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New type 2 diabetes outpatient initiation — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareNew type 2 diabetes outpatient initiationUSMLE Step 3

A 43-year-old woman with hereditary spherocytosis and chronic hemolysis has polyuria and polydipsia. Fasting plasma glucose is 132 mg/dL on two separate mornings, but A1c is 5.6%. Which interpretation is most appropriate?

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Correct answer: E — Diagnose diabetes from the two repeated fasting plasma-glucose results

The best answer is “Diagnose diabetes from the two repeated fasting plasma-glucose results”. Conditions that alter erythrocyte turnover can make A1c misleading, so plasma-glucose criteria should be used. Two fasting plasma glucose values at or above 126 mg/dL confirm diabetes despite a falsely low A1c from shortened red-cell survival.

Reference: ADA Standards of Care in Diabetes—2026: Diagnosis and Classification: https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes