Categories
CDE Diabetes

Practice Exam: Definition, Classification & Diagnosis (Chapter 3)

Welcome to the Chapter 3 Practice Exam. This assessment is designed specifically for Canadian healthcare professionals preparing for the Certified Diabetes Educator (CDE) examination.

This module focuses on the foundational “rules” of diabetes care: how we define, classify, and diagnose the condition in various populations. In the actual CDE exam, these questions often appear as straightforward recall (Knowledge) or as discordant lab results requiring interpretation (Critical Thinking).

Exam Details

  • Source Material: Diabetes Canada Clinical Practice Guidelines (Chapter 3).

  • Format: Multiple Choice Questions (Case-based and Standard).

  • Difficulty: Mixed (Knowledge, Application, Critical Thinking).

  • Goal: To simulate the decision-making required when interpreting lab results and classifying diabetes types in clinical practice.

Competency Alignment

This exam has been developed to map directly to the CDECB Competencies:

  • 1.B: Distinguishes between the major types of diabetes (Etiology, Signs/Symptoms).

  • 1.D: Identifies the diagnostic criteria for all types of diabetes.

  • 4.4.F: States the interpretation and limitations of A1C testing.

  • 5.D: Identifies risk factors for macrovascular complications (Metabolic Syndrome).

  • 7.C: Identifies aspects of assessment for pregnancy (Screening exclusions).

Instructions

  1. Read each clinical scenario carefully. Pay attention to details like “symptomatic vs. asymptomatic” or “fasting vs. random.”

  2. Select the single best answer based strictly on the 2018 Guidelines.

  3. Review the Detailed Answer Key at the end to understand the rationale for the correct and incorrect options.

1. Case: A 23-year-old woman with a BMI of 24 kg/m² is diagnosed with diabetes. She has no family history of type 1 diabetes, but her father was diagnosed with diabetes at age 28 and her paternal grandmother at age 30. Her autoantibodies are negative and C-peptide is normal. What is the most appropriate clinical reasoning?

2. Case: A 45-year-old asymptomatic man has a routine FPG of 7.3 mmol/L. What is the most appropriate next step?

3. Which diagnostic test is NOT recommended for use in diagnosing diabetes in pregnant women as part of routine screening for gestational diabetes?

4.

A diabetes educator is counselling a patient with newly diagnosed prediabetes. The patient has IGT but not IFG. According to the guidelines, what should the educator emphasize about cardiovascular risk?

5. Which A1C range is used by Diabetes Canada to define prediabetes?

6.

What minimum fasting duration is required before measuring fasting plasma glucose?

7.

Case: A person diagnosed with type 1 diabetes at age 2 is now 18 years old. The healthcare team is reviewing their records and notes the early diagnosis. What action should be taken based on current guidelines?

8. The combination of an FPG of 6.1-6.9 mmol/L AND an A1C of 6.0-6.4% is predictive of what rate of progression to type 2 diabetes over 5 years?

9.

Case: A 32-year-old woman presents with polyuria, polydipsia, and unintentional weight loss. Her random plasma glucose is 14.2 mmol/L. What is the most appropriate action?

10.

Latent autoimmune diabetes in adults (LADA) is classified under which category of diabetes?

11. How many criteria must be met to diagnose metabolic syndrome according to the harmonized definition?

12.

According to the guidelines, A1C values can increase by approximately how much per decade of life?

13. Case: A 4-month-old infant is diagnosed with diabetes. What is the most appropriate management consideration?

14. When evaluating the evidence grading for diagnostic recommendations, which test has the highest level of evidence (Grade A, Level 1) for diagnosing prediabetes?

15. Case: An 18-year-old lean male presents with DKA. His family has no history of diabetes. Which autoantibody test would be most helpful in confirming type 1 diabetes?

16.

A diabetes educator is developing a screening program. According to the guidelines, which statement about confirmatory testing is most accurate?

17. What waist circumference threshold indicates elevated cardiovascular risk for Canadian men according to metabolic syndrome criteria?

18. Case: A 14-year-old adolescent with obesity and acanthosis nigricans has an FPG of 7.2 mmol/L. Islet autoantibodies are negative. What is the most likely diagnosis?

19. Case: A 19-year-old lean patient is diagnosed with diabetes and has symptoms of hyperglycemia with ketonuria. The physician wants to wait for confirmatory testing before starting treatment. What is the most appropriate advice from the diabetes educator?

20. A patient with iron deficiency anemia has an A1C of 6.8%. How might this condition affect the A1C interpretation?

21.

Case: A clinical team is debating whether to use FPG 5.6-6.0 mmol/L or 6.1-6.9 mmol/L to define IFG in their screening protocol. Based on Diabetes Canada guidelines, which definition is recommended and why?

