Certified Diabetes Educator Exam

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Yale University *

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2023

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May 1, 2024

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Certified Diabetes Educator Exam - Based off of ADA SOC 2023 and AADE Questions With Complete Solutions Goals of DM Tx Correct Answer: 1. Promote normal physical and psychological growth and development. 2. Avoid acute and chronic complications of DM Plasma GLU and A1C Goals Adults (T1D) Correct Answer: premeal 80-130 bedtime 80-150 A1C<7% DM Education for School-aged Adolescents Correct Answer: Most should be directed towards teens with parents included Survival Skills at Initial Teaching T1D Correct Answer: Testing BG and urine or blood ketons Measuring and administering insulin Understanding insulin actions Performing insulin actions Meal planning Preventing, recognizing and treating hypoglycemia 4 Key Components of T1D Management Correct Answer: Monitoring BG (6-8x/day) Taking medication Healthy Eating

Being Active ADA recommends BG checks when? Correct Answer: prior to meals and snacks occasional postprandial at bedtime prior to exercise suspect low BG prior to critical tasks like driving for multiple daily injections When to complete frequent BG monitoring (>4 checks)? Correct Answer: Preprandial: determine meal insulin dose Postprandial: determine if premeal dose was correct Overnight: detect nocturnal hypoglycemia Frequent testing for anyone w/ hypoglycemic unawareness When to use Continuous Glucose Monitoring? Correct Answer: Hypoglycemia unawareness Frequent episodes hypoglycemia Nocturnal hypoglycemia Unexplained GLU excursions Gastroparesis Ketone Test When? Correct Answer: BG>250mg/dL and during illness, can be tested in urine or blood Dawn Phenomenon Correct Answer: Overnight insulin deficiency resulting in fasting hyperglycemia r/t normal rise in growth hormone, cortisol, and other hormones that raise BG in absence of insulin

Ketone level indicating risk DKA Correct Answer: >0.6mmol/L ADA SOC 2017 - 4 Recommendations for Health Promotion and Disparity Reduction Correct Answer: 1. Tx should be timely, evidence-based, and collaborative. 2. Providers should consider the burden of treatment and self-efficacy of patients when recommending treatments. 3. Treatment plans should align with the Chronic Care Model 4. Support team-based care, community involvement, patient registries, and decision support tools to meet patient needs. 6 Core Elements of Chronic Care Model Correct Answer: 1. Delivery system design (moving from a reactive to a proactive care delivery system where planned visits are coordinated through a team-based approach) 2. Self-management support 3. Decision support (basing care on evidence-based, effective care guidelines) 4. Clinical information systems (using registries that can provide patient-specific and population-based support to the care team) 5. Community resources and policies (identifying or developing resources to support healthy lifestyles) 6. Health systems (to create a quality-oriented culture) Medication adherence and medication titration Correct Answer: 80% (calculated as the number of pills taken by the

patient in a given time period divided by the number of pills prescribed by the physician in that same time period) (15). If adherence is 80% or above, then treatment intensification should be considered (e.g., up-titration). ADA SOC 2017 - Diabetes can be classified into the following 4 general categories Correct Answer: 1.Type 1 diabetes (due to autoimmune -cell destruction, usually leading to β absolute insulin deficiency) 2.Type 2 diabetes (due to a progressive loss of -cell insulin β secretion frequently on the background of insulin resistance) 3.Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation) 4.Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation) ADA Stage 1 T1D Correct Answer: Autoimmunity Normoglycemia Presymptomatic Multiple autoantibodies No IGT or IFG

ADA Stage 2 T1D Correct Answer: Autoimmunity Dysglycemia Presymptomatic Multiple autoantibodies Dysglycemia: IFG and/or GTT Increase in A1C ADA Stage 3 T1D Correct Answer: New-onset hyperglycemia Symptomatic Clinical symptoms Diabetes by standard criteria T/F: FPG, 2-h PG after 75-g OGTT, and A1C are equally appropriate for diagnostic testing? Correct Answer: True T/F: OGTT, compared with FPG and A1C cut points, diagnoses more people with diabetes? Correct Answer: True A1C advantages compared with the FPG and OGTT Correct Answer: Greater convenience (fasting not required), greater preanalytical stability, and less day-to-day perturbations during stress and illness. However, lower sensitivity, greater cost, limited availability and the imperfect correlation between A1C and average glucose in certain individuals. T/F: A1C identified 1/3 more cases of undiagnosed DM than FBG>/=126mg/dL Correct Answer: False. A1C cut point of

≥6.5% identifies one-third fewer cases of undiagnosed diabetes than a fasting glucose cut point of ≥126 mg/dL T/F: Age and A1C, A1C is accurate in children Correct Answer: False: Uncertain if can be used in children, cut points were for adults. However, ADA continues to recommend in this age-group for T2D. T/F: A1C is not the same across all Races/Ethnicities Correct Answer: True: A1C levels may vary with race/ethnicity independently of glycemia. For example African Americans may have higher A1C levels than non- Hispanic whites despite similar fasting and postglucose load glucose levels What are examples of Hemoglobinopathies/Red Blood Cell Turnover that impact A1C and test to use? Correct Answer: 1. Sickle cell with normal cell turnover but abnormal Hgb: A1C assay without interference from abnormal hemoglobins should be used 2. Conditions associated with increased red blood cell turnover, such as pregnancy (second and third trimesters), hemodialysis, recent blood loss or transfusion, or erythropoietin therapy, only blood glucose criteria should be used to diagnose diabetes. Confirming Diabetes Diagnosis per ADA Correct Answer: Unless there is a clear clinical diagnosis (e.g., patient in a hyperglycemic crisis or with classic symptoms of

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