Name:
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Contact Email:
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Check this box ONLY if you DO NOT want your answers to be used for research purposes.
I do not want my answers used for research I do not want my answers used for research
What is your professional degree?
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DO/MD
Physician Assistant (PA)
Nurse Practitioner (NP)
PA Student
NP Student
Medical Student
Medical Resident
Pharmacist
RN
Other
DO/MD
Physician Assistant (PA)
Nurse Practitioner (NP)
PA Student
NP Student
Medical Student
Medical Resident
Pharmacist
RN
Other
Where do you currently practice medicine?
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Please list your location/state of practice
How many years have you practiced medicine?
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Still in training
< 1 year
1-3 years
3-5 years
5-7 years
7-10 years
11-20 years
> 20 years
Still in training
< 1 year
1-3 years
3-5 years
5-7 years
7-10 years
11-20 years
> 20 years
Consider the last few months: On average, how many half-days of clinic do you work in a typical week?
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1-2 half-days
3-4 half-days
5-6 half-days
7-8 half-days
>8 half-days
1-2 half-days
3-4 half-days
5-6 half-days
7-8 half-days
>8 half-days
Consider the last few months: In a typical week, approximately how many patients do you see who have: Type 2 Diabetes, Cardiometabolic disease, Renal disease, and/or Obesity?
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1-5 patients
6-10 patients
11-15 patients
16-20 patients
>20 patients
>30 patients
> 50 patients
1-5 patients
6-10 patients
11-15 patients
16-20 patients
>20 patients
>30 patients
> 50 patients
What percent of your patients with diabetes (type 1 and type 2) in your clinic had a HbA1c value of > 9% during the past calendar year?
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Less than 5%
5-10%
Greater than 10-15%
Greater than 15-20%
Greater than 20-25%
Greater than 25-30%
Greater than 30-35%
Greater than 35-40%
Greater than 40-45%
Greater than 45-50%
Greater than 50%
I do not know
Less than 5%
5-10%
Greater than 10-15%
Greater than 15-20%
Greater than 20-25%
Greater than 25-30%
Greater than 30-35%
Greater than 35-40%
Greater than 40-45%
Greater than 45-50%
Greater than 50%
I do not know
1 For patients with type 2 diabetes, what HbA1c goal do you recommend?
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A) < 6.5%
B) < 7.0%
C) < 8.0%
D) Depends on patient characteristics
E) Other
A) < 6.5%
B) < 7.0%
C) < 8.0%
D) Depends on patient characteristics
E) Other
2 You are seeing a newly diagnosed 49-year-old female with type 2 diabetes and current HbA1c is 10.5%. She reports weight loss and polyuria. Her kidney function is normal.
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A) Start metformin only
B) Start glipizide only
C) Start metformin and glipizide
D) Start metformin and basal insulin
E) Start metformin and a GLP-1 receptor agonist
A) Start metformin only
B) Start glipizide only
C) Start metformin and glipizide
D) Start metformin and basal insulin
E) Start metformin and a GLP-1 receptor agonist
3 How do you typically initiate basal insulin in a patient with type 2 diabetes?
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A) I never initiate basal insulin
B) I start at 10 units daily
C) I start a weight-based dose of 0.1-0.3 units/kilogram
A) I never initiate basal insulin
B) I start at 10 units daily
C) I start a weight-based dose of 0.1-0.3 units/kilogram
4 You are seeing a 55-year-old male with normal kidney function and BMI 33. Previously, he had sub-optimally managed his diabetes for 6 years. He had recent admission for stroke. He was discharged on metformin 500mg XR twice a day and glargine. His current HbA1c is 7.0%.
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A) Continue current therapy
B) Reduce insulin by 20% and increase metformin to 1000mg twice a day
C) Reduce insulin by 20% and add GLP-1 receptor agonist
D) Reduce insulin by 20% and add SGLT2 inhibitor
A) Continue current therapy
B) Reduce insulin by 20% and increase metformin to 1000mg twice a day
C) Reduce insulin by 20% and add GLP-1 receptor agonist
D) Reduce insulin by 20% and add SGLT2 inhibitor
5 Of the medications listed below, which classes of medications also have the Food and Drug Administration indication for cardiovascular disease benefit?