22. What is the FPG threshold that correlates most closely with a 2hPG value of ≥11.1 mmol/L in predicting retinopathy?

23. Case: A person presents with DKA and has 3 negative autoantibody tests. After resolution of DKA, fasting C-peptide is measured at 0.45 nmol/L. Based on this information, what is the likely clinical course?

24. What percentage of individuals with type 2 diabetes have a family history of the condition?

25. A person with an A1C of 6.0% asks about their 5-year risk of developing diabetes. What is the most accurate response based on systematic review data?

26. Case: A 55-year-old Japanese-Canadian woman has the following: waist circumference 82 cm, triglycerides 2.1 mmol/L, HDL-C 1.4 mmol/L, BP 142/88 mmHg, FPG 5.8 mmol/L. Does she meet criteria for metabolic syndrome?

27. A patient with type 2 diabetes is also diagnosed with the metabolic syndrome. Which additional cardiovascular risk factor should be specifically targeted?

28. What is the 2-hour plasma glucose threshold in a 75g OGTT for diagnosing impaired glucose tolerance (IGT)?

29. A patient has the following results: FPG 6.8 mmol/L and A1C 6.7%. How should these discordant results be interpreted?

30. According to Diabetes Canada, what fasting plasma glucose (FPG) level is diagnostic for diabetes?

31.

Monogenic diabetes typically presents in individuals younger than what age?

32. Case: A 35-year-old patient has Graves’ disease and is being evaluated for diabetes. An A1C result shows 6.6%. What should the clinician consider?

33. A patient has both IFG (FPG 6.5 mmol/L) and IGT (2hPG 9.2 mmol/L). Compared to having either condition alone, this patient’s risk is:

34.

Case: A 50-year-old man of African descent has an A1C of 6.4%. His FPG is 5.8 mmol/L. Based on current evidence regarding ethnicity and A1C, what should be considered?

35. Case: A 60-year-old person with chronic kidney disease stage 4 has a suspected diagnosis of diabetes. Which diagnostic consideration is most important?

36. Case: An 8-year-old child presents with an FPG of 8.2 mmol/L. The parents ask why A1C alone cannot be used for diagnosis. What is the most appropriate explanation?

37.

Case: A person living at high altitude has an A1C of 6.3% and FPG of 5.9 mmol/L. The patient asks if their A1C is accurate. Based on current evidence, what should the clinician explain?

38. Case: A 28-year-old woman has diabetes that was diagnosed at age 22. Her grandmother, mother, and two siblings also have diabetes, all diagnosed before age 25. Her BMI is 23 kg/m². What type of diabetes should be suspected?


 

Categories
CDE Diabetes

Study Guide: Definition, Classification & Diagnosis (Chapter 3)

CDECB Competency Focus: 1.B, 1.D, 4.4.F, 5.D Exam Weight: High (Foundational Knowledge)

1. Diagnostic Criteria for Diabetes

Competency 1.D: Identifies the diagnostic criteria for all types of diabetes.

For the CDE exam, you must memorize these specific thresholds. Remember that in Canada, all glucose values are measured in mmol/L.

The 4 Diagnostic Tests

Diabetes is diagnosed if any of the following criteria are met:

 

Test

Threshold

Notes

FPG (Fasting Plasma Glucose)

≥ 7.0 mmol/L

Fasting = No caloric intake for at least 8 hours.

 

A1C (Glycated Hemoglobin)

≥ 6.5%

Must use a standardized, validated assay.

 

2hPG (75 g OGTT)

≥ 11.1 mmol/L

The standard oral glucose tolerance test.

Random PG

≥ 11.1 mmol/L

Measured at any time of day, regardless of last meal.

 

2. Confirmatory Testing Rules

Competency 1.D / Critical Thinking: Applying rules to discordant or uncertain results.

The guidelines have specific algorithms for when to confirm a diagnosis. You cannot diagnose everyone on a single test result.

Symptomatic vs. Asymptomatic

  • Symptomatic Hyperglycemia: If the patient has classic symptoms (polyuria, polydipsia, weight loss), a single test in the diabetes range is sufficient. Do not delay treatment.

  • Asymptomatic: If a single test is in the diabetes range, a repeat confirmatory test must be done on another day.

Which Test to Repeat?

  • Ideally: Repeat the same test to confirm.

  • Exception: If the initial positive test was a Random PG, confirm with an alternate test (FPG, A1C, or OGTT).

Two Different Tests: If two different tests (e.g., FPG and A1C) are both available and both are above the threshold, the diagnosis is confirmed.

