Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What recommendation is suitable for a person with hypertension and diabetic nephropathy?

1. Blood pressure treatment should include an ACE inhibitor.

2. Dietary protein intake should be maintained at 1 g/kg/day.

3. A1C goals should be relaxed to greater than 8%.

4. Combination of ACE inhibitors with ARBs preserve kidney function.

The correct answer is: Blood pressure treatment should include an ACE inhibitor.

The recommendation that blood pressure treatment should include an ACE inhibitor is particularly suitable for a person with hypertension and diabetic nephropathy due to the protective effects of ACE inhibitors on kidney function. These medications not only help lower blood pressure but also offer renal benefits by reducing intraglomerular pressure. This is important for patients with diabetic nephropathy as it can slow the progression of kidney disease. The ability of ACE inhibitors to help manage both hypertension and diabetic nephropathy makes them a first-line treatment in such cases. In terms of dietary protein intake, while a low-protein diet may be recommended in advanced stages of nephropathy to limit the strain on the kidneys, a general recommendation to maintain protein intake at 1 g/kg/day does not specifically address the needs of a person with diabetic nephropathy, as protein restrictions can vary based on the stage of kidney disease. Setting A1C goals greater than 8% is inconsistent with current guidelines that emphasize the importance of maintaining optimal glycemic control to prevent complications, including further kidney damage. Lastly, while combining ACE inhibitors with ARBs (angiotensin receptor blockers) may provide additional blood pressure control, this combination is often not recommended due to increased risks of kidney injury and hyperkalemia. Thus