For last week’s practice question, we quizzed participants on prediabetes after GDM. It was a challenging question and 60% 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 experienced gestational diabetes with their third pregnancy and now, at age 41, was just diagnosed with prediabetes. LR’s BMI is 29.3 and she is trying to lose weight.

Based on the 2023 ADA Standards of Care, in addition to providing LR with lifestyle coaching, what other intervention is recommended?

Answer Choices:

1. Start a GLP-1 RA Inhibitor to support weight loss.
2. Initiate metformin therapy.
3. Start pioglitazone (Actos) at a low dose
4. Suggest adding a SGLT-2i to lower glucose and protect renal function.

Getting to the Best Answer

Answer 1 is incorrect. 29.67% chose this answer, “Start a GLP-1 RA Inhibitor to support weight loss.” Since LR has prediabetes, not diabetes, and her BMI is less than 30, GLP-1 RA therapy isn’t indicated. Plus, this recommendation isn’t included in the ADA standards (see below).

Answer 2 is correct. 60.63% of you chose this answer, “Initiate metformin therapy.” YES, this is the BEST answer. GREAT JOB! For people with a history of GDM who now express prediabetes, they have a very high risk of getting diabetes in the near future. In addition to referring to a Diabetes Prevention Program, the Standards recommend initiation of metformin therapy to delay the onset of diabetes.

Answer 3 is incorrect. 2.27% of respondents chose this answer, “Start pioglitazone (Actos) at a low dose” Although low dose pioglitazone is recommended for those with prediabetes or diabetes and a history of stroke, LR has no history of stroke. In addition, pioglitazone is associated with weight gain and is not recommended in the ADA Standards to treat prediabetes.

Finally, Answer 4 is incorrect. 7.44% chose this answer, “Suggest adding a SGLT-2i to lower glucose and protect renal function.” Since LR has prediabetes, not diabetes and no signs of kidney problems, SGLT-2i therapy isn’t indicated. Plus, this recommendation isn’t included in the ADA standards (see below).

Thank you so much for reading this “Rationale of the Week”. For more information on this topic, we also invite you to join our Online Courses and Virtual DiabetesEd Training Program.