For last week’s practice question, over 1,900 participants submitted their answers for how LR could improve glucose while preparing for pregnancy. 37% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question: LR is 29 years old, has newly discovered diabetes and polycystic ovary syndrome (PCOS) and is trying to get pregnant. In addition to treating the diabetes and PCOS, LR would like to lose weight. LR was referred to the RD/RDN and encouraged to increase activity level. To treat PCOS and diabetes, LR was started on metformin ER 500mg BID.  After a month of treatment, LR’s A1C was still above 8%.

 According to ADA Standards, besides increasing the metformin dose, what additional therapy could be added to get LR’s glucose to goal?

Answer Choices:

1. GLP-1 Receptor Agonist
2. SGLT-2 Inhibitor
3. Either A or B
4. None of the above

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 25.41% chose this answer. “GLP-1 Receptor Agonist.” Given that LR has elevated blood glucose and wants to lose weight, starting a GLP-1 seems like a reasonable idea. However, GLP-1’s are not FDA approved for use during pregnancy. Since LR is trying to get pregnant, this class of medication would not be recommended.

Answer 2 is incorrect. 13.35% of you chose this answer. “SGLT-2 Inhibitor.” Given that LR has elevated blood glucose and wants to lose weight, starting a SGLT-2i seems like a reasonable idea. However, SGLT-2i’s are not FDA approved for use during pregnancy. Since LR is trying to get pregnant, this class of medication would not be recommended.

Answer 3 is incorrect. About 24.51% of respondents chose this. “Either A or B.” Given that LR has elevated blood glucose and wants to lose weight, starting either a SGLT-2i or a GLP-1 seems like a reasonable idea. However, SGLT-2i’s and GLP-1’s are not FDA approved for use during pregnancy. Since LR is trying to get pregnant, neither class of medication would not be recommended.

Finally, Answer 4 is correct. 36.73% chose this answer. “None of the above.” YES, This is the Best Answer. Metformin is the only non-insulin diabetes medication the ADA recommends for the first trimester of pregnancy. Many people with PCOS are treated with metformin to decrease insulin resistance and ovulation can resume, resulting in pregnancy. The ADA recommends stopping metformin after the first trimester and starting insulin if blood glucose levels remain above target.

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!

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ADCES Art & Science Desk Reference
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