CME Post Test Translational Endocrinology & Metabolism: Metabolic Surgery Update Please select the best answer to each question on the online answer sheet. Go to http://www.endojournals.org/translational/ Defining Priorities for Clinical Research in Metabolic/Diabetes Surgery 1. Which one of the following statements is true regarding research comparing diabetes/ metabolic surgery with conventional therapy for type 2 diabetes mellitus? A. Randomized controlled trials are not necessary in this setting B. More than 25% of eligible candidates choose surgery C. Criteria to assess efficacy and safety of weight-loss devices and procedures are well established D. Few long-term studies focus on hard outcome measures E. Randomized controlled trials cannot be performed because participants cannot be blinded to their treatment group 2. The presence of which one of the following preoperative factors is most likely to predict remission of type 2 diabetes mellitus after diabetes/metabolic surgery? A. Body mass index less than 30 kg/m 2 B. Duration of diabetes less than 5 years C. Hemoglobin A 1c level greater than 10% D. Treatment with insulin E. Age older than 55 years 3. Which one of the following statements is true regarding the effect of diabetes/metabolic surgery on comorbid conditions associated with diabetes and obesity? A. Many patients must continue lipid-lowering and antihypertensive medications after surgery B. Most patients using nasal continuous positive airway pressure therapy for obstructive sleep apnea before surgery can discontinue its use after surgery C. Low-density lipoprotein cholesterol levels reliably decrease after surgery D. Systolic blood pressure and diastolic blood pressure reliably decrease after surgery E. The effect on blood pressure depends on which bariatric procedure is performed Pharmacological Treatment of Type 2 Diabetes: Advantages and Dilemmas 4. Which one of the following factors best accounts for increasingly complex treatment regimens that Translational Endocrinology & Metabolism, Volume 3, Number 2, 2012 89
become necessary with longer duration of type 2 diabetes mellitus? A. Increased rate of drug metabolism B. Negative drug-drug interactions C. Progressive loss of β -cell function D. Development of insulin antibodies E. Nonadherence to therapeutic regimen 5. Which one of the following classes of antidiabetes agents is associated with an increased incidence of fractures? A. Thiazolidinediones B. Insulin C. α -Glucosidase inhibitors D. Incretin-based therapies E. Sulfonylureas 6. Which one of the following statements is true about clinical outcomes observed with improved glycemic control in the setting of type 2 diabetes mellitus? A. Stroke risk is significantly reduced B. There is a progressively reduced impact on preventing long-term complications the longer that intensive glycemic control is delayed during the course of diabetes C. The occurrence of chronic heart failure is significantly reduced D. Microvascular outcomes are not affected E. Duration of diabetes has no effect on clinical outcomes Metabolic Surgery and Control of Type 2 Diabetes 7. Which one of the following bariatric procedures has the highest rate of remission of type 2 diabetes mellitus? A. Vertical banded gastroplasty B. Roux-en-Y gastric bypass C. Biliopancreatic diversion D. Laparoscopic adjustable gastric banding E. Laparoscopic sleeve gastrectomy 8. Which one of the following statements is correct regarding metabolic surgery and medical management for the treatment of type 2 diabetes mellitus in obese patients? A. Intense medical treatment achieves diabetes remission rates similar to those achieved with metabolic surgery B. Metabolic surgery is associated with superior glycemic control, but not improvement in cardiovascular risk factors, when compared with medical treatment C. Diabetes remission after metabolic surgery only exceeds diabetes remission with conventional medical treatment if the preoperative body mass index is greater than 35 kg/m 2 D. Intensive medical treatment achieves total body weight loss similar to that achieved with metabolic surgery E. Two-year follow-up studies show that diabetes remission rates are more than 50% higher with metabolic surgery than with conventional medical treatment 9. Which one of the following bariatric procedures is considered 90 Translational Endocrinology & Metabolism: Metabolic Surgery Update
