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CCDE Module 1

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1. Glucagon secretes from which cell?

a) Beta Cell

b) Delta cell

c) Alpha cell

d) Gama cell

2. What happens with Type2 Diabetes?

a) The body does not produce insulin

b) The body doesn’t respond normally to the insulin it makes

c) Blood sugar is always too low

d) There is not enough glucose in the body

3. When a person’s has Type1 Diabetes:

a) There’s not enough insulin to transport glucose from the blood to the cells.

b) There’s too much insulin and not enough glucose.

c) The body has too much glucose

d) Insulin levels drop if the person doesn’t eat enough.

4. People can sometimes prevent Type 1 Diabetes.

a) True

b) False

5. Which type of diabetes is known as Type 1.5 diabetes?

a) MODY

b) LADA

c) NDM

d) SIRD

6. Following are the modifiable risk factor except________

a. Physical inactivity

b. High body fat or body weight

c. High blood pressure

d. Race/Ethnicity

7. Which HbA1c value is the diagnostic criteria for diabetes?

a) 5.7-6.4 %

b) <5.7 %

c) ≥ 6.5 %

d) ≥ 6 %

8. What is the cut-off value of waist circumference for Asian-Indian Men?

a) ≥80 cm

b) ≥95cm

c) <90cm

d) <95cm

9. What is the Diagnostic criteria for GDM as per DIPSI guideline?

a) OGTT with 75gm glucose,2hrs plasma glucose level ≥180mg/dl

b) OGTT with 75gm glucose,2hrs plasma glucose level ≥140mg/dl

c) OGTT with 75gm glucose,2hrs plasma glucose level ≥150mg/dl

d) OGTT with 75gm glucose,2hrs plasma glucose level ≥ 130mg/dl

10. Decreased incretin effect is one of the cause of Diabetes.

a) True

b) False

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Dapaglyn Survey

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1. What percentage of T2DM patients with high CV risk comes to your clinic practice?

a) <10 %

b) 10 %-30 %

c) 30 %-50 %

d) >50 %

2. In your clinical opinion, how often do you check HbA1C after initiating Pharmacotherapy?

a) Every 3 months

b) Every 4 months

c) Every 6 months

d) Yearly

3. Where do you initiate the FDC of Dapagliflozin +Sitagliptin in the management of T2DM in your clinical practice?

a) Newly Diagnosed T2DM

b) Uncontrolled on Metformin Monotherapy

c) Uncontrolled on either Monotherapy

d) All of the above

4. At which HbA1C, do you start this FDC in your clinical practice?

a) <7.5 %

b) ≥ 7.5 %

c) <9 %

d) All of the above

5. In your clinical practice, what is the primary reason for T2DM patients coming for consultation?

a) Uncontrolled Glycemic Parameters

b) Prevention of CV Outcomes

c) Prevention of Renal Outcomes

d) All of the above

6. In your clinical practice, on an average how much HbA1C reduction do you notice with Dapagliflozin + Sitagliptin combination?

a) ≤ 0.5%

b) 0.5 - ≤1 %

c) > 1-≤ 2 %

d) > 2%

7. In your opinion, to have most of the benefits of Dapagliflozin + Sitagliptin, when should it be ideally started in Management of T2DM?

a) Newly Diagnosed T2DM

b) Uncontrolled on Metformin Monotherapy

c) Uncontrolled on either Monotherapy

d) All of the above

8. What type of patients benefit more from this FDC in your clinical practice?

a) Heart Failure Patients

b) CKD Patients

c) Newly Diagnosed Type 2 Diabetes Patients

d) Poorly Controlled Type 2 Diabetes Patients

e) All of the above

9. As per your clinical experience, what are the advantages of this FDC?

a) Better Glycemic Durability

b) Reduction of CV events in HFrEF

c) Lesser Renal Adverse Outcome

d) Extra-glycemic Benefits

e) All of the above

10. In your clinical practice, do you feel this FDC can address most of the problems in T2DM?

a) Not Likely

b) Likely

c) Very Likely

d) None of the above

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Gastro Speciality

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1. When do you initiate Dapagliflozin in the Management of T2DM in your clinical practice?

