CME/CE QUIZ CME/CE QUESTIONS

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1 CME/CE QUIZ CME/CE QUESTIONS Continuing Medical Education Accreditation The University of Cincinnati College of Medicine designates this educational activity for a maximum of two (2) AMA PRA Category 1 CME credits. Physicians should only claim credit commensurate with the extent of their participation in this activity. The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Continuing Pharmacy Education Accreditation Pharmacy Times/Ascend Media Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of H01. Instructions After reading New Treatment Strategies for Type 2 Diabetes: Role of the Thiazolidinediones, complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (with a minimum score of 70%) the examination at the conclusion of the program. 1. Which one of the following is thought to occur earliest in the development of type 2 diabetes? a) impaired glucose tolerance b) impaired fasting glucose c) insulin resistance d) loss of beta cell function 2. Insulin resistance and hyperinsulinemia are linked with: a) central (visceral) obesity b) hypertension c) elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol 3. The risk for macrovascular complications in type 2 diabetes: a) begins to increase when glycemia exceeds the diagnostic threshold for diabetes b) begins to increase when glycated hemoglobin (A1C) exceeds 7% c) begins to increase even at normal levels of glycemia (A1C <6%) d) is unrelated to A1C after adjustment for other cardiovascular risk factors 4. For diabetes screening, the American Diabetes Association (ADA) recommends: a) fasting plasma glucose (FPG), especially in pregnant women b) 2-hour oral glucose tolerance test (OGTT) c) A1C measurement d) either FPG or OGTT, or both 5. The ADA treatment goal for patients in general is an A1C of: a) <8.0% b) 7.5% c) <7.0% d) <6.0% 6. The major effect of metformin is to: a) reduce hepatic glucose output by decreasing gluconeogenesis b) increase muscle glucose uptake c) decrease lipolysis in adipose tissue and reduce circulating free fatty acids d) stimulate insulin release from the pancreatic beta cells 7. A common side effect of thiazolidinedione (TZD) monotherapy is: a) weight gain due to increased visceral adiposity b) fluid retention with peripheral edema c) congestive heart failure d) pulmonary edema 8. A case can be made for early use of TZDs because they appear to: a) address the primary defect of insulin resistance and preserve beta cell function b) produce a larger initial increase in beta cell function than sulfonylureas (SUs) or metformin, as demonstrated by data from the United Kingdom Prospective Diabetes Study c) produce significantly greater A1C reductions during the first year of therapy than other oral agents 9. Combination therapy with a TZD plus metformin: a) does not produce an additive or synergistic effect, because both drugs reduce insulin resistance b) may result in less weight gain than a TZD alone c) may result in more weight gain than a TZD alone d) may result in more gastrointestinal adverse effects than metformin alone VOL. 12, NO. 14, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S393

2 CME/CE QUIZ 10. Combination therapy with a TZD plus an SU: a) produces an additive or synergistic effect, with TZD reducing insulin resistance while SU increases insulin secretion b) may result in more weight gain than an SU alone c) is a reasonable alternative to metformin plus an SU 11. The ADA estimates that by 2010 the costs of diabetes could increase to: a) $121 billion b) $132 billion c) $145 billion d) $156 billion 12. Primary features of the metabolic syndrome include: a) hypertension b) visceral obesity c) complex dyslipidemia 13. The leading cause of death in patients with diabetes is: a) coronary heart disease b) hyperglycemia c) stroke d) kidney failure 14. All of the following are demonstrated cardiovascular effects of TZDs except: a) reduced restenosis after stent implantation b) lower levels of inflammatory markers c) lower levels of thrombotic risk markers d) lower levels of HDL cholesterol 15. Weight gain with oral antidiabetic therapy can be minimized with dietary behavior modification and certain combination pharmacotherapies. a) true b) false 16. Fluid retention with TZD use: a) is minimal and not a concern b) occurs in about 25% of patients c) may be manageable with spironolactone d) may decrease with concurrent insulin therapy 17. The primary purpose of the Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) trial was to assess the effects of TZD therapy on: a) development of diabetes in high-risk individuals b) cardiovascular events c) renal events d) preservation of beta cell function 18. Aggressive diabetes intervention resulting in tight glycemic control may have all of the following effects except: a) prevent microvascular and macrovascular complications b) prevent weight gain c) prevent disease progression d) lower the costs associated with diabetes S394 THE AMERICAN JOURNAL OF MANAGED CARE NOVEMBER 2006

