Weight Management Practice Exam: Diabetes Chapter 17

Obesity is a significant risk factor for the development of type 2 diabetes and complications in both type 1 and type 2 diabetes. The 2018 Clinical Practice Guidelines emphasize that weight management is not merely an aesthetic goal but a primary therapeutic target to improve glycemic control and cardiovascular health.

This practice exam tests your ability to apply the evidence-based recommendations for behavioural, pharmacological, and surgical weight management interventions.

Key Concepts Covered in This Exam:

Therapeutic Targets: Understanding that a sustained weight loss of $\ge$ 5% of initial body weight can significantly improve glycemic control and cardiovascular risk factors.
Intervention Hierarchy: Recognizing healthy behaviour interventions as the cornerstone of treatment, to be maintained even when medications or surgery are added.
Pharmacotherapy: Identifying the role of specific weight management medications for individuals with diabetes and obesity to improve metabolic control.
Surgical Options: Knowing the indications for bariatric surgery and its potential to induce diabetes remission or significant improvement.
Medication Selection: Applying the principle that the effect on body weight must be considered when selecting antihyperglycemic agents, prioritizing those with weight-loss or weight-neutral properties.

1. Case: A patient is being considered for bariatric surgery. What type of team should evaluate candidacy and appropriateness for surgical procedures?

Surgeon only
Interdisciplinary team with medical, surgical, psychiatric, and nutritional expertise
Endocrinologist and dietitian
Primary care provider only

2. What are the effects of moderate carbohydrate reduction in people with diabetes regarding weight management?

Worsening of lipid profile
No metabolic benefits
Improvements in HDL and triglycerides, blood glucose stability, and reductions in diabetes medication requirements
Increased risk of hypoglycemia only

3. Case: A clinical team is evaluating a patient for bariatric surgery. What are the predictors of likelihood of remission of type 2 diabetes after bariatric surgery?

Lower preoperative C-peptide, older age, and longer duration of diabetes
Higher BMI
Use of oral medications only
Higher preoperative C-peptide, younger age, shorter duration of diabetes, and no insulin therapy

4. What is the typical weight loss associated with SGLT2 inhibitors?

8 to 10 kg
5 to 7 kg
0 to 1 kg
2 to 3 kg

5. Which of the following two medications are approved for chronic weight management in Canada?

Canagliflozin and dulaglutide
Metformin and sitagliptin
Empagliflozin and exenatide
Orlistat and liraglutide

6. What are the rare potential complications of liraglutide treatment for weight management?

Cardiovascular events and stroke
Gallbladder disease and acute pancreatitis
Liver failure and kidney damage
Hypoglycemia and weight gain

7. What are the potential adverse effects of orlistat that may affect long-term compliance?

Weight gain
Nausea and vomiting
Loose stools and gastrointestinal side effects
Hypoglycemia

8. Case: A 52-year-old patient with type 2 diabetes has a BMI of 32 kg/m², A1C=7.3%, and is currently on glyburide and metformin. The patient is struggling with weight. What antihyperglycemic medication consideration is most appropriate?

Consider switching from glyburide to an agent not associated with weight gain
Half the glyburide dose
Add pioglitazone for additional glycemic control
Add insulin to improve glycemic control

9. Case: A 45-year-old patient with type 2 diabetes, BMI 29 kg/m², has tried healthy behaviour interventions without success. The patient is asking about weight management medications. What BMI threshold is required for pharmacotherapy in people with type 2 diabetes?

BMI ≥27.0 kg/m²
BMI ≥25.0 kg/m²
BMI ≥30.0 kg/m²
BMI ≥35.0 kg/m²

10. Case: A patient with type 2 diabetes has been on intensive insulin therapy and has gained significant weight. According to the guidelines, what is the weight gain range associated with some antihyperglycemic medications?

1 to 2 kg
2 to 3 kg
10 to 15 kg
4 to 9 kg or more

11. Case: A patient with type 2 diabetes is being considered for bariatric surgery. What effect has bariatric surgery been shown to have on diabetic nephropathy?

Bariatric surgery has no effect on kidney function
Bariatric surgery worsens albuminuria
Bariatric surgery is contraindicated in patients with nephropathy
Bariatric surgery can prevent the development and progression of albuminuria

12. Case: A diabetes educator is counselling a patient about weight management programs. According to the guidelines, what is a reasonable weight loss goal per month?

1 to 2 kg/month
3 to 4 kg/month
0.5 to 1 kg/month
5 to 6 kg/month

13. What percentage of people with type 2 diabetes have overweight or obesity?

70% to 80%
80% to 90%
60% to 70%
50% to 60%

14. What is the mechanism of action of liraglutide in weight management?

Increases glucose excretion through the kidneys
Blocks carbohydrate absorption
Decreases fat absorption in the intestine
Increases satiety and decreases hunger in the brain

15. A diabetes educator is reviewing the evidence on bariatric surgery and diabetes remission. What is important to communicate to patients who experience remission?

Medications should continue indefinitely regardless of remission
No dietary modifications are needed after surgery
People may experience recurrence of diabetes years later
Remission is permanent and no follow-up is needed

16. What is the BMI threshold for Class II obesity?

30.0 to 34.9 kg/m²
35.0 to 39.9 kg/m²
≥40.0 kg/m²
27.0 to 29.9 kg/m²

17. What has been shown regarding the increase in obesity prevalence in people with type 1 diabetes over the last 20 years?