a. Newly diagnosed T2DM as Monotherapy

b. Failure to metformin monotherapy cases

c. As FDC with Metformin

d. After failure of metformin & other therapy options

2. What percentage of patients do you prescribe Dapagliflozin in your practice?

a) <10%

b) 10%-30%

c) 30%-50%

d) >50%

3. In your clinical opinion, how often do you check HbA1c?

a. Every 3 months

b. Every 4 months

c. Every 6 months

d. Yearly

4. How much HbA1C do you target for in your clinical practice?

a. <6.5 %

b. < 7 %

c. < 8 %

d. < 9 %

5. In your clinical practice what is the primary reason for T2DM patients coming for consultation?

a. Glycemic Control

b. Prevention of CV outcomes

c. Prevention of Renal Outcomes

d. All of the above

6. In your clinical practice, on an average how much HbA1C reduction do you notice with Dapagliflozin?

a. ≤ 0.5%

b. 0.5 - ≤1 %

c. > 1-≤ 2 %

d. > 2%

7. In your opinion, to have most of the benefits of Dapagliflozin when should it be ideally started in Management of T2DM?

a. Newly diagnosed T2DM as Monotherapy

b. Failure to metformin monotherapy cases

c. As FDC with Metformin

d. As 3rd line option after Metformin & other conventional OADs

8. What type of patients benefits more from Dapagliflozin in your clinical practice?

a. Heart Failure Patients

b. CKD Patients

c. Newly Diagnosed Type 2 Diabetes Patients

d. Poorly controlled Type 2 Diabetes Patients

e. All of the above

9. As per your clinical experience, Dapagliflozin is superior compared to other SGLT2 inhibitors in which clinical parameters?

a) Better glycemic durability

b) Reduction of CV events in HFrEF

c) Lesser renal adverse outcome

d) Extra-glycemic benefits

e) All of the above

10. In your clinical practice, what percentage of patients develops UTI after starting SGLT2inhibitors?

a. 1 –2 %

b. 5– 10 %

c. 10–15 %

d. 15 – 20 %

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EXPLOR Study

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1.How many T2DM patients do you see on a daily basis?

a) <20

b) 20-40

c) 40-60

d) 60-80

e) >80

2. What is the most recommended OAD do you prefer for diabetes management?

a) Biguanides

b) SUs

c) Acarbose

d) DPP4i

e) SGLT2i

3. According to you, how many percentages of patients require combination therapy for diabetes management?

4. What is your preferred indication for DPP4i?

a) As first line monotherapy

b) As a first add-on to metformin

c) As a second add-on to metformin & SUs

d) As a third add-on to metformin, SUs &other oral antidiabetic

5. Which DPP4i do you prefer in combination with Metformin in case of lower and/or middle class diabetes patients?

a) Vildagliptin

b) Sitagliptin

c) Teneligliptin

d) Saxagliptin

6. In which clinical parameters Atorvastatin scores over Rosuvastatin ?

7. In which indication you prefer Atorvastatin more than Rosuvastatin?

a) Patients at high risk of ASCVD

b) Patients with diabetes

c) Patients with mixed dyslipidemia/atherogenic dyslipidemia

d) Patients with established ASCVD for secondary prevention

e) Dyslipidemia with CKD

8. In which indication do you prefer Atorvastatin based FDC?

a) Uncontrolled LDL/TG post high dose atorvastatin

b) Recurrent MI/ post MI

c) High risk or ASCVD patients

d) Post stroke

e) Diabetic dyslipidemia

9. In which indication/s do you prefer fixed drug combination Atorvastatin + Clopidogrel?

a) Stable CAD

b) Stroke

c) Post-MI patients who are aspirin intolerant (within 1st year of MI)

d) Post ACS

10. For what average duration do you prescribe Atorvastatin + Clopidogrel to your patient?

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CarbA1c Study

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1. The joint Commission mandates that nutrition screening within ………. hours of admission to an acute care centre.

