BC ADM Comprehensive Diabetes Assessment & Diagnosis 4 — Questions and Answers
Question 1: Which screening test is recommended by the ADA for detecting peripheral arterial disease in patients with diabetes?
- Doppler ultrasonography of the lower extremities
- Ankle-brachial index (ABI) (Correct answer)
- CT angiography
- Capillary refill time assessment
Correct answer: Ankle-brachial index (ABI)
The ABI (ratio of ankle systolic BP to brachial systolic BP) is a validated, non-invasive screening tool for PAD; values ≤0.9 indicate obstruction.
Question 2: A patient with type 2 diabetes and BMI of 42 kg/m² undergoes Roux-en-Y gastric bypass. Post-operatively, blood glucose normalizes without medication. What is the primary mechanism?
- Caloric restriction alone
- Enhanced GLP-1 secretion and improved insulin sensitivity (Correct answer)
- Elimination of dietary fat absorption
- Increased glucagon secretion
Correct answer: Enhanced GLP-1 secretion and improved insulin sensitivity
Bariatric surgery rapidly improves diabetes through increased GLP-1 secretion from the gut, altered bile acid signaling, and weight-independent improvements in insulin sensitivity.
Question 3: When diagnosing gestational diabetes using the one-step OGTT approach (IADPSG criteria), which value meets the threshold at the 2-hour mark?
- ≥130 mg/dL
- ≥140 mg/dL
- ≥153 mg/dL (Correct answer)
- ≥160 mg/dL
Correct answer: ≥153 mg/dL
IADPSG one-step 75g OGTT thresholds are: fasting ≥92, 1-hour ≥180, and 2-hour ≥153 mg/dL; one abnormal value is sufficient for GDM diagnosis.
Question 4: A patient with type 1 diabetes uses a CGM. Time below range (TBR <70 mg/dL) is 6%. What is the recommended clinical target for TBR?
- < 10%
- < 5%
- < 1%
- < 4% (Correct answer)
Correct answer: < 4%
International consensus recommends TBR <4% for time spent below 70 mg/dL in most adults with type 1 or type 2 diabetes on insulin therapy.
Question 5: Which complication of diabetes is most directly linked to the polyol pathway and sorbitol accumulation?
- Diabetic nephropathy
- Osmotic cataract formation in the lens (Correct answer)
- Atherosclerotic cardiovascular disease
- Non-alcoholic fatty liver disease
Correct answer: Osmotic cataract formation in the lens
Excess glucose enters the polyol pathway, accumulating sorbitol and fructose in the lens, which draws water in and causes osmotic cataracts.
Question 6: A diabetic patient has a UACR of 350 mg/g on two consecutive tests. What stage of albuminuria does this represent?
- A1 — normal to mildly increased
- A2 — moderately increased (microalbuminuria)
- A3 — severely increased (macroalbuminuria) (Correct answer)
- A4 — nephrotic range proteinuria
Correct answer: A3 — severely increased (macroalbuminuria)
UACR 300–3000 mg/g (formerly macroalbuminuria) is classified as A3 (severely increased albuminuria) per KDIGO CKD classification.
Question 7: Which scoring tool is validated for assessing hypoglycemia unawareness in clinical practice?
- PAID (Problem Areas in Diabetes) scale
- Clarke Hypoglycemia Awareness Survey (Correct answer)
- DTSQ (Diabetes Treatment Satisfaction Questionnaire)
- PHQ-9 depression screening
Correct answer: Clarke Hypoglycemia Awareness Survey
The Clarke Hypoglycemia Awareness Survey quantifies reduced awareness of hypoglycemia by assessing the frequency of symptomatic vs. asymptomatic low glucose episodes.
BC ADM Comprehensive Diabetes Assessment & Diagnosis 4
Which screening test is recommended by the ADA for detecting peripheral arterial disease in patients with diabetes?