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CDE Diabetes

Practice Exam: Remission of Type 2 Diabetes (Chapter 39)

For decades, Type 2 diabetes was viewed as a progressive, lifelong condition. The updated Clinical Practice Guidelines challenge this paradigm, confirming that remission—restoring healthy blood glucose levels without the use of antihyperglycemic medications—is a viable goal for many people.

This practice exam tests your ability to define remission, identify eligible candidates, and manage the intensive interventions (both lifestyle and surgical) required to achieve and maintain this state.

Key Concepts Covered in This Exam:

  • Defining Remission: Memorizing the specific criteria for remission: an A1C <6.0% measured at least 3 months after stopping all glucose-lowering pharmacotherapy.

  • Structured Interventions: Understanding the role of Low-Energy Diets (LED) (800–1000 kcal/day, typically using meal replacements) and bariatric surgery as the most effective evidence-based methods for achieving remission.

  • Deprescribing Safety: Applying protocols for safely tapering or stopping insulin, sulfonylureas, and SGLT2 inhibitors (to prevent euglycemic DKA) at the start of a remission intervention.

  • Terminology: Recognizing why the term “remission” is preferred over “reversal” or “cure,” emphasizing that the underlying physiology remains and hyperglycemia can return.

  • Long-Term Monitoring: Acknowledging that patients in remission still require regular screening for complications (such as retinopathy and nephropathy) and ongoing cardiovascular risk management.

1. According to the User’s Guide, during Phase 1 of the low-calorie diet protocol, exercise is:

2. A 55-year-old woman with type 2 diabetes for 3 years, BMI 30 kg/m², on metformin only, achieves an A1C of 5.5% after 6 months without medications. Her perindopril was stopped due to low BP. According to the case studies, should her statin be continued?

3. Which of the following is a predictor of late relapse after bariatric surgery?

4. The Diabetes Canada guideline prefers the term ‘remission’ over ‘reversal’ or ‘regression’ to signify which characteristic of glucose improvement?

5. After remission criteria have been met, how frequently should A1C testing be performed to evaluate for persistence of remission versus relapse?

6. If an individual achieves remission but subsequently has an A1C ≥6.5%, what is their classification according to Diabetes Canada terminology?

7. According to the guideline, sustained weight loss of what amount is associated with the greatest probability of type 2 diabetes remission?

8. In the “Shared Decision-Making Checklist for Remission of Type 2 Diabetes,” which statement about remission is emphasized for patients to understand?

9. According to Diabetes Canada, what is the minimum duration without antihyperglycemic medications required to meet the definition of type 2 diabetes remission?

10. In the low-calorie diet for remission protocol, how often should the HCP follow up during Phase 1 (Total Dietary Replacement)?

11. According to the guideline, why are no recommendations formulated for pharmacological interventions to induce type 2 diabetes remission?

12. According to the guideline, bariatric surgery should be recommended as an option to potentially induce type 2 diabetes remission in nonpregnant adults with type 2 diabetes and a BMI of at least:

13. If A1C is unreliable (e.g., hemoglobinopathy), what alternative criteria can be used to define remission to normal glucose levels?

14. If a person pursuing remission achieves modest weight loss (5-10% of initial body weight) but does not meet remission criteria, what benefits might they still experience?

15. A patient with type 2 diabetes for 20 years who is on basal-bolus insulin asks about remission. What is the most appropriate approach?

16. According to the User’s Guide, what is the duration of Phase 1 (Total Dietary Replacement) in the low-calorie diet protocol?

17. In the 5As framework for remission counselling, what does the first ‘A’ represent?

18. A 45-year-old patient with type 2 diabetes for 4 years, BMI 32 kg/m², A1C 8.5%, on metformin only, asks about remission. According to the guideline, which intervention would be most appropriate to recommend?

19. According to the literature cited in the guideline, what is the median remission period following Roux-en-Y gastric bypass surgery?

20. The approach to deprescribing antihyperglycemic agents should incorporate which principles?

21. According to Diabetes Canada, ‘remission to prediabetes’ is defined as achieving an A1C in which range without antihyperglycemic medications?

22. For the exercise training recommendation (Grade C, Level 2), what is the target exercise duration per week?

23. According to the Diabetes Canada definitions, what A1C threshold defines ‘remission to normal glucose levels’?

24. A patient achieves remission criteria but is then started on empagliflozin for heart failure management. According to Diabetes Canada definitions, this patient’s diabetes status would be classified as:

25. According to the guideline, what is the target weight loss for the low-calorie diet approach to induce remission?

26. A patient with type 2 diabetes, established ASCVD, and CKD asks about pursuing remission. According to the guideline, what is the most appropriate response?

27. In the meta-analysis comparing RYGB to sleeve gastrectomy, what were the remission rates at 1 year?

28. At what time points should lab evaluation be performed after stopping antihyperglycemic medications to determine if remission criteria are met?

29. Low-calorie (∼800 to 850 kcal/day) diets with meal replacement products are recommended for remission in nonpregnant adults meeting which of the following criteria?

30. According to the guideline, what is a potential harm of setting a management plan of remission for patients at high cardiovascular risk?