a) 20 hours

b) 15 hours

c) 24 hours

d) 48 hours

2. Portion size calculation is not an essential part for preparation of a particular diet chart of an individual.

a) True

b) False

3. Which is important for nutritional assessment?

a) Diet history

b) Medical history

c) BMI

d) All of the above

4. Stamp is the nutritional tool for_______

a) Children

b) Adult

c) Young adult

d) All of the above

5. RDA of different minerals & vitamins according to ICMR should not be kept in knowledge while planning a diet chart.

a) True

b) False

6. For an adult clinic-based patient the following anthropometric measurements are taken:

a) BMI

b) Waist -hip ratio

c) Both the above

d) None of the above

7. Calculation of percentile is essential for planning diet chart for paediatric individual.

a) True

b) False

8. What is the Estimated Average Requirement of energy (According to EAR, 2023) for 7 to 9 years of children?

a) 64 kcal/kg/day

b) 70 kcal/kg/day

c) 67 kcal/kg/day

d) 72 kcal/kg/day

9. A 65 years female come to your clinic with different problems like High BP , Diabetes & Hyperlipidemia . Her height is 157cm. & weight is 65kg. What should be the energy requirement of this patient per day ?

a) 1600 kcal/day

b) 1500 kcal/day

c) 1400 kcal/day

d) 1300 kcal/day

10. A 57 years old man is suffering from diabetes &CKD. He has grade 3 CKD. His height is 167cm. & body weight is 65 kg. What will be the dietary protein intake /day suitable for him?

a) 25.2gm/day

b) 30.5 gm/day

c) 40.2 gm/day

d) 50.3 gm/day

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Ortho Survey

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1. In Your Clinical Practice, rate the prevalence of patients ranking Highest to Lowest among the followings - a) Neuropathy, b) Epilepsy, c) Stroke, d) Migraine e) Others.

2. In Epilepsy Management, your Choice of 1st line treatment in the preference of Highest to Lowest among the followings: a) Pheniytoin, b) Sodium Valproate, c) Levetiracetam, d) Any other.

3. In what % of Patients , you need more than 1 Anti-Epileptic medicine?

a) <10%

b) 10-20%

c) 20-30%

d) 30-40%

c) >50%

4. In uncontrolled patients of Epilepsy, what are your treatment choices?

a) Up Titrate Dose to Max

b) Add On other Antiepileptic

5. What is your favorite Levetiracetam Brand & Strengths?

6. In Neuropathy pain, 1st line treatments is _____

a) Pregabaline

b) Gabapentine

c) Pregabaline & Combinations

7. What % of patients need a combination treatment in Neuropathic pain?

a) 5-10%

b) 10-20%

c) 20-30%

d) >50%

8. What is the right patient profile for Pregabaline+Duloxitine combination ?

a) Neuropathic Pain

b) Neuropathic Pain with Anxiety

c) Any Other

9. How many such patients comes across to you in your clinical practice?

a) 5-10%

b) 10-20%

c) 20-30%

d) >50%

10. What duration you will continue this combination to your patients?

a) 1 -3 Months

b) 3-6 Months

c) 6-12 Months

d) More than 1 Year/ Lifelong

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Study on management of Panic disorder

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1.In which of the following groups of patients, you prefer Atorvastatin as a first choice statin?