3 CME EVALUATION CME TEST FORM New Treatment Strategies for Type 2 Diabetes: Role of the Thiazolidinediones Please circle your answers: 1. a b c d 2. a b c d 3. a b c d 4. a b c d 5. a b c d 6. a b c d 7. a b c d 8. a b c d 9. a b c d 10. a b c d 11. a b c d 12. a b c d 13. a b c d 14. a b c d 15. a b 16. a b c d 17. a b c d 18. a b c d (PLEASE PRINT CLEARLY) Name/Degree Street City State/ZIP Daytime Phone Fax Sponsored by the University of Cincinnati for Two (2) AMA PRA Category 1 credits TM. Release Date: November 1, 2006 Expiration Date: November 30, 2007 CME Activity Evaluation Answer Form Instructions: Testing and Grading Procedures 1. Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CME credits earned. This form should be safeguarded and may be used as documentation of credits earned. 2. Participants receiving a failing grade on any exam will be notified and permitted to take 1 reexamination at no cost. 3. All answers should be circled on the answer form. 4. To receive credit certification electronically, please provide your address. Detach and mail or fax this page to: University of Cincinnati, Office of CME, PO Box , Cincinnati, OH ; phone: ; fax: Please print clearly to ensure receipt of CME credit. Activity Evaluation How long did it take you to complete this activity? minutes How well did this activity achieve its educational objectives? Very well Well Somewhat Not at all What overall grade would you assign this activity? A B C D Did this activity exhibit promotional bias for any pharmaceutical agents? Yes No Will you make changes in your practice as a result of the information presented in this lesson? Yes No Proj A167 VOL. 12, NO. 14, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S395

4 CE EVALUATION PROGRAM EVALUATION Please mark your level of agreement with the following statements. (4 = Strongly Agree; 0 = Strongly Disagree) 1) Met its stated objectives ) Was well organized ) Contributed to my knowledge ) Presented current and relevant information ) Presented information in a fairly balanced and noncommercial manner ) Offered information useful in my professional practice ) Provided new insights into contemporary pharmacy practice (PLEASE PRINT CLEARLY) Name/Degree Street City State/ZIP Daytime Phone Fax Check (payable to Pharmacy Times) Credit Card (check one) VISA MasterCard American Express SSN - - Credit Card Number Expiration Date Signature (REQUIRED) Answer Form Instructions: Testing and Grading Procedures 1.Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CE credits earned. This form should be safeguarded and may be used as documentation of credits earned. 2.Participants receiving a failing grade on any exam will be notified and permitted to take 1 reexamination at no cost. 3.All answers should be recorded on the answer form. Please print clearly to ensure receipt of CE credit. 4.To receive credit certification electronically, please provide your address. Detach and mail completed exam form with your $10.00 payment to Pharmacy Times, 405 Glenn Drive, Suite 4, Sterling, VA ; or fax to Take the test online for FREE at www. pharmacytimes.com and receive immediate grading and CE credits, and download your CE statement of credit. Please photocopy the test form for additional test takers. Sponsored by Pharmacy Times/Ascend Media Office of Continuing Professional Education for 2 contact hours (0.2 CEUs) of ACPE credit. Expiration Date: November 30, 2007 ANSWER CARD Please circle your answers: a a a a a a a a a a b b b b b b b b b b c c c c c c c c c c d d d d d d d d d d a a a a a a a a b b b b b b b b c c c c c c c d d d d d d d PROJ A167 S396 THE AMERICAN JOURNAL OF MANAGED CARE NOVEMBER 2006

5 CONTINUING EDUCATION New Treatment Strategies for Type 2 Diabetes: Role of the Thiazolidinediones GOAL To increase understanding of the basic pathophysiologic defects of type 2 diabetes and the importance of selecting therapy that addresses these defects to improve clinical outcomes. TARGET AUDIENCE This activity is intended for physicians, medical directors, pharmacists, pharmacy directors, primary care physicians, and other managed care decision makers. LEARNING OBJECTIVES After completing this continuing education activity, the participant should be able to: Describe the pathophysiology of type 2 diabetes and its relationship with the metabolic syndrome and cardiovascular disease. Summarize the goals of diabetes treatment. Discuss long-term glycemic outcomes of monotherapy with oral antidiabetic agents and the rationale for combination therapy. Explain the rationale for early use of thiazolidinediones (TZDs) and glycemic outcomes of combination therapy with TZDs. Review the cost burden of type 2 diabetes and cost effectiveness of tight glycemic control. CONTINUING MEDICAL EDUCATION ACCREDITATION The University of Cincinnati College of Medicine designates this educational activity for a maximum of two (2) AMA PRA Category 1 CME credits. Physicians should only claim credit commensurate with the extent of their participation in this activity. The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Release Date: November 1, Expiration Date: November 30, CONTINUING PHARMACY EDUCATION ACCREDITATION Pharmacy Times/Ascend Media Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of H01. Release Date: November 1, Expiration Date: November 30, FUNDING This program is supported by an educational grant from GlaxoSmithKline. The contents of this supplement may include information regarding the use of products that may be inconsistent outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products. THE AMERICAN JOURNAL OF MANAGED CARE