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Flashcards: Screening for Diabetes in Adults (Chapter 4)

Who needs screening? When? And how often?

Welcome to the Interactive Flashcard Deck for Chapter 4 of the Diabetes Canada Clinical Practice Guidelines.

While Chapter 3 was about diagnosing the disease, Chapter 4 is about finding it. For the CDE exam, you need to be able to look at a patient profile and instantly decide: “Do I screen them now, or can they wait?”

This chapter requires you to memorize a long list of risk factors and master the specific Screening Algorithm.

Ready to practice your risk assessment skills? Click the cards below to start.

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CDE Diabetes

Practice Exam: Screening for Diabetes in Adults (Chapter 4)

Based on the Diabetes Canada Clinical Practice Guidelines

Welcome to the Chapter 4 Practice Exam. This assessment is tailored for Canadian healthcare professionals preparing for the Certified Diabetes Educator (CDE) examination.

While Chapter 3 covers how to diagnose diabetes, Chapter 4 focuses on the critical public health question: Who needs to be tested, and when?

With an estimated 20% to 40% of diabetes cases remaining undiagnosed, your ability to identify high-risk individuals and implement appropriate screening intervals is a core competency for any diabetes educator. This exam will test your ability to apply the “Screening Algorithm” to diverse patient scenarios.

Competency Alignment

This exam is designed to map directly to the CDECB Competencies:

  • 1.G: Describes the impact of lifestyle, genetics, and body composition (Risk Factors).

  • 5.E: Describes the recommendations for screening for microvascular and macrovascular complications (and underlying diabetes).

Key Concepts to Review

Before starting, ensure you are familiar with:

  1. The “Rule of 40”: The baseline recommendation for everyone 40 years old.

  2. The Risk Factor List: Specific conditions that mandate earlier screening (e.g., PCOS, Acanthosis Nigricans, Schizophrenia).
  3. Screening Intervals: The difference between the standard 3-year interval and the 6–12 month interval for high-risk or “At Risk” results.

1. According to Diabetes Canada 2018 guidelines, what is the recommended screening interval for diabetes in individuals ≥40 years of age?

2. What A1C level is diagnostic for diabetes when confirmed by a second test?

3. What is the estimated prevalence of undiagnosed type 2 diabetes in the general Canadian population using FPG criteria?

4. Based on retinopathy data, approximately how many years before clinical diagnosis does the onset of type 2 diabetes occur?

5. According to Diabetes Canada, routine screening for type 1 diabetes is:

6. When should an oral glucose tolerance test (OGTT) be considered according to Diabetes Canada guidelines?

7. In the CANRISK questionnaire, for what age group has it NOT been validated?

8. What is the estimated proportion of total diabetes cases that are undiagnosed?

9. Case: A 42-year-old asymptomatic woman comes for her annual check-up. She has no known risk factors for diabetes. What screening recommendation should you make?

10. Case: A 35-year-old South Asian man with BMI 27 kg/m² requests diabetes screening. He has no other risk factors. What is the most appropriate recommendation?

11. Case: A 52-year-old woman has FPG 6.5 mmol/L and A1C 5.9%. According to Diabetes Canada guidelines, what should you do next?

12. Case: A 28-year-old woman with a history of gestational diabetes 3 years ago asks when she should be screened for diabetes. What do you recommend?

13. Case: A 45-year-old woman with polycystic ovary syndrome (PCOS) has FPG 5.8 mmol/L and A1C 5.7%. What is your assessment and recommendation?

14. Case: A 38-year-old Indigenous Canadian man with BMI 29 kg/m² and hypertension requests screening. What should you do?

15. A patient has FPG 6.3 mmol/L. What additional information would strengthen consideration for an OGTT?

16. Case: A 55-year-old man on chronic glucocorticoid therapy for rheumatoid arthritis has never been screened for diabetes. What is the most appropriate action?

17. Case: A 60-year-old man with schizophrenia on atypical antipsychotic medication has not been screened for diabetes in 5 years. What is your recommendation?

18. A patient has elevated A1C at 6.3% but normal FPG at 5.4 mmol/L. The patient has multiple risk factors for diabetes. What is the most appropriate next step?

19. Case: A 32-year-old woman delivered a 4.5 kg (9.9 lb) baby 2 years ago. She has normal BMI and no other risk factors. When should she be screened for diabetes

20. Which patient would be at highest priority for diabetes screening before age 40?

21. Case: A 50-year-old man with obstructive sleep apnea (OSA), BMI 32 kg/m², and hypertension has FPG 5.9 mmol/L. What is your recommendation?

22. Which screening test combination would be most appropriate for a patient from a high-risk ethnic population with known hemoglobinopathy?


 

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CDE Diabetes

Study Guide: Screening for Diabetes in Adults (Chapter 4)

Based on the Diabetes Canada Clinical Practice Guidelines Competency Focus: 5.E (Screening), 1.G (Risk Factors) Exam Weight: Moderate

1. Screening for Type 1 Diabetes

The Rule: Routine screening for Type 1 diabetes is not recommended.

  • Reasoning: There is currently no evidence for effective interventions to prevent or delay Type 1 diabetes in the general population.

