CDCES Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: A patient's continuous glucose monitor (CGM) report shows 45% time-in-range (70–180 mg/dL). According to international consensus targets, what is the minimum recommended time-in-range for most adults with diabetes?
- 50%
- 70% (Correct answer)
- 60%
- 80%
Correct answer: 70%
The international consensus target for time-in-range (70–180 mg/dL) is at least 70% for most non-pregnant adults with diabetes.
Question 2: Which assessment parameter best distinguishes type 1 from type 2 diabetes in a newly diagnosed adult patient?
- Fasting glucose level
- BMI and waist circumference
- C-peptide level and autoantibody panel (Correct answer)
- HbA1c at diagnosis
Correct answer: C-peptide level and autoantibody panel
Low C-peptide with positive islet autoantibodies (GAD65, IA-2, ZnT8) confirms type 1 diabetes by demonstrating immune-mediated beta-cell destruction.
Question 3: A CDCES assesses a 68-year-old patient with type 2 diabetes, stage 3b CKD, and an HbA1c of 7.9%. Which glycemic target is most appropriate per ADA guidelines?
- <6.5%
- <7.0%
- <7.5–8.0% (Correct answer)
- <9.0%
Correct answer: <7.5–8.0%
ADA guidelines recommend a less stringent HbA1c target of <7.5–8.0% for older adults with complex comorbidities to reduce hypoglycemia risk.
Question 4: During foot assessment, a 10-gram Semmes-Weinstein monofilament test is performed. Inability to feel the monofilament at plantar sites indicates:
- Peripheral arterial disease
- Loss of protective sensation (Correct answer)
- Venous insufficiency
- Charcot foot deformity
Correct answer: Loss of protective sensation
Failure to detect the 10-g monofilament indicates loss of protective sensation, placing the patient at high risk for diabetic foot ulcers.
Question 5: A patient with type 2 diabetes reports postprandial glucose values consistently above 250 mg/dL despite fasting values in target range. Which assessment step is most appropriate?
- Order a repeat fasting glucose test
- Evaluate carbohydrate intake and meal timing with a food diary review (Correct answer)
- Reduce basal insulin dose immediately
- Order a cortisol stimulation test
Correct answer: Evaluate carbohydrate intake and meal timing with a food diary review
Reviewing carbohydrate intake and meal timing through a food diary directly addresses postprandial spikes when fasting levels are controlled.
Question 6: Which urine test is the standard first-line screening for diabetic kidney disease in patients with type 2 diabetes?
- 24-hour urine protein collection
- Urine albumin-to-creatinine ratio (UACR) (Correct answer)
- Urine dipstick for protein
- Urine microalbumin timed overnight
Correct answer: Urine albumin-to-creatinine ratio (UACR)
UACR on a random spot urine sample is the preferred standard for early detection of diabetic kidney disease due to its convenience and accuracy.
Question 7: A patient with type 1 diabetes and an HbA1c of 8.4% reports their CGM data shows frequent glucose variability. Which metric from CGM data best quantifies this variability?
- Mean glucose
- Coefficient of variation (CV) (Correct answer)
- Time above range
- Estimated HbA1c (eA1c)
Correct answer: Coefficient of variation (CV)
Coefficient of variation (CV) ≥36% indicates high glycemic variability and correlates with hypoglycemia risk independent of mean glucose.
CDCES Patient Assessment and Evaluation 3
A patient's continuous glucose monitor (CGM) report shows 45% time-in-range (70–180 mg/dL).
According to international consensus targets, what is the minimum recommended time-in-range for most adults with diabetes?