Glycemic Targets Practice Exam: CDE Prep (Chapter 8)

You have reviewed the study guide, now it is time to test your mastery of Chapter 8: Targets for Glycemic Control.

For the CDE exam, simply knowing that “7 is the magic number” is not enough. You must demonstrate the ability to individualize care. The guidelines emphasize that while optimal control reduces complications, the “legacy effect” and safety concerns (especially hypoglycemia) dictate different targets for different people. This exam will test your ability to balance these competing priorities in complex clinical scenarios.

What to expect in this quiz: This practice exam focuses on the nuances of target setting and the evidence behind the numbers. You will be tested on:

The Hierarchy of Targets: Identifying exactly which patients qualify for a target of ≤6.5% (to reduce CKD/retinopathy) versus those who need a relaxed target of 7.1%–8.5% (e.g., frail elderly or high functional dependence).
A1C Composition: Understanding when Fasting Plasma Glucose (FPG) is the main driver of A1C versus when Postprandial Glucose (PPG) takes over.
Safety First: Recognizing the specific triggers for relaxing targets, such as hypoglycemia unawareness or limited life expectancy.

Use this quiz to ensure you can confidently answer the question “How low should we go?” for any patient profile the exam presents.

1. According to the ADVANCE trial, what was the relative reduction in nephropathy with intensive glucose control?

31%

41%

11%

21%

2. Case: A diabetes educator is counseling a patient about glucose variability. According to the literature, what is linked to the pathogenesis of vascular complications?

Glucose variability inducing inflammatory activation and oxidative stress

Only fasting glucose levels

Only A1C levels

Only postprandial glucose levels

3. Case: A patient with type 2 diabetes has an A1C approaching 7.0%. According to the evidence on FPG vs. PPG contributions, which glucose component becomes a greater contributor to A1C at this level?

Pre-meal glucose levels

Fasting plasma glucose levels

Postprandial plasma glucose levels

Random glucose levels

4. According to Diabetes Canada guidelines, at what A1C level is there a significantly increased risk of both microvascular and cardiovascular complications?

>6.5%

>7.0%

>7.5%

>6.0%

5. Case: A 45-year-old with newly diagnosed type 2 diabetes has no cardiovascular disease and is at low risk of hypoglycemia on metformin monotherapy. According to the guidelines, what A1C target may be appropriate to reduce the risk of CKD and retinopathy?

≤6.0%

≤7.5%

≤6.5%

≤7.0%

6. Case: A person with type 2 diabetes is at end of life. According to the guidelines, what is recommended regarding A1C measurement and glycemic goals?

Target A1C ≤7.0%

A1C measurement not recommended; avoid symptomatic hyperglycemia and any hypoglycemia

Target A1C 7.1%–8.5%

Target A1C 7.1%–8.0%

7. What term is used to describe the persistence of benefits from early intensive glycemic control observed in long-term follow-up studies?

Glucose imprinting

Glycemic legacy

Vascular memory

Metabolic memory or legacy effect

8. According to the DCCT cohort long-term follow-up, what was the reduction in CV outcomes in previously intensively treated participants?

32%

22%

52%

42%

9. Case: A diabetes care team is evaluating intensive glycemic control for a patient with long-standing type 2 diabetes. Based on the evidence from ACCORD, ADVANCE, and VADT trials, what patient characteristics suggest caution with intensive therapy targeting A1C of 6.0%?

Newly diagnosed diabetes with no complications

Patients on metformin monotherapy

Younger age with short diabetes duration

Older/frail individuals, longer duration of diabetes, advanced CAD, and history of severe hypoglycemia

10. According to the evidence, which plasma glucose component has been shown to constitute a stronger independent risk factor for CV complications?

Fasting plasma glucose

Bedtime glucose

Pre-meal glucose

Postprandial plasma glucose

11. What is the recommended fasting plasma glucose (FPG) target range for achieving an A1C ≤7.0%?

5.0 to 8.0 mmol/L

4.0 to 7.0 mmol/L

3.0 to 6.0 mmol/L

6.0 to 9.0 mmol/L

12. What is the recommended 2-hour postprandial plasma glucose (PPG) target range for achieving an A1C ≤7.0%?

5.0 to 10.0 mmol/L

7.0 to 12.0 mmol/L

6.0 to 11.0 mmol/L

4.0 to 8.0 mmol/L

13. Case: A diabetes educator is using CGM data. According to the study using continuous glucose monitoring, what 2-hour PPG level correlates best with an A1C <7.0%?

<7.0 mmol/L

<6.0 mmol/L

<9.0 mmol/L

<8.0 mmol/L

14. What is the recommended A1C target for most people with type 1 or type 2 diabetes to reduce the risk of microvascular complications?

≤7.0%

≤7.5%

. ≤6.0%

≤6.5%

15. Case: A person with type 2 diabetes is not achieving A1C ≤7.0% despite FPG of 4.0–7.0 mmol/L. According to the guidelines, what tighter FPG target may be considered?

5.0 to 6.5 mmol/

3.0 to 4.5 mmol/L

4.0 to 5.5 mmol/L

5.5 to 7.0 mmol/L

16. Case: An 80-year-old frail person with dementia has type 2 diabetes. According to the guidelines, what A1C target range is recommended?

6.1%–7.0%

A1C measurement not recommended

8.6%–9.5%

7.1%–8.5%

17. Case: A person is using CGM and the team wants to minimize glucose variability. According to the suggested clinical targets, what is recommended for daily glucose standard deviation (SD)?

Less than 3 times the mean BG

Less than the mean BG

Less than 2 times the mean BG

Less than 4 times the mean BG

18. Case: A patient has limited life expectancy. According to the guidelines, what A1C target range is recommended?

8.6%–9.5%

6.1%–7.0%

A1C measurement not recommended

7.1%–8.5%

19. What A1C target range is recommended for people with diabetes who have a history of recurrent severe hypoglycemia with hypoglycemia unawareness?

8.6%–9.5%

7.1%–8.0%

9.6%–10.5%

7.1%–8.5%

20. Case: A 70-year-old patient with type 2 diabetes of 15 years duration has advanced coronary artery disease. According to the guidelines, what is the appropriate A1C target consideration for this patient?

Tight glycemic control targeting A1C of 6.0%

No specific target is recommended

Standard target of ≤7.0%

Higher glycemic targets may be appropriate

21. A diabetes educator is explaining the relationship between A1C and glucose values. What is the estimated mean glucose range for an A1C of 7.0–7.4%?

8.6–9.3 mmol/L

9.4–10.1 mmol/L

10.2–10.9 mmol/L

7.8–8.5 mmol/L

22. Case: A diabetes educator is explaining time in range targets. According to the guidelines, what is the suggested time in range for CGM monitoring?

4.9 to 10.5 mmol/L

3.9 to 10 mmol/L

2.9 to 9 mmol/L

3.4 to 11 mmol/L

23. Case: A patient is functionally dependent due to stroke. According to the guidelines, what A1C target range is recommended for functionally dependent individuals?

8.1%–9.0%

6.1%–7.0%

7.1%–8.0%

9.1%–10.0%

Loading…

Share this: