Categories
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?