Questionnaire

1. John’s HbA1c has increased from 7.7% to 8.3% over the last 6 months with rising home glucose readings. What is the most likely explanation for this change?

2. Which of the following should be the main priority when intensifying diabetes treatment for John?

3. In a 76-year-old patient with long-standing diabetes and complications, an HbA1c target of <7% is always recommended.

4. During the consultation his daughter raised the concern that he sometimes forgets his medication schedule and appears unsure about how to take his diabetes medication. Before intensifying therapy, the decision was made to assess his cognitive function. Which of the following is the most appropriate screening tool to use in this situation?

5. After evaluating John’s glucometer data, it is evident that his fasting levels ranges between 10-14 mmol/L, with readings during the day and post prandial values ranging between 8-15 mmol/L. If insulin therapy is indicated to improve John’s fasting glucose control, which option would be most appropriate for an elderly patient with possible cognitive decline?

6. Considering John’s age, long-standing diabetes and complications, which of the following is the most important potential challenge to anticipate when managing his diabetes therapy going forward?

7. If John is initiated on once-daily basal insulin such as Insulin glargine U-300, which glucose monitoring strategy would be most appropriate initially?

8. Given John’s history of peripheral neuropathy and pre-proliferative retinopathy, which of the following should be the most appropriate ongoing monitoring strategy in primary care?

9. What is the most appropriate next step in John’s diabetes management?

10. Which of the following best explains the clinical benefit of the current basal insulin regimen in this older patient?