a) All Patients at high risk of ASCVD

b) Patients with diabetes

c) Patients with mixed dyslipidemia/atherogenic dyslipidemia

d) Patients with established ASCVD for secondary prevention

e) All of the above

2. In your clinical practice, what % of patients are prescribed high intensity Atorvastatin treatments?

a) < 10%

b) 10-25%

c) 25-50%

d) > 50%

3. In your clinical practice, for how much duration high intensity Atorvastatin is routinely prescribed?

a) 3 months

b) 3 months – 6 months

c) 6 months – 1 year

d) > 1 year

4. In what proportion of patients, you prescribe FDC of Atorvastatin, Aspirin & Clopidogrel?

a) <25%

b) 25-50%

c) 50-75%

d) >75%

5. In your clinical practice, how long you put patient on FDC of Atorvastatin & DAPT?

a) 3 months

b) 6 months

c) 1 year

d) > 1 year

6. What is the minimum LDL-C goal you try to achieve in your very high CV risk patients?

a) < 70 mg/dl

b) < 55 mg/dl

c) < 40 mg/dl

d) < 30 mg/dl

7. How many patients in your routine clinical practice, are prescribed with Atorvastatin + Clopidogrel Therapy?

a) < 5%

b) 5-10%

c) 10-15%

d) 15-20%

e) > 20%

8. In which indication/s do you prefer fixed drug combination Atorvastatin + Clopidogrel?

a) Stable CAD

b) Stroke

c) Post-MI patients who are aspirin intolerant (within 1st year of MI)

d) Post ACS

9. For what average duration do you prescribe Clopitorva in your patient?

a) < 3 months

b) < 6 months

c) 6 – 12 months

d) > 1 year

e) Life Long

10. Which is your most preferred Combination in secondary prevention of CVD?

a) Atorvastatin + Clopidogrel

b) Rosvastatin + Clopidogrel

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Questionnaire – Vinglyn

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1. In your opinion, why does the management of type 2 diabetes pose a unique and complex health challenge in India?

a) Burden is higher than in developed countries

b) Burden may be masked by inadequate reporting

c) Substantially lower number of diabetes registries available

d) All of the above

2. Which factors are associated with development of diabetes in the thin Indian phenotype patient?

a) Early age of T2DM onset

b) Early decline in beta cell mass

c) Higher insulin resistance

d) Higher carbohydrateintake and physical inactivity

3. In your opinion, which are the patient-centric factors responsible for poor glycemic control in India?

a) Non-compliance to lifestyle measures

b) Poor frequency of self-monitoring of blood glucose levels

c) Poor drug adherence

d) Low disease awareness

e) All of the above

4. In your opinion, what are the disease-centric factors responsible for poor glycemic control in India?

a) Obesity

b) Longer duration of diabetes

c) Hypertension

d) Requirement for diverse therapeutic options for the individualization of care (personalized medicine)

5. When do you usually initiate Vildagliptin in the Management of T2DM in your clinical practice?

a) As monotherapy in Newly diagnosed T2DM

b) As an add-on to patients uncontrolled on metformin monotherapy

c) As FDC with Metformin with high baseline HbA1c

d) As an add-on to patients uncontrolled on metformin-based combinations

6. When do you initiate Dapagliflozin in the Management of T2DM in your clinical practice?

a) As monotherapy in newly diagnosed T2DM

b) As an add-on to patients uncontrolled on metformin monotherapy

c) As FDC with Metformin with high baseline HbA1c

d) As an add-on to patients uncontrolled on metformin-based combinations

7. In your clinical practice how frequently do you see patients with high HbA1C levels who require FDC of vildagliptin-dapagliflozin?

a) <5 patients per month

b) 5-10patients per month

c) 10-20patients per month

d) >20patients per month

8. In your opinion which sequence of administering antidiabetic drug will be more effective ?

a) Vildagliptin followed by Dapagliflozin

b) Dapagliflozin followed by Vildagliptin

c) Molecule can be used in any order

9. In your opinion which category of patients can be benefitted with a FDC of Vildagliptin & Dapagliflozin?

a) Treatment naïve patients

b) As an add-on to patients uncontrolled on vildagliptin or dapagliflozin monotherapy

c) As an add-on to patients uncontrolled on Metformin monotherapy

d) As an alternative add-on to patients uncontrolled on metformin-based combinations with other DPP4 Inhibitors/SGLT2 Inhibitors

e) As an alternative add-onto patients uncontrolled on metformin-based combinations other than DPP4 Inhibitors/SGLT2 Inhibitors

f) All of the above

10. Is the use of FDC of SGLT2i + DPP4i more safe than sequential addition of SGLT2i to DPP4i Therapy?

a) YES

b) NO

11. Along with vildagliptin 100 mg SR formulation what strength of Dapagliflozin (5/10) mg is more preferred as FDC in clinical practice?

