CDCES Diabetes in Pregnancy and Special Populations

Question 1

For a woman with diabetes who is planning pregnancy, which A1C target is recommended if it can be reached without significant hypoglycemia?

Accepted Answer

Below 6.5%

Answer

ADA Standards of Care recommend a preconception A1C below 6.5% when it can be achieved safely. This lowers the risk of congenital anomalies and other adverse outcomes. An A1C below 5.0% would carry a high risk of hypoglycemia, and targets of 7.5% or above are too high for pregnancy planning.

Question 2

Which set of glucose targets is recommended during pregnancy complicated by diabetes?

Accepted Answer

Fasting below 95 mg/dL, 1-hour postprandial below 140 mg/dL, or 2-hour postprandial below 120 mg/dL

Answer

ADA recommends fasting glucose below 95 mg/dL, with 1-hour postprandial below 140 mg/dL or 2-hour postprandial below 120 mg/dL. Fetal outcomes depend on tight glycemic control, so these targets are much stricter than those for non-pregnant adults.

Question 3

When is routine screening for gestational diabetes mellitus (GDM) typically performed in a woman without known diabetes?

Accepted Answer

At 24–28 weeks of gestation

Answer

Screening with an OGTT is recommended at 24–28 weeks of gestation. This is when placental hormones raise insulin resistance enough to unmask GDM. Women at high risk may be screened earlier, at the first prenatal visit.

Question 4

A patient with type 2 diabetes takes lisinopril, metformin and atorvastatin and tells you she wants to become pregnant. Which medication change should you flag for her provider?

Accepted Answer

Discontinue the ACE inhibitor (lisinopril) and the statin before conception

Answer

ACE inhibitors, ARBs and statins are generally stopped before conception or as soon as pregnancy is confirmed because of fetal risk. Insulin is the preferred agent for glycemic management in pregnancy. Metformin use is decided individually by the provider.

Question 5

Which A1C goal is generally appropriate for an older adult with multiple coexisting chronic illnesses or mild-to-moderate cognitive impairment (complex/intermediate health)?

Accepted Answer

Below 8.0%

Answer

ADA suggests an A1C goal below 8.0% for older adults with complex or intermediate health. Healthy older adults have a tighter goal, below 7.0–7.5%. For those in very poor health, the priority is avoiding hypoglycemia and symptomatic hyperglycemia. Treatment is de-intensified to reduce the risk of hypoglycemia.

(CDCES) Certified Diabetes Care and Education Specialist Practice Test

(CDCES) Certified Diabetes Care and Education Specialist Practice Test

CDCES Diabetes in Pregnancy and Special Populations