to have both restrictive and malabsorptive characteristics? A. Laparoscopic adjustable gastric banding B. Laparoscopic sleeve gastrectomy C. Vertical banded gastroplasty D. Roux-en-Y gastric bypass E. Intragastric balloon Mechanisms Mediating Weight Loss and Diabetes Remission After Bariatric/Metabolic Surgery 10. Which one of the following statements is true regarding evidence for weight lossindependent factors involved in type 2 diabetes remission after bariatric/metabolic surgery? A. Assuming weight loss is equivalent, diabetes remission rates are similar between purely gastric-restrictive operations and procedures that combine gastric restriction with intestinal bypass B. The degree to which diabetes and glucose homeostasis improve is closely and consistently tied to the magnitude of weight loss after Roux-en-Y gastric bypass C. Studies of duodenal-jejunal bypass, endoluminal duodenal bypass sleeve, and ileal interposition have shown inconclusive results regarding effects on glucose homeostasis D. β -Cell hyperactivity has been observed during long-term follow-up of numerous bariatric procedures, including Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and vertical sleeve gastrectomy E. After Roux-en-Y gastric bypass or biliopancreatic diversion, type 2 diabetes often resolves within a few days or weeks 11. Which one of the following factors is thought to be a major contributor to the anti-diabetes effects of metabolic surgery? A. Proximal intestinal nutrient exclusion B. Decreased postprandial glucagon-like peptide 1 levels C. Increased ghrelin levels D. Hindered delivery of bile acids to the distal intestine E. Increased levels of total and branched-chain amino acids 12. Which one of the following statements is true regarding the use of metabolic surgery to treat type 2 diabetes in patients with a body mass index less than 35 kg/m 2? A. Safety and efficacy data in less obese patients deviate substantially from those observed in morbidly obese patients B. Lowering the body mass index threshold to 30 kg/m 2 for surgery in patients with type 2 diabetes would affect more than one-fourth of the persons with diabetes in the United States C. Excessive weight loss has been observed in patients with a preoperative body mass index less than 35 kg/m 2 after laparoscopic CME Post Test 91
gastric banding and standard, proximal Roux-en-Y gastric bypass D. Use of bariatric/metabolic surgery to treat poorly controlled type 2 diabetes is now approved by NIH consensus guidelines for patients with a body mass index as low as 30 kg/m 2 E. Current evidence does not support lowering the recommended body mass index threshold for surgery to 30 kg/m 2 in patients with poorly controlled type 2 diabetes 92 Translational Endocrinology & Metabolism: Metabolic Surgery Update
Metabolic Surgery: Patient Resources from the Hormone Health Network The Hormone Health Network, The Endocrine Society s new patient edu cation enterprise, builds on the former Hormone Foundation s 15-year patient education effort. The Network helps endocrine patients have more informed discussions about hormones and health with endocrinologists, primary care physicians, and other healthcare providers. Among its patient education offerings are the award-winning Hormones and You fact sheet series in English and Spanish, and patient guides based on The Endocrine Society s Clinical Practice Guidelines. The easy-to-read fact sheets provide basic information about the causes, symptoms, diagnosis, and treatment of a broad array of hormone-related conditions. Patient guides offer more detail about the evaluation and diagnosis of a specific disorder and how patients can work with their physicians to achieve the therapeutic goals of treatment. For patients undergoing metabolic surgery, the Hormone Health Network offers two publications specific to this topic: Bariatric Surgery and the Endocrine System: Benefits and Risks Patient Guide to Endocrine and Nutritional Management After Bariatric Surgery Other Network publications address weight-related issues and type 2 diabetes. A few examples include: Hormones and Obesity Proven Methods of Weight Loss Diabetes and Nutrition: Carbohydrates Diabetes, Dyslipidemia, and Heart Protection Type 2 Diabetes and A1c Developed with The Endocrine Society s leading clinical and scientific experts, the Hormone Health Network s free online resources provide easy-to-understand information on more than 80 hormone-related topics. Visit www.hormone.org to view and download fact sheets, patient guides, brochures, and more. Translational Endocrinology & Metabolism, Volume 3, Number 2, 2012 93
CME Answers: 1, D; 2, B; 3, A; 4, C; 5, A; 6, B; 7, C; 8, E; 9, D; 10, E; 11, A; 12, B 94
The Translational Endocrinology & Metabolism monograph series highlights the intersection of basic science, clinical research, and patient care that forms the foundation of translational medicine. It represents the collective expertise of The Endocrine Society, providing bench to bedside information in an integrated approach. A continuing medical education component is provided for self-assessment and credit. The Endocrine Society 8401 Connecticut Avenue, Suite 900 Chevy Chase, Maryland 20815 www.endo-society.org ISBN: 1-936704-07-1 ISSN (Print): 1948-9536 ISSN (Online): 1948-9544 Founded in 1916, The Endocrine Society is dedicated to advancing excellence in endocrinology and promoting its essential role as an integrative force in scientific research and medical practice.