CDE Practice Exam: Diabetes Diagnosis & Classification (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

Read each clinical scenario carefully. Pay attention to details like “symptomatic vs. asymptomatic” or “fasting vs. random.”
Select the single best answer based strictly on the 2018 Guidelines.
Review the Detailed Answer Key at the end to understand the rationale for the correct and incorrect options.

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

8.0 mmol/L

7.0 mmol/L

6.1 mmol/L

5.6 mmol/L

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

≥94 cm

≥90 cm

≥102 cm

≥88 cm

3. 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?

Latent autoimmune diabetes in adults

Type 1 diabetes

Monogenic diabetes (MODY)

Type 2 diabetes

4. 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?

A1C is not recommended as the sole diagnostic test in children and adolescents

Children require only random glucose testing

A1C is always accurate in children

A1C should be the primary test in pediatric patients

5. 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?

Start insulin immediately as this is likely type 1 diabetes

Consider genetic testing for monogenic diabetes given the multigenerational pattern

Treat as type 2 diabetes with metformin

Repeat autoantibody testing in 6 months

6. 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?

75%

100%

25%

50%

7. 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?

The patient may be able to discontinue insulin and be treated with oral agents

Genetic testing for monogenic diabetes is required

The patient has confirmed type 1 diabetes

The patient will definitely require lifelong insulin

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?

Convert to type 2 diabetes diagnosis given the patient’s age

No additional testing is needed as the diagnosis is established

Review whether diagnosis occurred before 6 months of age; if so, genetic testing should be performed

Discontinue insulin and trial oral agents

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

Gestational diabetes

Type 2 diabetes

Monogenic diabetes

Type 1 diabetes

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

Metformin as first-line therapy

Genetic testing as the infant may respond to oral sulfonylurea therapy

Immediate insulin therapy as the only option

Dietary modifications alone

11. 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?

Type 1 diabetes

Monogenic diabetes

LADA

Type 2 diabetes

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

25-50%

5-10%

75-90%

50-75%

13. 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?

Cannot be determined without additional testing

Yes, she meets 4 criteria

No, she only meets 2 criteria

Yes, she meets 3 criteria

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

A1C 6.0-6.4%

Fructosamine levels

FPG 6.1-6.9 mmol/L (IFG)

Random glucose 7.0-11.0 mmol/L

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

A1C is the most reliable test in this patient

Diagnosis cannot be made in patients with renal disease

Only OGTT should be used

A1C may be misleading and glucose-based testing should be considered

16.

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?

Prediabetes does not increase CVD risk

CVD risk only becomes relevant after diabetes is diagnosed

Individuals with prediabetes are at risk for CVD, and cardiovascular risk factor modification is beneficial

Only individuals with IFG are at increased CVD risk

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

At least 3 of 5 criteria

All 5 criteria

At least 2 of 5 criteria

At least 4 of 5 criteria

18. 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:

Higher for both diabetes and CVD

Only elevated for microvascular complications

Lower for developing CVD

The same for developing diabetes

19.

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?

Altitude has no effect on A1C values

A1C is always more accurate than FPG regardless of altitude

Studies show the relationship between glucose and A1C may vary at extremes of altitude

Only OGTT can be used at high altitude

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

Diabetic ketoacidosis prevention

Only glucose control needs to be optimized

Insulin resistance alone

Blood pressure, dyslipidemia, and abdominal obesity

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

6.0% to 6.4%

5.7% to 6.4%

6.5% to 6.9%

5.5% to 5.9%

22.

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

At least 4 hours

At least 12 hours

At least 6 hours

At least 8 hours

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

FPG

Random plasma glucose

A1C

2hPG in a 75g OGTT

24. 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?

Less than 5%

Greater than 50%

25-50%

9-25%

25.

Monogenic diabetes typically presents in individuals younger than what age?

20 years

30 years

15 years

25 years

26.

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?

6.1-6.9 mmol/L, due to the higher risk of developing diabetes in this range

Either definition is acceptable

5.6-6.9 mmol/L, as recommended by the ADA

5.0-5.5 mmol/L for earlier intervention

27.

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?

FPG should be ignored in favour of A1C in this population

Ethnicity has no effect on A1C interpretation

A1C may be up to 0.4% higher at similar glycemic levels in African Americans

Both results indicate prediabetes with no need for further consideration

28.

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

Approximately 40-90% of people with an initial positive test will be confirmed on repeat testing

Two different tests on the same day can confirm diabetes

A confirmatory test always requires the same test to be repeated

Confirmatory testing should be delayed by at least 1 month

29. 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?

A1C is more accurate in hyperthyroid patients

No further testing is needed

Graves’ disease may affect A1C accuracy; glucose-based testing should be used

Diagnose diabetes based on A1C alone

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

A1C is not affected by iron deficiency

A1C becomes more accurate in iron deficiency

A1C may be falsely elevated

A1C may be falsely decreased

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

Order a repeat confirmatory test on another day

Order an OGTT to confirm the diagnosis

Recheck the FPG in 3 months

Diagnose diabetes and initiate treatment immediately

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

≥5.6 mmol/L

. ≥8.0 mmol/L

≥7.0 mmol/L

≥6.1 mmol/L

33.

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?

Order an A1C test to confirm diagnosis

Order a confirmatory FPG test on another day

Schedule an OGTT for the following week

Diagnose diabetes and initiate treatment without waiting for confirmatory testing

34. 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?

Anti-glutamic acid decarboxylase (GAD) antibodies

Anti-nuclear antibodies

Anti-thyroid peroxidase antibodies

Anti-parietal cell antibodies

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

Diagnose prediabetes based on the FPG result

Diagnose diabetes based on the A1C result

Repeat the A1C test to confirm diabetes

Average the two results to determine diagnosis

36. 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?

Recommend dietary changes while waiting for confirmatory results

Support the physician’s decision to wait for confirmatory testing

Advise that treatment should not be delayed to avoid rapid metabolic deterioration

Suggest scheduling the confirmatory test for the next week

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

≥11.1 mmol/L

6.1-6.9 mmol/L

7.8-11.0 mmol/L

7.0-7.7 mmol/L

38.

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

Up to 0.05%

Up to 0.5%

Up to 0.3%

Up to 0.1%

Exam Details

Competency Alignment

Instructions

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