CDCES EXAM QUESTIONS WITH EVIDENCE-BASED RATIONALES, COVERING ALL ADA-ALIGNED DOMAINS (ASSESSMENT, CARE/EDUCATION INTERVENTIONS, AND PROFESSIONAL STANDARDS) FOR THE CERTIFICATION BOARD FOR DIABETES CARE AND EDUCATION CREDENTIALING EXAMINATION.

CDCES EXAM QUESTIONS WITH EVIDENCE-BASED RATIONALES, COVERING ALL ADA-ALIGNED DOMAINS (ASSESSMENT, CARE/EDUCATION INTERVENTIONS, AND PROFESSIONAL STANDARDS) FOR THE CERTIFICATION BOARD FOR DIABETES CARE AND EDUCATION CREDENTIALING EXAMINATION. 1. A 58-year-old patient with type 2 diabetes and obesity presents for a follow-up visit. Current medications include metformin 1,000 mg twice daily. Fasting blood glucose is 168 mg/dL and A1C is 7.8%. Which of the following is the most appropriate next step in medication management? A. Add sitagliptin B. Add insulin glargine C. Add semaglutide D. Increase metformin to 2,500 mg daily Answer: C Rationale: Semaglutide is a GLP-1 receptor agonist that provides glycemic control and promotes weight loss, making it an excellent choice for this patient with obesity and suboptimal glycemic control on metformin. Metformin maximum dose is 2,000 mg daily (not 2,500 mg), and while sitagliptin or insulin could be options, semaglutide offers the added benefit of weight loss. 2. A patient with type 1 diabetes reports morning fasting blood glucose values of 200-220 mg/dL for the past week. The patient takes insulin glargine at bedtime and insulin lispro before meals. Overnight glucose readings at 3:00 AM are 90-110 mg/dL. What is the most likely cause of the elevated fasting glucose? A. Somogyi effect B. Dawn phenomenon C. Inadequate basal insulin dose D. Excessive carbohydrate intake at dinner Answer: B Rationale: Dawn phenomenon is characterized by elevated fasting glucose due to early morning release of growth hormone and cortisol, with normal overnight glucose levels. The Somogyi effect would show hypoglycemia followed by rebound hyperglycemia, which is not present here (3:00 AM readings are normal). 3. Which of the following is the most appropriate screening recommendation for nephropathy in a patient with type 2 diabetes diagnosed 2 years ago? A. Annual urine albumin-to-creatinine ratio B. Annual serum creatinine only C. Urine albumin-to-creatinine ratio every 2 years D. Renal ultrasound annually Answer: A Rationale: Annual screening for diabetic kidney disease using urine albumin-to-creatinine ratio and estimated glomerular filtration rate is recommended for all patients with type 2 diabetes starting at diagnosis. Serum creatinine alone is insufficient as it does not detect microalbuminuria. 4. A patient with diabetes is prescribed a SGLT-2 inhibitor. Which of the following adverse effects should the diabetes care and education specialist emphasize during patient education? A. Weight gain B. Increased risk of urinary tract infections and genital mycotic infections C. Hypoglycemia D. Hyperkalemia Answer: B Rationale: SGLT-2 inhibitors increase urinary glucose excretion, creating a favorable environment for bacterial and fungal growth, leading to increased risk of urinary tract infections and genital mycotic infections. These medications are associated with weight loss, not weight gain, and have low hypoglycemia risk unless combined with insulin or sulfonylureas. 5. A 45-year-old patient with type 2 diabetes has an A1C of 9.2% on metformin and glimepiride. The patient reports adherence to medications and diet. Which of the following is the most appropriate next step? A. Add a GLP-1 receptor agonist B. Add insulin therapy C. Refer to endocrinology D. Increase glimepiride dose Answer: B Rationale: With an A1C above 9% despite dual oral therapy, insulin is indicated to achieve glycemic targets. While a GLP-1 receptor agonist could be considered, insulin provides the most rapid and effective glycemic lowering at this level of hyperglycemia. 6. A patient with type 1 diabetes is planning to participate in a marathon. Which of the following is the most appropriate recommendation regarding insulin adjustment? A. Take full insulin dose and increase carbohydrate intake B. Reduce basal insulin by 20-50% on the day of the race C. Skip all insulin on race day D. Increase bolus insulin to cover anticipated carbohydrate loading Answer: B Rationale: For prolonged endurance exercise, basal insulin should be reduced by 20-50% to prevent exercise-induced hypoglycemia. Skipping insulin entirely is dangerous and can lead to hyperglycemia and ketoacidosis. Bolus insulin may also need adjustment based on pre-exercise glucose levels. 7. Which of the following insulin regimens most closely mimics physiologic insulin secretion? A. NPH insulin twice daily B. Insulin glargine once daily plus insulin lispro before meals C. Regular insulin before meals only D. Insulin glargine once daily only Answer: B Rationale: Basal-bolus therapy with long-acting insulin (glargine) once daily providing basal coverage and rapid-acting insulin (lispro) before meals providing prandial coverage most closely mimics normal physiologic insulin secretion. 8. A patient with diabetes has a foot examination finding of loss of protective sensation on monofilament testing. Which of the following is the most appropriate recommendation? A. Refer to podiatry for specialized foot care B. Instruct the patient to inspect feet daily C. Prescribe therapeutic footwear