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CDE Diabetes

Practice Exam: Type 2 Diabetes and Indigenous Peoples (Chapter 38)

Indigenous peoples in Canada face a disproportionate burden of Type 2 diabetes, with prevalence rates 3 to 5 times higher than the general population. The 2018 Clinical Practice Guidelines emphasize that this disparity is not inherent but is deeply rooted in the legacy of colonization, residential schools, and the resulting loss of traditional lifestyles.

This practice exam tests your ability to provide culturally safe care, apply aggressive screening protocols, and address the specific complications that affect this population at younger ages.

Key Concepts Covered in This Exam:

  • Screening Protocols: Mastering the recommendation to screen asymptomatic Indigenous adults for Type 2 diabetes starting at age 18 (or younger if risk factors are present) and repeating every 6 to 12 months.

  • Social Determinants: Recognizing colonization, residential school experiences, and food insecurity as critical determinants of health that directly impact diabetes management and outcomes.

  • Complication Risks: Understanding that Indigenous peoples experience higher rates of severe complications, particularly end-stage renal disease and lower limb amputations, often at a younger age.

  • Maternal Health: Identifying the elevated risk of diabetes in pregnancy (both pre-existing and gestational) and the critical importance of postpartum screening to prevent intergenerational transmission.

  • Cultural Safety: Applying the principles of culturally safe care, which prioritizes building trust, respecting traditional knowledge, and acknowledging the power imbalances in healthcare.

1. A pregnant Indigenous woman is identified as being at high risk for type 2 diabetes. She has not been screened preconception. What screening test should be offered at the first antenatal visit?

2. The infant of an Indigenous woman with diabetes should receive close monitoring for neonatal hypoglycemia with capillary blood glucose monitoring for up to how many hours?

3. What is the most common proximal determinant of diabetes in Indigenous populations?

4. A physician notices an Indigenous patient with diabetes becoming resistant and withdrawn during a clinical encounter. According to the E4E framework, what should the physician do first?

5. A 25-year-old asymptomatic Indigenous adult with obesity and a strong family history of diabetes presents to your clinic. According to the guidelines, how often should screening for diabetes be considered?

6. According to the guideline, in Indigenous populations, which gender has a disproportionate burden of diabetes?

7. In a non-pubertal Indigenous child with ≥2 additional risk factors, at what age should screening for type 2 diabetes begin?

8. Which of the following is NOT mentioned as a possible environmental exposure contributing to diabetes risk in Indigenous peoples?

9. According to the guideline, what percentage of Indigenous peoples in Canada live in cities and towns (urban areas)?

10. In a remote Indigenous community without standard laboratory access, which of the following is recommended for diabetes screening?

11. What test should be used for postpartum screening in an Indigenous woman with a history of GDM?

12. In an Indigenous woman with hemoglobinopathy who is pregnant and at high risk for diabetes, which screening test should be used instead of A1C?

13. According to the Educating for Equity (E4E) Care Framework, which of the following is positioned as a facilitator of improved clinical relationships and patient capacity?

14. An Indigenous child already possesses one risk factor (high-risk ethnic group). According to the screening recommendations, how often should type 2 diabetes screening be considered if additional risk factors are present?

15. Which of the following barriers should Indigenous communities be supported in addressing according to the guideline recommendations?

16. According to a recent Alberta study, what is the estimated lifetime risk of diabetes for First Nations persons over the age of 18 years?

17. According to the guideline, the age-standardized prevalence rate for diabetes among Inuit people compared to the general Canadian population is:

18. Which dietary pattern was found NOT to be predictive of incident diabetes in an Indigenous study, after adjustment for confounders?

19. In the Canadian context, the Truth and Reconciliation Commission (TRC) made how many calls to action related to various domains of public life including health?

20. An Indigenous woman who is at risk for type 2 diabetes is screened at her first antenatal visit and the A1C result is 6.7%. According to the guideline, what should be her classification?

21. According to Diabetes Canada, what is the age-standardized prevalence rate for diabetes among First Nations individuals living on-reserve?

22. Compared to non-First Nations persons, First Nations youth diagnosed with diabetes under 20 years of age have how many times higher rates of end-stage renal disease and death?

23. According to the guideline, what should be promoted among Indigenous women to reduce their risk for gestational diabetes?

24. A pregnant Indigenous woman with A1C <6.5% at her first antenatal visit should be:

25. According to the guideline, what proportion of high-risk individuals with impaired fasting glucose may have a 2-hour plasma glucose ≥11.1 mmol/L?

26. According to the guideline, diabetes management targets in Indigenous peoples should be:

27. A 10-year-old obese Indigenous child with a first-degree relative with type 2 diabetes requires diabetes screening. What combination of tests should be used?

28. In Canada, which three Aboriginal groups are recognized by the Constitution?

29. An Indigenous woman is planning a pregnancy and is identified as being at risk for type 2 diabetes. What screening test(s) should be used?

30. Prevention of type 2 diabetes in those with identified prediabetes can include which of the following interventions?

31. Which screening program is recommended to promote access to retinal screening in Indigenous communities living in remote areas?

32. A health-care provider working with Indigenous patients should understand that the legacy of colonization may recall conditions similar to which historical experience when expecting patients to acquire diabetes knowledge and produce ‘test’ results?

33. An Indigenous woman with diabetes delivers her baby. According to the guideline, breastfeeding should be encouraged immediately for what primary reason?

34. According to the World Health Organization, what is the most significant social determinant of health affecting Indigenous peoples worldwide?

35. An Indigenous woman had gestational diabetes during her pregnancy. When should she be screened postpartum for prediabetes and diabetes?