  • Limitations: Antibody screening (GAD, IA-2) is not universally available and has variable sensitivity (identifying only ~60% of future cases in some studies).

2. Screening for Type 2 Diabetes: The “Who” and “When”

Competency: Identifies the recommendations for screening.

Unlike the US guidelines (which target age 40-70 with obesity), Diabetes Canada recommends broader screening to catch the 20-40% of cases that are undiagnosed.

General Recommendation

  • Who: Everyone ≥ 40 years of age.

  • Frequency: Every 3 years.

  • Tool: Fasting Plasma Glucose (FPG) and/or A1C.

Earlier/More Frequent Screening

Screening should be done earlier (before age 40) and/or more frequently (every 6 to 12 months) in people with risk factors.

  • Use a risk calculator (like CANRISK) to assess risk.

  • High risk is defined as a 33% chance of developing diabetes over 10 years.

3. Risk Factors (Memorization List)

Competency: Identifies risk factors contributing to complications and diabetes development.

You must recognize these factors in case scenarios. If a patient has these, they need screening regardless of age.

Demographics & History

  • Age ≥ 40 years.

  • First-degree relative with Type 2 diabetes.

  • Member of a high-risk population (African, Arab, Asian, Hispanic, Indigenous, or South Asian descent; low socioeconomic status).

  • History of prediabetes (IFG, IGT, or A1C 6.0-6.4%).

  • History of Gestational Diabetes (GDM).

  • History of delivery of a macrosomic infant.

Vascular Risk Factors

  • HDL-C: <1.0 mmol/L (males) or <1.3 mmol/L (females).

  • Triglycerides: ≥1.7 mmol/L.

  • Hypertension.

  • Overweight or Abdominal Obesity.

  • Smoking.

Associated Diseases & Conditions

  • Polycystic Ovary Syndrome (PCOS).

  • Acanthosis Nigricans (sign of insulin resistance).

  • History of Pancreatitis.

  • Hyperuricemia / Gout.

  • Non-alcoholic steatohepatitis (NASH).

  • Cystic Fibrosis.

  • Obstructive Sleep Apnea (OSA).

  • Psychiatric disorders (Bipolar, Depression, Schizophrenia).

  • HIV infection.

Medications Associated with Diabetes

  • Glucocorticoids.

  • Atypical Antipsychotics.

  • Statins.

  • HAART (Highly Active Antiretroviral Therapy).

  • Anti-rejection drugs.

4. The Screening Algorithm: What do the numbers mean?

Competency: Interpreting screening results.

When you screen with FPG or A1C, the result determines the follow-up interval. 

Result: Normal

  • Values: FPG <5.6 mmol/L AND A1C <5.5%.

  • Action: Rescreen as recommended (usually every 3 years).

Result: At Risk

  • Values: FPG 5.6 – 6.0 mmol/L OR A1C 5.5% – 5.9%.

  • Action: Rescreen more often.

  • Consider: A 75g OGTT if suspicious of T2D or high risk factors.

Result: Prediabetes

  • Values: FPG 6.1 – 6.9 mmol/L OR A1C 6.0% – 6.4%.

  • Action: Rescreen more often.

  • Consider: A 75g OGTT should be considered to check for Impaired Glucose Tolerance.

Result: Diabetes

  • Values: FPG ≥ 7.0 mmol/L OR A1C ≥ 6.5%.

  • Action: Confirm diagnosis (repeat test).

5. Special Clinical Notes

Schizophrenia

  • The incidence of T2D is 3 times higher in people with schizophrenia.

  • Antipsychotic medications further increase this risk.

Discordant Results

  • If you perform both FPG and A1C and they disagree (e.g., FPG is Normal but A1C is Prediabetes), treat the patient according to the test that is furthest to the right (the more severe result) on the algorithm.

The Role of OGTT (Oral Glucose Tolerance Test)

  • While FPG and A1C are the primary screening tools, the OGTT is not obsolete.

  • When to use: It is considered when FPG is 6.1–6.9 mmol/L or A1C is 6.0–6.4% to clarify the diagnosis.

  • Why: A1C misses approximately 50% of people who have prediabetes defined by an OGTT.

Reference:

Ekoe JM, Goldenberg R, Katz P. Screening for Diabetes in Adults. Canadian Journal of Diabetes. 2018;42:S16-S19. doi:10.1016/j.jcjd.2017.10.004
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CDE Diabetes

Flashcards: Definition, Classification & Diagnosis (Chapter 3)

Master the Numbers. Ace the Exam.

Welcome to the Interactive Flashcard Deck for Chapter 3 of the Diabetes Canada Clinical Practice Guidelines.

This chapter is heavily focused on memorization. To pass the CDE exam, you cannot just “understand” the concepts; you need to instantly recall specific diagnostic thresholds (down to the decimal point) and differentiate between similar-sounding conditions like Impaired Fasting Glucose and Metabolic Syndrome.

Ready to test your recall? Click the cards below to flip them.

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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.

Please go to Practice Exam: Definition, Classification & Diagnosis (Chapter 3) to view this quiz
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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