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CDE Diabetes

Practice Exam: Reducing the Risk of Developing Diabetes (Chapter 5)

Welcome to the practice exam for Chapter 5 of the Diabetes Canada Clinical Practice Guidelines.

Welcome to the practice exam for Chapter 5 of the Diabetes Canada Clinical Practice Guidelines.

With the increasing incidence and prevalence of diabetes, the development of safe and cost-effective interventions to reduce risk is urgently needed to decrease the burden on individuals and the healthcare system. Ideally, prevention strategies should range from efforts focused on high-risk individuals to broader population-based strategies.

This practice exam focuses on the evidence-based recommendations for preventing or delaying the onset of type 2 diabetes, as well as the current status of interventions for type 1 diabetes.

Key Concepts Covered in This Exam:

  • Type 1 Diabetes Prevention: Understanding the distinction that current attempts to prevent type 1 diabetes should be undertaken only within formal research protocols.

  • Healthy Behaviour Interventions: The critical role of intensive, structured lifestyle modifications—specifically targeting a sustained weight loss of approximately 5% and regular physical activity—in reducing the risk of progression from prediabetes to type 2 diabetes by nearly 60%.

  • Dietary Patterns: Identifying evidence-based dietary patterns that reduce risk, including the Mediterranean diet, DASH diet, and the Alternate Healthy Eating Index (AHEI).

  • Pharmacotherapy: Indications for the use of pharmacologic therapy, specifically metformin, in individuals with prediabetes to delay or prevent type 2 diabetes.

  • Risk Stratification: Differentiating interventions based on risk profiles, such as Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), and elevated A1C.

1. Case: A 55-year-old man with IGT and IFG (FPG 6.5 mmol/L) is being considered for metformin therapy. According to DPP subgroup analysis, what additional benefit might he expect compared to IGT alone?

2. According to the evidence, what effect does vitamin D3 supplementation have on preventing diabetes?

3. According to the dose-response meta-analysis on physical activity, individuals achieving 60 MET h/week had what level of risk reduction for type 2 diabetes?

4. According to the Diabetes Canada guidelines, intensive healthy behaviour interventions can reduce the risk of progression from prediabetes to type 2 diabetes by approximately what percentage?

5. A diabetes educator is explaining the long-term outcomes of the Finnish Diabetes Prevention Study. According to the 13-year follow-up, what was observed regarding diabetes incidence?

6. A 50-year-old patient with IGT completed 6 months of healthy behaviour interventions but blood glucose has not normalized. According to guidelines, what pharmacologic therapy may be considered?

7. A 48-year-old South Asian woman with IGT asks about culturally appropriate prevention strategies. According to the Indian Diabetes Prevention Programme, what was the relative risk reduction with healthy behaviour interventions?

8. According to the guidelines, what statement is true regarding type 1 diabetes prevention?

9. In the Diabetes Prevention Program (DPP), metformin reduced progression to diabetes by approximately what percentage compared to placebo?

10. What percentage of initial body weight loss is the target for healthy behaviour interventions to effectively reduce diabetes risk?

11. What prevalence of type 2 diabetes is reported among high-risk ethnic groups in the Western world?

12. The Mediterranean diet has been shown to reduce the risk of developing type 2 diabetes by what percentage according to systematic review data?

13. A patient with prediabetes wants to know about whole grain consumption. Based on the Women’s Health Initiative data, women consuming >2 servings of whole grains per day had what reduction in diabetes risk?

14. A diabetes educator is developing a prevention program. According to the Da Qing study 23-year follow-up, which outcome was significantly reduced in the intervention group?

15. A diabetes educator is advising a 65-year-old patient with IGT about metformin for diabetes prevention. Based on DPP data, what should the educator consider?

16. In the SCALE Obesity and Prediabetes study, what was the reduction in diabetes risk with liraglutide 3.0 mg over 3 years?

17. What is the recommended minimum duration of moderate-intensity physical activity per week for diabetes prevention?

18. According to the guidelines, how many metabolic equivalent (MET) hours per week of physical activity corresponds to a 26% risk reduction for type 2 diabetes?

19. Case: A clinical team is debating whether to recommend thiazolidinediones for diabetes prevention in their practice. Despite favourable effects on delaying diabetes, what is the main reason the guidelines do not recommend widespread use?

20. Case: A 62-year-old woman with IGT asks about the DREAM trial results with rosiglitazone. What was the relative risk reduction for the primary composite outcome of diabetes or death?

21. Case: A 45-year-old man with prediabetes asks about using metformin for diabetes prevention. Based on the DPP data, which patient characteristic would suggest metformin may be more effective?

22. Case: A diabetes educator is explaining to a colleague why the effect of healthy behaviour interventions differs from metformin. According to the evidence, which factor best predicts reduced diabetes incidence with healthy behaviour interventions?

23. Case: A 52-year-old woman with IGT has lost 5% of her body weight through healthy behaviour interventions over 6 months. According to evidence from landmark trials, what is the expected benefit?