American Board of Internal Medicine (ABIM) Certification Practice Exam

What A1c level indicates the initiation of insulin therapy in patients with Type 2 Diabetes Mellitus?

1. 8

2. 9

3. 10

4. 11

The correct answer is: 10

The initiation of insulin therapy in patients with Type 2 Diabetes Mellitus is generally considered when HbA1c levels are significantly elevated, indicating poor glycemic control. An HbA1c level of 10% is often used as a threshold for starting insulin therapy. At this level, the risk for microvascular complications, such as retinopathy and nephropathy, increases, prompting a more aggressive approach to management to prevent such complications. In clinical guidelines, insulin therapy may also be considered for patients with an A1c level above 9%, particularly if there are additional factors such as symptoms of hyperglycemia or significant weight loss. However, 10% is recognized as a more definitive trigger for initiating insulin, especially in the absence of other contraindications or when oral medications are insufficient to achieve glycemic targets. The higher A1c levels above 10% not only indicate a need for insulin therapy but also highlight the chronic nature of hyperglycemia in these patients, necessitating intensive management to avoid complications.