a) 5 mg

b) 10 mg

c) Both will be useful as per patient’s requirement

12. In your opinion FDC of SGLT2i + DPP4i is a suitable option for Indian T2D patients, because of _______

a) Safer, rapid, and sustained glycemic control

b) Improves both insulin resistance and beta cell function

c) Helps reduce body weight and blood pressure (extra-glycemic benefits)

d) Reduces pill burden (improved adherence and compliance)

e) Reduction in occurrence of hypoglycemia or weight gain

f) All of the above

13. Evidence suggests that time in range (TIR) complements HbA1c as a parameter of glycemic control, with higher TIR associated with better clinical outcomes. In your clinical experience, do DPP4i and SGLT2i have beneficial effects on TIR?

a) YES

b) NO

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Lipaglyn PRP Quest Discovery

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1. In routine clinical practice, how many NAFLD patients do you treat in a month?

a) < 10 patients / month

b) 10-20 patients / month

c) 20-40 patients / month

d) 40-60 patients / month

e) > 60 patients / month

2. NAFLD is metabolic condition and commonly associated with Obesity, DM and Dyslipidemia. So, in which type of patients, based on major guidelines such as AASLD/EASL/ADA do you recommend screening of NAFLD disease? (Can tick multiple options)

a) T2DM & Pre-diabetics with elevated ALT

b) Dyslipidemia

c) Hypertension

d) Prior h/o Cardiovascular disease

3. In routine clinical practice; which diagnostic tests do you apply to confirm NAFLD diagnosis in suspected patients? (Can tick multiple options)

a. Liver enzymes

b. Ultrasonography

c. Transient Elastography (Fibroscan)

d. Liver Biopsy

4. What percentage of your Diabetic patients do you screen for Liver Enzyme / Ultrasonography for suspected NAFLD?

a) <20%

b) 20% - 40%

c) 40% -50%

d) >50%

5. Which of below mentioned tests would you prefer to evaluate risk of fibrosis in NAFLD patients? (Can tick multiple options)

a. FIB-4 Index calculator

b. Transient Elastography (Fibroscan)

c. MR Elastography

d. Liver Biopsy

6. In current routine practice, which is most common medication that do you prescribe in NAFLD treatment?

a) Pioglitazone

b) Ursodeoxycholic Acid

c) Saroglitazar

d) Any other:

7. In current time, Saroglitazar is the only approved medication for NAFLD management. So in how many NAFLD patients would you like to start or switch to Saroglitazar treatment ?

a) < 10%

b) 10% - 20%

c) 20% - 40%

d) 40% - 50%

e) > 50%

8. What duration of therapy do you recommend for Saroglitazar to your NAFLD patients?

a) 16 weeks

b) 24 weeks

c) 48 weeks

d) 52 weeks

9. In what % of your NAFLD patients, do you observe absolute fat reduction after Saroglitazar therapy in USG?

a) <20%

b) 20% - 40%

c) 40% - 50%

d) 50% - 60%

e) > 60%

10. How much average Liver enzyme reduction, do you observe in NAFLD patients after Saroglitazar treatment ?

a) <30%

b) 30% - 50%

c) 50% - 70%

d) > 70%

11. In how many NAFLD patients after Saroglitazar treatment, do you find regression in level of fibrosis?

a) <30%

b) 30% - 50%

c) 50% - 70%

d) > 70%

12. How would you like to scale safety experience of Saroglitazar in routine practice?

a) 0 = No any adverse events

b) 1= Very few adverse events

c) 2= Mild adverse events

d) 3= Moderate adverse events

e) 4= Serious adverse events

f) 5= Extremely serious adverse events

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