ATI DIABETES MANAGEMENT EXAM PREDICTION Q&A 2026
,A 54-year-old patient with type 2 diabetes has an HbA1c of 8.7%
despite metformin 2000 mg daily. According to ADA 2025 guidelines,
which medication should be prioritized as add-on therapy if the patient
has established atherosclerotic cardiovascular disease?
A. DPP-4 inhibitor
B. GLP-1 receptor agonist
C. Sulfonylurea
D. Thiazolidinedione
Correct Answer: B
Explanation: GLP-1 receptor agonists are recommended as first-line add-
on therapy for patients with type 2 diabetes and established ASCVD due
to their proven cardiovascular benefit. ADA 2025 emphasizes GLP-1 RAs
beyond weight loss for heart and kidney health benefits.
Which of the following is the most appropriate HbA1c target for a
healthy 65-year-old adult with type 2 diabetes, multiple comorbidities,
and a history of severe hypoglycemia?
A. <6.5%
B. <7.0%
C. <7.5%
D. <8.0%
Correct Answer: D
Explanation: For older adults with multiple comorbidities and
hypoglycemia history, ADA guidelines recommend a less stringent
HbA1c target of <8.0% to minimize hypoglycemia risk.
,A patient with type 1 diabetes presents with blood glucose of 350
mg/dL, positive serum ketones, pH 7.25, and bicarbonate 15 mEq/L.
What is the most appropriate initial management step?
A. Subcutaneous rapid-acting insulin only
B. IV fluid resuscitation with normal saline
C. Oral glucose supplementation
D. Immediate discharge with insulin adjustment
Correct Answer: B
Explanation: This patient has diabetic ketoacidosis (DKA). Initial
management requires IV fluid resuscitation with normal saline to
address dehydration and restore perfusion before insulin therapy.
Which medication class is associated with the highest risk of
hypoglycemia when used as monotherapy in type 2 diabetes?
A. Metformin
B. GLP-1 receptor agonist
C. Sulfonylurea
D. SGLT2 inhibitor
Correct Answer: C
Explanation: Sulfonylureas stimulate insulin secretion regardless of
glucose levels, carrying the highest hypoglycemia risk among oral
antidiabetic agents when used alone.
A 45-year-old woman with type 2 diabetes is planning pregnancy. Her
current HbA1c is 7.8%. What is the recommended HbA1c target before
conception?
A. <6.0%
, B. <6.5%
C. <7.0%
D. <7.5%
Correct Answer: B
Explanation: ADA guidelines recommend pre-conception HbA1c <6.5%
(if achievable without significant hypoglycemia) to reduce risk of
congenital anomalies and pregnancy complications.
Which of the following is the primary mechanism of action of
metformin?
A. Stimulates pancreatic beta-cell insulin secretion
B. Increases hepatic gluconeogenesis
C. Decreases hepatic glucose production and increases insulin
sensitivity
D. Inhibits intestinal alpha-glucosidase
Correct Answer: C
Explanation: Metformin works primarily by decreasing hepatic glucose
production (gluconeogenesis) and improving peripheral insulin
sensitivity, particularly in muscle tissue.
A patient on insulin therapy experiences recurrent hypoglycemia
episodes. Which assessment tool should be used to screen for fear of
hypoglycemia according to ADA 2025?
A. HDFQ (Hypoglycemia Fear Survey)
B. PHQ-9
C. GAD-7
D. ADA Diabetes Distress Scale
,A 54-year-old patient with type 2 diabetes has an HbA1c of 8.7%
despite metformin 2000 mg daily. According to ADA 2025 guidelines,
which medication should be prioritized as add-on therapy if the patient
has established atherosclerotic cardiovascular disease?
A. DPP-4 inhibitor
B. GLP-1 receptor agonist
C. Sulfonylurea
D. Thiazolidinedione
Correct Answer: B
Explanation: GLP-1 receptor agonists are recommended as first-line add-
on therapy for patients with type 2 diabetes and established ASCVD due
to their proven cardiovascular benefit. ADA 2025 emphasizes GLP-1 RAs
beyond weight loss for heart and kidney health benefits.
Which of the following is the most appropriate HbA1c target for a
healthy 65-year-old adult with type 2 diabetes, multiple comorbidities,
and a history of severe hypoglycemia?
A. <6.5%
B. <7.0%
C. <7.5%
D. <8.0%
Correct Answer: D
Explanation: For older adults with multiple comorbidities and
hypoglycemia history, ADA guidelines recommend a less stringent
HbA1c target of <8.0% to minimize hypoglycemia risk.
,A patient with type 1 diabetes presents with blood glucose of 350
mg/dL, positive serum ketones, pH 7.25, and bicarbonate 15 mEq/L.
What is the most appropriate initial management step?
A. Subcutaneous rapid-acting insulin only
B. IV fluid resuscitation with normal saline
C. Oral glucose supplementation
D. Immediate discharge with insulin adjustment
Correct Answer: B
Explanation: This patient has diabetic ketoacidosis (DKA). Initial
management requires IV fluid resuscitation with normal saline to
address dehydration and restore perfusion before insulin therapy.
Which medication class is associated with the highest risk of
hypoglycemia when used as monotherapy in type 2 diabetes?
A. Metformin
B. GLP-1 receptor agonist
C. Sulfonylurea
D. SGLT2 inhibitor
Correct Answer: C
Explanation: Sulfonylureas stimulate insulin secretion regardless of
glucose levels, carrying the highest hypoglycemia risk among oral
antidiabetic agents when used alone.
A 45-year-old woman with type 2 diabetes is planning pregnancy. Her
current HbA1c is 7.8%. What is the recommended HbA1c target before
conception?
A. <6.0%
, B. <6.5%
C. <7.0%
D. <7.5%
Correct Answer: B
Explanation: ADA guidelines recommend pre-conception HbA1c <6.5%
(if achievable without significant hypoglycemia) to reduce risk of
congenital anomalies and pregnancy complications.
Which of the following is the primary mechanism of action of
metformin?
A. Stimulates pancreatic beta-cell insulin secretion
B. Increases hepatic gluconeogenesis
C. Decreases hepatic glucose production and increases insulin
sensitivity
D. Inhibits intestinal alpha-glucosidase
Correct Answer: C
Explanation: Metformin works primarily by decreasing hepatic glucose
production (gluconeogenesis) and improving peripheral insulin
sensitivity, particularly in muscle tissue.
A patient on insulin therapy experiences recurrent hypoglycemia
episodes. Which assessment tool should be used to screen for fear of
hypoglycemia according to ADA 2025?
A. HDFQ (Hypoglycemia Fear Survey)
B. PHQ-9
C. GAD-7
D. ADA Diabetes Distress Scale
