ABFM & KSA Diabetes Certification Exam | 2026/2027 Review
Questions and Answers |Rationales
1. According to the ADA guidelines, what is the A1C threshold for diagnosing
diabetes?
A. 6.5%
B. 6.0%
C. 5.7%
D. 7.0%
Answer: A
Rationale: A diagnosis of diabetes is made if the A1C level is 6.5% or higher. A level of
5.7% to 6.4% is considered pre-diabetes.
2. What is the recommended threshold for initiating Metformin in a patient
with Chronic Kidney Disease (CKD)?
A. GFR < 60 mL/min/1.73m²
B. GFR < 30 mL/min/1.73m²
C. GFR < 45 mL/min/1.73m²
D. GFR < 15 mL/min/1.73m²
Answer: B
Rationale: Metformin is contraindicated when the eGFR is less than 30 mL/min/1.73m². It
should not be started if the eGFR is between 30 and 45, and if already taking it, the dose
should be reduced.
,3. Which class of diabetes medication is specifically recommended for patients
with Type 2 Diabetes and Heart Failure with reduced ejection fraction (HFrEF)?
A. DPP-4 Inhibitors
B. Sulfonylureas
C. SGLT2 Inhibitors
D. Thiazolidinediones
Answer: C
Rationale: SGLT2 inhibitors (like Empagliflozin or Dapagliflozin) have shown significant
benefits in reducing hospitalizations for heart failure.
4. A 55-year-old patient with T2DM and established atherosclerotic
cardiovascular disease (ASCVD) requires additional glucose lowering. Which
class is preferred?
A. Meglitinides
B. DPP-4 Inhibitors
C. GLP-1 Receptor Agonists
D. Alpha-glucosidase inhibitors
Answer: C
Rationale: GLP-1 receptor agonists with proven CVD benefit are recommended for
patients with established ASCVD or high risk.
5. According to USPSTF, what is the starting age for screening for pre-diabetes
and Type 2 Diabetes in asymptomatic adults with overweight or obesity?
A. 25 years
B. 35 years
C. 45 years
D. 50 years
Answer: B
, Rationale: The USPSTF updated guidelines recommend screening for pre-diabetes and
T2DM in adults aged 35 to 70 who are overweight or obese.
6. Which of the following values is a diagnostic criterion for pre-diabetes using
Fasting Plasma Glucose (FPG)?
A. 80-99 mg/dL
B. > 200 mg/dL
C. 126-140 mg/dL
D. 100-125 mg/dL
Answer: D
Rationale: Fasting Plasma Glucose of 100-125 mg/dL indicates pre-diabetes. 126 mg/dL
or higher indicates diabetes.
7. A patient with T2DM has an A1C of 8.2% despite Metformin. They have a
strong desire for weight loss. Which medication is the most appropriate
addition?
A. Semaglutide
B. Pioglitazone
C. Glipizide
D. Sitagliptin
Answer: A
Rationale: Semaglutide (a GLP-1 RA) provides significant weight loss benefits compared to
other listed options.
Questions and Answers |Rationales
1. According to the ADA guidelines, what is the A1C threshold for diagnosing
diabetes?
A. 6.5%
B. 6.0%
C. 5.7%
D. 7.0%
Answer: A
Rationale: A diagnosis of diabetes is made if the A1C level is 6.5% or higher. A level of
5.7% to 6.4% is considered pre-diabetes.
2. What is the recommended threshold for initiating Metformin in a patient
with Chronic Kidney Disease (CKD)?
A. GFR < 60 mL/min/1.73m²
B. GFR < 30 mL/min/1.73m²
C. GFR < 45 mL/min/1.73m²
D. GFR < 15 mL/min/1.73m²
Answer: B
Rationale: Metformin is contraindicated when the eGFR is less than 30 mL/min/1.73m². It
should not be started if the eGFR is between 30 and 45, and if already taking it, the dose
should be reduced.
,3. Which class of diabetes medication is specifically recommended for patients
with Type 2 Diabetes and Heart Failure with reduced ejection fraction (HFrEF)?
A. DPP-4 Inhibitors
B. Sulfonylureas
C. SGLT2 Inhibitors
D. Thiazolidinediones
Answer: C
Rationale: SGLT2 inhibitors (like Empagliflozin or Dapagliflozin) have shown significant
benefits in reducing hospitalizations for heart failure.
4. A 55-year-old patient with T2DM and established atherosclerotic
cardiovascular disease (ASCVD) requires additional glucose lowering. Which
class is preferred?
A. Meglitinides
B. DPP-4 Inhibitors
C. GLP-1 Receptor Agonists
D. Alpha-glucosidase inhibitors
Answer: C
Rationale: GLP-1 receptor agonists with proven CVD benefit are recommended for
patients with established ASCVD or high risk.
5. According to USPSTF, what is the starting age for screening for pre-diabetes
and Type 2 Diabetes in asymptomatic adults with overweight or obesity?
A. 25 years
B. 35 years
C. 45 years
D. 50 years
Answer: B
, Rationale: The USPSTF updated guidelines recommend screening for pre-diabetes and
T2DM in adults aged 35 to 70 who are overweight or obese.
6. Which of the following values is a diagnostic criterion for pre-diabetes using
Fasting Plasma Glucose (FPG)?
A. 80-99 mg/dL
B. > 200 mg/dL
C. 126-140 mg/dL
D. 100-125 mg/dL
Answer: D
Rationale: Fasting Plasma Glucose of 100-125 mg/dL indicates pre-diabetes. 126 mg/dL
or higher indicates diabetes.
7. A patient with T2DM has an A1C of 8.2% despite Metformin. They have a
strong desire for weight loss. Which medication is the most appropriate
addition?
A. Semaglutide
B. Pioglitazone
C. Glipizide
D. Sitagliptin
Answer: A
Rationale: Semaglutide (a GLP-1 RA) provides significant weight loss benefits compared to
other listed options.
