Categories
CDE Diabetes

Practice Exam: Blood Glucose Monitoring (Chapter 9 & 2021 Update)

Welcome to the practice exam for Chapter 9: Monitoring Glycemic Control and the 2021 Guideline Update.

Glucose monitoring remains a cornerstone of diabetes management, but the landscape has evolved significantly with the rapid uptake of new technologies. This exam tests your knowledge of the foundational principles from the 2018 Guidelines as well as the critical changes introduced in the 2021 Update, specifically regarding terminology, technology, and new glycemic metrics.

Key Concepts Covered in This Exam:

  • Updated Terminology: Mastering the shift in language, including Capillary Blood Glucose (CBG) instead of SMBG, and the distinction between Real-Time CGM (rtCGM) and Intermittently-Scanned CGM (isCGM)
  • Glycemic Metrics: Understanding new targets beyond A1C, such as Time in Range (TIR), Time Below Range (TBR), and Glucose Management Indicator (GMI).
  • Technology Recommendations: Identifying the evidence-based indications for rtCGM and isCGM in specific populations, including adults with type 1 and type 2 diabetes, and pregnant women.
  • Standard Monitoring Protocols: Reviewing the recommended frequency for A1C testing and CBG testing based on treatment type and glycemic stability.
  • Limitations & Accuracy: Recognizing factors that affect A1C accuracy (e.g., hemoglobinopathies) and when to verify CBG results against laboratory venous plasma glucose.

Are you ready to test your knowledge on the evolving standards of blood glucose monitoring?

1. According to the 2021 Diabetes Canada update, in adults with type 1 diabetes comparing rtCGM to isCGM, which finding was demonstrated?

2. What is the recommended Time in Range target for pregnant women with type 1 diabetes according to the glucose metrics consensus?

3. Case: A clinician is comparing blood ketone testing to urine ketone testing. According to the guidelines, why might blood ketone testing be preferred?

4. According to the 2021 update, for older/higher risk individuals, what is the Time in Range target?

5. According to the 2021 update, what is the updated terminology for “self-monitored blood glucose (SMBG)”?

6. What glucose range defines Time in Range (TIR) for most individuals with diabetes (excluding pregnancy)?

7. Case: A diabetes educator is counselling a patient about CGM accuracy during pregnancy. According to the accuracy study, which sensor site had the lowest MARD (best accuracy)?

8. What percentage of the A1C result comes from the mean blood glucose level in the 30 days immediately preceding the blood sampling?

9. Case: A woman with gestational diabetes is managing with diet alone after 1 week of daily CBG testing (4 times/day). According to the 2021 update, what testing frequency is reasonable?

10. According to the 2021 update, what is the recommended target for Time Above Range (TAR) Level 2 (>13.9 mmol/L) for most individuals?

11. Glycated hemoglobin (A1C) is a reliable estimate of mean plasma glucose levels over what time period?

12. What is the recommended percentage of Time Below Range (TBR) for Level 1 hypoglycemia (3.8-3.0 mmol/L) in most individuals?

13. Case: A child aged 8 years with type 1 diabetes is using rtCGM inconsistently. According to the evidence, what factor predicts better A1C outcomes with rtCGM in children?

14. At what A1C level is approximately equivalent to 70% Time in Range?

15. According to the 2021 update, what is the updated terminology for “flash glucose monitoring (FGM)”?

16. Case: A patient with type 2 diabetes has an A1C of 6.8% on metformin. According to the guidelines, what is the recommended frequency of CBG testing?

17. At what A1C level is approximately equivalent to 70% Time in Range?

18. What is the recommended Time in Range (TIR) target for most individuals with type 1 or type 2 diabetes according to the International Consensus?

19. In a patient with type 1 diabetes using CSII, for what additional period can the FGM/isCGM sensor be worn continuously?

20. Case: A patient with type 1 diabetes is experiencing unexplained hyperglycemia and nausea. According to the guidelines, when should ketone testing be performed?

21. Case: A patient with type 2 diabetes on basal-bolus insulin therapy has not achieved A1C target. According to the 2021 update, what monitoring may be used to reduce A1C and duration of hypoglycemia?

22. Case: A diabetes educator is reviewing glucose metrics with a patient. According to the International Consensus, each 10% change in Time in Range equates to approximately what change in A1C?

23. Case: A diabetes educator is counselling a patient about A1C accuracy. Which of the following factors would cause a DECREASED A1C that may not reflect true glycemic status?

24. According to the glucose metrics recommendations, what is the target for glycemic variability (%CV)?

25. Case: A patient with type 1 diabetes using multiple daily injections has impaired awareness of hypoglycemia. According to the 2021 update, which monitoring modality should be used?