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Rationale of the Week | What medication changes do you recommend?

For last week’s practice question, we quizzed participants on medication recommendations. 61% 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:

RL was newly diagnosed 43 with type 2 diabetes 6 months ago with an initial A1C of 10.1%. They have no cardiovascular disease and their renal function is within normal limits. At a recent office visit, you notice RL’s A1C has dropped to 7.3, their BP is 112/78 and the LDL cholesterol is 103mg/dL. RL’s current medication regimen includes, rosuvastatin 10mg, empagliflozin 25mg, metformin 1000 BID, glargine 12 units and aspirin 81mg.

Based on this information, what changes to RL’s medication plan do you recommend to the provider?

Answer Choices:

      1. Consider increasing rosuvastatin and stopping ASA therapy.
      2. Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.
      3. Consider adding an ACE or ARB and increasing basal insulin.
      4. Consider increasing metformin and decreasing basal insulin.


    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 correct. 60.90% chose this answer. “Consider increasing rosuvastatin and stopping ASA therapy.”  – YES, this is the best answer. GREAT JOB. According to the ADA Standards of Care, the goal is to reduce the LDL by 50% and less than 70mg/dL. The max dose of rosuvastatin is 40mg and RL is only on 10mg. Increasing the dose of rosuvastatin will help decrease LDL levels. Aspirin therapy is indicated for people 55 years and older with an elevated CV risk. For those under 55, aspirin therapy is based on their CV risk profile. Since RL has no CV disease, aspirin therapy is not indicated.

    Answer 2 is incorrect. 13.76% of you chose this answer. “Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.” This is not the best answer since there is no reason to stop empagliflozin when starting a GLP-1 RA. In addition, there is no mention in the vignette that RL has weight loss as a goal, so switching from an SGLT-2 to a GLP-1 is not indicated at this time.

    Answer 3 is incorrect. About 9.27% of respondents chose this. “Consider adding an ACE or ARB and increasing basal insulin.” This is not the best answer, since the first part of the response isn’t correct. RL has great renal function and their BP is below the target of 130/80, so an ACE or ARB is not indicated at this time.

    Finally, Answer 4 is incorrect. 16.07% chose this answer. “Consider increasing metformin and decreasing basal insulin.” This is not the best answer, since the metformin is already very close to the maximum dose of 2,550 mg day and we need more information about the fasting blood glucose levels before increasing the basal insulin. Most importantly, the first answer is a better answer.

    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!


    Want to learn more about this question?

    Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST

    Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.

    Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care.  Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!

    Our instructors co-teach the content to keep things fresh and lively.

    Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!


    Program Details

        • Dates: April 17-19th, 2024
        • Registration Fee: $399-$569 (see more about reg. options below)
        • Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
        • CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.


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