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1. Which of the following medication classes is not recommended for use in combination with a GLP-1 RA?

A. Sulfonylurea B. DPP-4 inhibitor C. Basal insulin D. Prandial insulin E. Unsure

2. For Questions 2 and 3, please refer to the following CASE scenario:
RJ is a 56-year-old woman with T2D. She was diagnosed with T2D 11 years ago. Her past medical history (PMH) is additionally notable for obesity (BMI = 35 kg/m²), essential hypertension, hypercholesterolemia, and hospitalization for a myocardial infarction (MI) 4 months ago. Her T2D is currently managed on insulin degludec (U-100) 60 U subcutaneously once daily and metformin 1,000 mg ER twice daily. RJ’s current A1C is 7.3%.

RJ’s primary care provider (PCP) would like to start her on dulaglutide 0.75 mg subcutaneously once weekly.

Which of the following is true regarding initiation of a GLP-1 RA in the case of RJ?

A. Her metformin should be discontinued prior to initiation of the GLP-1 RA B. Her insulin degludec should be discontinued prior to initiation of the GLP-1 RA C. GLP-1 RAs should be avoided in patients with a history of cardiovascular disease D. Initiation of a GLP-1 RA can help improve her A1C and promote weight loss E. Unsure

3. In consideration of RJ's current A1C, which of the following adjustments to her background therapy would be empirically recommended?

A. Decrease her metformin dose to 500 mg twice daily B. Permanently discontinue her insulin degludec C. Decrease her insulin degludec dose initially by 20% D. Increase her insulin degludec dose initially by 20% E. Unsure

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