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A) Empagliflozin and sitagliptin (SGLT2I and DPP-4I)
B) Sitagliptin and metformin (DPP-4I and Biguanides)
C) Metformin and liraglutide (Biguanides and GLP-1RA)
D) Liraglutide and empagliflozin (GLP-1RA and SGLT2I)
E) Sitagliptin and liraglutide (DPP-4I and GLP-1RA)
A) Empagliflozin and sitagliptin (SGLT2I and DPP-4I)
B) Sitagliptin and metformin (DPP-4I and Biguanides)
C) Metformin and liraglutide (Biguanides and GLP-1RA)
D) Liraglutide and empagliflozin (GLP-1RA and SGLT2I)
E) Sitagliptin and liraglutide (DPP-4I and GLP-1RA)
6 At what degree for renal insufficiency do you need to stop metformin 1,000 mg?
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A) Creatinine of 1.4 mg/dL in women and 1.5mg/dL in men
B) GFR < 45 mL/min / 1.73 m2
C) GFR < 30 mL/min / 1.73 m2
A) Creatinine of 1.4 mg/dL in women and 1.5mg/dL in men
B) GFR < 45 mL/min / 1.73 m2
C) GFR < 30 mL/min / 1.73 m2
7 Select the most correct statement for patients with Type 2 diabetes that are on pre-meal and basal insulin.
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A) Metformin should be discontinued or not started in those on multi-dose insulin
B) Metformin may be continued or started based on GFR but other insulin-sparing agents should never be considered
C) Other insulin-sparing agents should be considered but metformin should be stopped or not started
D) Metformin should be started or continued based on GFR and other insulin-sparing agents should be considered
A) Metformin should be discontinued or not started in those on multi-dose insulin
B) Metformin may be continued or started based on GFR but other insulin-sparing agents should never be considered
C) Other insulin-sparing agents should be considered but metformin should be stopped or not started
D) Metformin should be started or continued based on GFR and other insulin-sparing agents should be considered
8 A 45-year-old male patient with Type 2 diabetes for 6 years, controlled hypertension, and obesity (BMI 32) presents for cardiovascular risk stratification after a second cousin died suddenly. He is taking Metformin 500 mg twice a day, Losartan 50 mg daily, and Co-Q10. HIs blood pressure is 122/69 mmHg, his lipid profile is: total cholesterol 189 mg/dL, HDL 41 mg/dL, and LDL 123 mg/dL. He is a non-smoker and has no first degree relatives with early heart disease. He is reluctant to take any new medications but is nervous about his health and willing to listen to your opinion.
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A) Start high intensity statin + aspirin 81 mg
B) Start high intensity statin + aspirin 325 mg
C) Start moderate intensity statin + aspirin 81 mg
D) Start moderate intensity statin ONLY
E) Order treadmill stress test to base treatment decision and to assess for silent myocardial ischemia
A) Start high intensity statin + aspirin 81 mg
B) Start high intensity statin + aspirin 325 mg
C) Start moderate intensity statin + aspirin 81 mg
D) Start moderate intensity statin ONLY
E) Order treadmill stress test to base treatment decision and to assess for silent myocardial ischemia
9 Sodium-glucose cotransporter-2 (SGLT2) inhibitors should not be initiated in which of the following patients?
* must provide value
A) Patient with Type 2 diabetes with recent kidney stones
B) Patient with diabetes and heart failure with preserved ejection fraction and history of pancreatitis
C) A patient with diabetes and history of coronary artery disease and unilateral renal artery stenosis with eGFR of 50 mL/min/1.74m2
D) A patient with fatty liver disease and an eGFR of 23 mL/min/1.74m2
A) Patient with Type 2 diabetes with recent kidney stones
B) Patient with diabetes and heart failure with preserved ejection fraction and history of pancreatitis
C) A patient with diabetes and history of coronary artery disease and unilateral renal artery stenosis with eGFR of 50 mL/min/1.74m2
D) A patient with fatty liver disease and an eGFR of 23 mL/min/1.74m2
10 A 32-year-old female with Type 2 diabetes is seeing you for her initial routine wellness visit. Her BMI is 35 kg/m2. She is on metformin 2,000 mg per day and glipizide 5 mg. Her A1c is 6.8% and blood pressure is 158/86 mmHg. Her additional past medical history includes nephrolithiasis 6 months ago and gallstone induced pancreatitis. She has been doing weight watchers again for the third time in her life and is struggling to lose weight. She confides to you that she is hungry all the time! She asks your opinion on how she should lose weight.
