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.  

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: 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!