1 diabetes is characterized by positive autoantibodies and dysglycemia (Impaired fasting glucose, Impaired glucose tolerance, or elevated A1c over 5.7% or 10% increase in A1C).

Answer C is incorrect: 4.2% chose this answer, “Stage 3 Type 1 diabetes.” J.C. does not have lab work confirming diabetes by the standard diagnostic criteria, and she is asymptomatic. Stage 3 type 1 diabetes is characterized by overt hyperglycemia and symptoms of diabetes with autoimmunity present.

Answer D is incorrect: 1.53% chose this answer, “Type 2 diabetes.” J.C. does not have type 2 diabetes. She does have a BMI in the overweight category, but she does not have hyperglycemia. She also has positive autoantibodies associated with type 1 diabetes. Type 2 diabetes is not immune-mediated.

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 correct: 56.08% chose this answer, “History of leg fatigue and calf pain when walking.”  YES, great job.  According to the ADA, if a person presents with leg fatigue and intermittent claudication, a more detailed screening for peripheral arterial disease (PAD) and poor arterial circulation is warranted. 

Answer B is incorrect: 21.08% chose this answer, “Lower extremity pain that is worse at night and restless legs.”  People experiencing neuropathy will complain of leg pain and burning that is worse when resting. People with PAD complain of leg and buttock pain when walking due to diminished circulation and poor blood flow to muscles that is relieved with rest.

Answer C is incorrect: 12.45% chose this answer, “Leg cramps coupled and frequent unexplained bruising.” Only part of this answer is correct. Although leg cramps or calf pain can occur with PAD, there is not direct association with frequent unexplained bruising. 

Answer D is incorrect: 10.4% chose this answer, “Onychomycosis and unusual callus formation.” People with diabetes do have an increased risk of toenail infections and onychomycosis, but this is not associated with the manifestations of PAD.

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!