American Board of Internal Medicine (ABIM) Certification Practice Exam

At what A1c level should you immediately start two agents for diabetes management?

1. 8

2. 9

3. 10

4. 11

The correct answer is: 9

Initiating treatment with two agents for diabetes management is typically recommended when the A1c level is particularly high, indicating significant hyperglycemia and potential for associated complications. An A1c level of 9% reflects a state where there is a considerable risk for both acute and chronic complications of diabetes, such as cardiovascular issues, neuropathy, and retinopathy. Starting dual therapy at this level aims to achieve more rapid glycemic control to mitigate these risks. Following the guidelines from diabetes management organizations, patients with an A1c of 9% or higher often require a more aggressive treatment approach. Glenuance in A1c levels shows that simply using one agent may not be sufficiently effective in achieving target levels quickly. The goal is to lower the A1c to below 7% to reduce long-term complications, but for those who present with an A1c of 9%, a more potent regimen of two agents is often warranted to expedite improvement. When looking at the higher options, while levels of 10% and above are certainly concerning and would also require aggressive management, the immediate recommendation for dual therapy generally starts at the A1c level of 9%, reflecting the seriousness of the patient's condition without delaying intervention.