Social Determinants of Health and Diabetes with Strategies to Ease the Pharmacological Financial Burden of Diabetes Management Webcast Post-Test

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* 1. After this session, please rate how your level of confidence changed.

Feel no more confident than before.

Feel a little more confident than before.

Feel somewhat more confident.

Feel more confident than before.

Feel a lot more confident than before.

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* 2. When considering the patient’s lack of prescription coverage and overall diabetes picture, which the following would be the best initial regimen to use for the patient?

Metformin IR 1000 mg PO BID + insulin NPH 10 units subQ BID

Metformin XR 2000 mg PO daily + pioglitazone 15 mg PO daily

Metformin XR 2000 mg PO daily + glipizide 2.5 mg PO before breakfast

D/C metformin, + insulin isophane/insulin regular 70/30 19 units before breakfast + 10 units before supper

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* 3. Over the course of the past 3 months, HS has been increased to the maximum dose of the agent that you selected at the previous office visit. You check a point-of-care HbA1c on the patient and it results as 7.5%. What is your next step?

Add pioglitazone 15 mg PO daily

Add nateglinide 60 mg PO TID before meals

Stop all oral agents and initiate insulin glargine 20 units subQ qHS + insulin lispro 7 units subQ TID before meals

Add insulin NPH 10 units subQ BID

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* 4. After filling the new regimen that you recommended, the patient consulted “Dr. Google” and heard that the new medication has a number of scary side effects. He has stopped taking the medication and his HbA1c remains stable at 7.5% after another 3 months. He states that he has heard “good things” about an injectable medication that he would only have to take once a week and would like to try that, as long as it did not cost him “his first-born.” You agree to try semaglutide, with an end goal of titrating the patient off of his sulfonylurea.

What is the best option to make it affordable? The patient has been doing handyman work and does not qualify for Medicaid.

As the patient’s income level is below 400% of the FPL - Sign him up for the NovoCare Patient Assistance Program.

Use a GoodRx coupon to bring down the price of semaglutide.

Tell the patient that he should see a physician who can provide him with medication samples.

If during open enrollment, advise the patient to visit healthcare.gov and sign up for a subsidized health insurance through the federal marketplace.

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* 5. For every $1 spent on health care in the United States, how much do we spend on social services?

$0.55

$0.75

$1.00

$2.00

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* 6. As part of the stress response, what hormone is theorized to ultimately be responsible for causing end-organ damage?

Thyroxine

Aldosterone

Cortisol

Growth Hormone

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* 7. Compared to the general population, what was the relative risk of a Diabetic with A1c > 9 to report that they were unable to afford their medications?

1

1.5

1.75

2