A 56-Year-Old Man Comes to the Office for Follow-Up of Type

question 332

Multiple Choice

A 56-year-old man comes to the office for follow-up of type 2 diabetes mellitus.  The patient has had inadequate glycemic control with metformin monotherapy, and a new medication that inhibits dipeptidyl peptidase-4 was prescribed 3 months ago.  He feels well and reports no adverse effects from the new therapy.  The patient also has hypertension, for which he takes ramipril.  He does not use tobacco, alcohol, or illicit drugs.  The patient says he is generally compliant with dietary guidance but occasionally eats fast foods.  Blood pressure is 126/74 mm Hg and pulse is 76/min.  BMI is 31.4 kg/m².  Physical examination shows no abnormalities.  Laboratory results show a hemoglobin A1c of 6.8%.  The newly prescribed medication most likely improved this patient's glycemic control through which of the following direct mechanisms?

• A)Decreased dietary carbohydrate digestion
• B)Decreased renal glucose reabsorption
• C)Increased glucagon secretion
• D)Increased glucose-dependent insulin release
• E)Increased peripheral tissue glucose uptake

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