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A) She should stick to weight watchers
B) She should exercise more and eat less
C) We should consider stopping the glipizide
D) She should try a ketogenic diet
A) She should stick to weight watchers
B) She should exercise more and eat less
C) We should consider stopping the glipizide
D) She should try a ketogenic diet
11 In the same patient as above, which medication would be the best choice for appetite suppression?
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A) Phentermine/Topiramate
B) Phentermine
C) Bupropion/Naltrexone
D) Fenfluramine/Phentermine
E) Semaglutide
A) Phentermine/Topiramate
B) Phentermine
C) Bupropion/Naltrexone
D) Fenfluramine/Phentermine
E) Semaglutide
12 A 48-year-old woman with biopsy proven diabetic chronic kidney disease (CKD) returns for follow-up. Review of her relevant laboratories indicates a creatinine of 1.7 (eGFR 38 mL/min), potassium 4.6, A1c 6.4%, and urine protein to creatinine ratio (UPCR) of 1.6 mg/g on a spot collection. In-office blood pressure is 124/72 mmHg, congruent with home blood pressure monitoring. She is currently on therapy with Olmesartan 40 mg daily, Dapagliflozin 10 mg daily, Semaglutide 1 mg subcutaneously weekly, and Chlorthalidone 25 mg daily.
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A) Diltiazem
B) Pentoxifylline
C) Finerenone
D) Linagliptin
A) Diltiazem
B) Pentoxifylline
C) Finerenone
D) Linagliptin
13 A 54-year-old man with a history of Type 2 diabetes, stage G3bA2 chronic kidney disease and hypertension presents for follow-up. He has been scrolling through twitter and read something about new Kidney Disease: Improving Global Outcomes (KDIGO) blood pressure guidelines. He asks you what his target blood pressure should be.
You tell him his target blood pressure is...
* must provide value
A) < 140/80 mmHg
B) < 130/80 mmHg
C) < 120/80 mmHg
D) < 150/80 mmHg
A) < 140/80 mmHg
B) < 130/80 mmHg
C) < 120/80 mmHg
D) < 150/80 mmHg
14 A 66-year-old male with Type 2 diabetes and known coronary artery disease has a lipid profile that reveals triglycerides of 289 mg/dL and LDL-C of 58 mg/dL. He is treated with Rosuvastatin 40 mg daily. His diabetes is treated with metformin and Sodium-glucose cotransporter-2 (SGLT2) inhibitor. His most recent A1C is 6.7%.
* must provide value
A) Decrease rosuvastatin to 20 mg
B) Add ezetimibe
C) Add icosapent ethyl
D) No further therapy is needed at this time
A) Decrease rosuvastatin to 20 mg
B) Add ezetimibe
C) Add icosapent ethyl
D) No further therapy is needed at this time
15 A 54-year-old woman with 10 years of Type 2 diabetes is noted to have mildly elevated liver enzymes. She drinks alcoholic beverages very rarely. BMI is 36 kg/m2. A1C is 6.9% with ALT 58 (7-40). Work up is negative for Hepatitis B and Hepatitis C, with normal iron studies. Ultrasound of the liver reveals "increased echogenicity of liver parenchyma consistent with hepatic steatosis".
* must provide value
A) Perform vibration controlled transient elastography (Fibroscan)
B) Perform magnetic resonance elastography
C) Refer for liver biopsy
D) Start statin therapy
E) Start vitamin E
A) Perform vibration controlled transient elastography (Fibroscan)
B) Perform magnetic resonance elastography
C) Refer for liver biopsy
D) Start statin therapy
E) Start vitamin E
In your experience, which of the following barriers most commonly prevents patients with cardiometabolic disease from reaching goal HbA1c, cholesterol, or blood pressure?
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Other barriers. Please explain:
Let's say you are able to make three changes to the way cardiometabolic disease care is provided at your health center.
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Other changes. Please explain:
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