Dealing with Discordance (Conflicting Results)

If one test is positive for diabetes and one is negative:

    1. Repeat the test that was above the diagnostic cut-point.

    2. Make the diagnosis based on the result of the repeat test.

EXAM ALERT: If a young or lean individual presents with symptomatic hyperglycemia and ketonuria (suspected Type 1), do not delay treatment to perform confirmatory testing. Rapid metabolic deterioration can occur.

 

3. Diagnosis of Prediabetes

Competency 1.D: Identifies the diagnostic criteria for prediabetes.

Prediabetes places individuals at high risk for developing diabetes and cardiovascular complications.

  • Impaired Fasting Glucose (IFG): FPG 6.1 – 6.9 mmol/L.
  • Impaired Glucose Tolerance (IGT): 2hPG in a 75 g OGTT 7.8 – 11.0 mmol/L.
  • Prediabetes (A1C): A1C 6.0% – 6.4%.

4. Differentiating Types of Diabetes

Competency 1.B: Distinguishes between major types of diabetes.

Use this table to answer case-based questions distinguishing Type 1, Type 2, and Monogenic diabetes.

Feature

Type 1 Diabetes

Type 2 Diabetes

Monogenic Diabetes

Age of Onset

Usually <25 years (but can be any age).

Usually >25 years (but increasing in adolescents).

Usually <25 years.

Weight

Usually thin/normal.

>90% are overweight/obese.

Similar to general population (often non-obese).

Auto-antibodies

Present (GAD, ICA).

Absent.

Absent.

Inheritance

Infrequent (5-10%).

Frequent (75-90%).

Autosomal Dominant (Multigenerational).

Insulin Status

Absent (low C-peptide).

Present (normal/high C-peptide).

Usually present.

5. Limitations of the A1C Test

Competency 4.4.F: States the definition, limitations, and interpretation of A1C.

A1C reflects average glucose over 2–3 months. It is convenient but not perfect.

Who Should NOT be Diagnosed with A1C?

Do not use A1C for diagnosis in:

  • Children and adolescents (as the sole diagnostic test).

  • Pregnant women (routine screening).

  • Suspected Type 1 diabetes.

  • Those with cystic fibrosis.

  • Those with factors affecting A1C accuracy (see below).

Factors Affecting Accuracy

  • False Highs: Iron deficiency, B12 deficiency, decreased erythropoiesis (e.g., renal failure), splenectomy.

  • False Lows: Use of Iron/B12/EPO, chronic liver disease, antiretrovirals, splenomegaly.

  • Ethnicity: African Americans, Hispanics, and Asians may have A1C values up to 0.4% higher than Caucasians at similar glucose levels.

  • Age: A1C rises by up to 0.1% per decade of life.

6. Metabolic Syndrome

Competency 5.D: Identifies risk factors for macrovascular complications.

Diagnosis requires ≥ 3 of the following 5 criteria:

  1. Elevated Waist Circumference:

    • Canada/USA/Europid: Men ≥102 cm, Women ≥88 cm.

    • Asian/South & Central American: Men ≥90 cm, Women ≥80 cm.

  2. Elevated Triglycerides: ≥ 1.7 mmol/L (or on drug treatment).

  3. Reduced HDL-C: Men <1.0 mmol/L, Women <1.3 mmol/L (or on drug treatment).

  4. Elevated Blood Pressure: Systolic ≥130 mmHg or Diastolic ≥85 mmHg (or on antihypertensive treatment).

  5. Elevated Fasting Glucose: FPG ≥ 5.6 mmol/L (or on drug treatment for elevated glucose).

Exam Trap: Notice that the FPG threshold for Metabolic Syndrome is ≥5.6 mmol/L, whereas the threshold for diagnosing Prediabetes (IFG) starts at 6.1 mmol/L. Read the question carefully to see which definition they are asking for!

Reference:

Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Canadian Journal of Diabetes. 2018;42:S10-S15. doi:10.1016/j.jcjd.2017.10.003
Categories
COPD

COPD Inhalers – Easy to Use Reference Tool

Choosing a COPD Inhaler

I was working on a COPD program over the last couple of weeks and came across a couple of great tools.

I have found that many clinicians and patients are often confused with all the different medications and inhaler options.  Resptrec has developed a couple of great tool for clinicians.  A great tool is the COPD medication chart.  It provides the different options for each of the main classes of COPD drugs in Canada (SABD, LAMA, LABA, ICS/LABA, LAMA/LABA).  It shows all the different devices for each class, as well as dosing and both the trade and drug names.

I like how this tool can be used with a patient in the device selection process when the product is being prescribed or can help to choose an alternative device in the class if they are having issues with an inhaler.  This may improve medication delivery and adherence.

It is just a great tool to download, have it available when you need to discuss the different COPD inhaler and medication options.

The tool can be downloaded from the Saskatchewan Lung Association at the RESPTREC resources page.

PS – They also have one of these tools for asthma medications as well.