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!

Answer A is incorrect: 14.66% chose this answer, “Partner with CS to reduce missed boluses and reassess in 3 months.” While reducing missed boluses and optimizing insulin therapy are essential to support A1c reduction, this intervention alone does not address the likely underlying psychological barriers to self-management.

Answer B is incorrect: 31.1% chose this answer, “Simplify regimen to support current state of diabetes distress.” While simplifying insulin dosing may be supportive in some cases, without addressing the underlying diabetes distress it is unlikely to achieve sustained improvement.

Answer C is correct: 50.55% chose this answer, “Refer to a qualified behavioral health professional for evaluation and treatment.” The 2026 ADA Standards of Care recommends a referral to a qualified behavioral health professional for evaluation and treatment when diabetes distress, burnout, reduced engagement in diabetes management or other psychosocial factors are impacting self-care and glycemic targets. ¹

Answer D is incorrect: 3.7% chose this answer, “Recommend referral to MNT for a structured weight-loss program.” Focusing solely on weight loss does not address the primary psychosocial barriers and weight gain may be a symptom of underlying behavioral health needs. Evaluation and treatment from a behavioral health provider would be the most appropriate next step.

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!