Fivefold increase
Twofold increase
Sevenfold increase
Threefold increase

18. Why was the gastric band largely abandoned in North America?

Less sustained weight loss and metabolic benefits, and high surgical complication rates
Too expensive compared to other procedures
Excessive weight loss
Lack of qualified surgeons

19. What has been demonstrated about the comparison of people with obesity and diabetes versus those without diabetes when attempting weight loss?

People with diabetes lose weight more easily
There is no difference between the groups
People with diabetes should not normally attempt weight loss
People with obesity and diabetes have greater difficulty achieving weight loss

20. Which antihyperglycemic medication class is associated with the most weight gain?

Insulin
DPP-4 inhibitors
Metformin
SGLT2 inhibitors

21. Case: A patient with type 2 diabetes and obesity is started on a weight loss program and begins losing weight. What medication adjustment may be required?

Increase antihyperglycemic medications to prevent weight regain
Adjustment of antihyperglycemic medications may be required to avoid hypoglycemia
Add additional insulin to maintain glycemic control
No medication changes are needed during weight loss

22. Case: A 58-year-old patient with type 2 diabetes, BMI 42 kg/m², has been unsuccessful with healthy behaviour interventions and pharmacotherapy. Which bariatric surgery procedure has been largely abandoned in North America?

Roux-en-Y gastric bypass
Gastric band
Sleeve gastrectomy
Biliopancreatic diversion

23. Which bariatric surgery procedures have the highest likelihood of improvement in control or remission of type 2 diabetes?

Gastric banding
All procedures have equal outcomes
Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion
Intragastric balloon

24. What psychological aspects of eating behaviours should be assessed when determining reasons for weight gain?

Exercise habits only
Medication adherence only
Emotional eating, binge eating, ADHD, and depression
Sleep patterns only

25. Case: A patient with type 1 diabetes and obesity is asking about weight management medications. What does the evidence say about pharmacotherapy for weight management in type 1 diabetes?

Liraglutide 3.0 mg is approved for type 1 diabetes
Pharmacotherapy directed at weight management has not been adequately studied in people with type 1 diabetes
Orlistat is specifically indicated for type 1 diabetes
All weight management medications are contraindicated in type 1 diabetes

26. What negative energy balance is needed to achieve a weight loss of 2 to 4 kg per month?

Approximately 500 kcal/day
Approximately 1000 kcal/day
Approximately 750 kcal/day
Approximately 250 kcal/day

27. Case: A clinician is considering the metabolic effects of bariatric surgery beyond weight loss. What has been shown about bariatric surgery and cardiovascular outcomes?

Bariatric surgery increases cardiovascular risk
Bariatric surgery has no effect on cardiovascular outcomes
Bariatric surgery may reduce the risk of myocardial infarction in people with type 2 diabetes
Cardiovascular outcomes have not been studied

28. Which interventions combined are most effective at improving health outcomes in weight management?

Dietary modification, increased physical activity, and behaviour therapy
Physical activity alone
Dietary modification alone
Medication therapy alone

29. Case: A patient with obesity and impaired glucose tolerance (IGT) is asking about medications to prevent progression to type 2 diabetes. Which weight management medication has been shown to improve glucose tolerance and reduce progression to type 2 diabetes?

Insulin
Metformin
Orlistat
Sulfonylureas

30. What are the waist circumference cut-off values for South Asian, Chinese, and Japanese populations indicating central obesity?

Men ≥90 cm; Women ≥80 cm
Men ≥102 cm; Women ≥88 cm
Men ≥85 cm; Women ≥75 cm
Men ≥94 cm; Women ≥80 cm

31. What are the NCEP-ATP III waist circumference cut-off values indicating increased risk of developing health problems?

Men ≥102 cm; Women ≥88 cm
Men ≥94 cm; Women ≥80 cm
Men ≥100 cm; Women ≥90 cm
Men ≥90 cm; Women ≥80 cm

32. What is the minimum sustained weight loss of initial body weight that can improve glycemic control and cardiovascular risk factors?

≥15%
≥10%
≥2%
≥5%

33. According to Health Canada guidelines, what measurements should be included in the initial assessment of people with diabetes?

Height, weight, and grip strength
Height, weight, calculation of BMI, and waist circumference
Height and weight only
Weight and waist circumference only

34. Case: A diabetes educator is reviewing the checklist for evaluating weight management programs. Which of the following is NOT part of the recommended checklist?

Access to a weight maintenance program
The program assesses and treats comorbid conditions
Cost is not prohibitive
Requirement to buy specific products, supplements, or injections

35. Which of the following antihyperglycemic medications are considered weight neutral?

Insulin and sulfonylureas
Thiazolidinediones and insulin
GLP-1 receptor agonists and SGLT2 inhibitors
Metformin, acarbose, and DPP-4 inhibitors

36. At what BMI threshold is bariatric surgery a treatment option for people with type 2 diabetes who have comorbidities?

BMI ≥40.0 kg/m²
BMI ≥30.0 kg/m²
BMI ≥45.0 kg/m²
BMI ≥35.0 kg/m²

37. What is the typical weight loss associated with liraglutide in people with diabetes?

About 3 kg
About 5 kg
About 10 kg
About 1 kg

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