BC ADM Lifestyle Management & Patient Education 3 — Questions and Answers
Question 1: Which patient education approach has the STRONGEST evidence for improving diabetes self-management outcomes?
- Didactic lectures delivered by a physician during clinic visits
- Mailed written educational materials without follow-up
- Group-based self-management education with peer support (Correct answer)
- Single one-on-one education sessions at the time of diagnosis only
Correct answer: Group-based self-management education with peer support
Group-based DSME with peer support combines expert instruction with social support, producing sustained improvements in self-management behaviors and A1C.
Question 2: A patient with T2DM asks about meal timing. Based on current evidence, which statement about breakfast and glycemic control is MOST accurate?
- Skipping breakfast consistently improves fasting blood glucose levels
- Eating a large breakfast is associated with better glycemic control and lower total daily glucose exposure (Correct answer)
- Meal timing has no significant effect on glycemic control independent of total caloric intake
- Consuming the majority of calories at dinner optimizes insulin sensitivity throughout the day
Correct answer: Eating a large breakfast is associated with better glycemic control and lower total daily glucose exposure
Front-loading calories with a larger breakfast and smaller dinner is associated with improved postprandial glycemia and lower 24-hour glucose profiles.
Question 3: When educating a patient on sick-day management, which instruction regarding insulin use is MOST appropriate for a patient with T1DM?
- Stop taking insulin if not eating to prevent hypoglycemia
- Continue basal insulin and adjust bolus insulin based on blood glucose and ketone levels (Correct answer)
- Switch to oral medications during illness to reduce hypoglycemia risk
- Double all insulin doses during illness to counteract the stress response
Correct answer: Continue basal insulin and adjust bolus insulin based on blood glucose and ketone levels
Basal insulin must be continued during illness; bolus doses should be adjusted based on frequent glucose monitoring and ketone testing.
Question 4: A patient asks about the role of dietary fiber in diabetes management. The MOST evidence-supported response is:
- Fiber has no significant effect on postprandial blood glucose
- Soluble fiber slows gastric emptying and glucose absorption, improving postprandial glycemia (Correct answer)
- Insoluble fiber is more effective than soluble fiber for glycemic control
- Fiber supplements are equally effective as dietary fiber from whole foods
Correct answer: Soluble fiber slows gastric emptying and glucose absorption, improving postprandial glycemia
Soluble fiber forms a viscous gel in the gut that slows glucose absorption, blunting postprandial glucose spikes.
Question 5: Which assessment tool is MOST appropriate for screening diabetes-related distress in clinical practice?
- PHQ-9 (Patient Health Questionnaire-9)
- GAD-7 (Generalized Anxiety Disorder-7)
- PAID (Problem Areas in Diabetes scale) (Correct answer)
- SF-36 (Short Form Health Survey)
Correct answer: PAID (Problem Areas in Diabetes scale)
The PAID scale is specifically validated to assess emotional distress related to diabetes management, distinguishing it from general depression or anxiety tools.
Question 6: A patient with T2DM is interested in intermittent fasting. Which consideration is MOST important for the diabetes care specialist to address FIRST?
- Whether the patient can afford specialty foods during eating windows
- The impact on medication timing and risk of hypoglycemia, especially with sulfonylureas or insulin (Correct answer)
- Whether the patient's BMI qualifies them for dietary intervention
- The need to increase carbohydrate intake during eating windows to prevent fatigue
Correct answer: The impact on medication timing and risk of hypoglycemia, especially with sulfonylureas or insulin
Fasting periods significantly alter medication timing requirements, and sulfonylureas and insulin carry high hypoglycemia risk during extended fasting.
Question 7: Which principle of adult learning (andragogy) is MOST relevant when designing diabetes education for older adults?
- Adults learn best through memorization of standardized protocols
- Adults are self-directed learners who are motivated by immediate relevance to their lives (Correct answer)
- Older adults require more visual aids than written materials regardless of literacy level
- Adults should receive the same standardized curriculum as pediatric patients
Correct answer: Adults are self-directed learners who are motivated by immediate relevance to their lives
Andragogy recognizes that adults are self-directed and learn best when education is immediately relevant to their real-life problems and goals.
BC ADM Lifestyle Management & Patient Education 3
Which patient education approach has the STRONGEST evidence for improving diabetes self-management outcomes?