CDCES Exam 2025
What tests are done to diagnose pt's with DM -
need 2/4
- Fasting plasma glucose ≥ 126 mg/dL
- 2-H plasma glucose ≥ 200 mg/dL
- A1c ≥ 6.5%
- Random plasma glucose ≥ 200 mg/dL
- Blood tests (i.e. autoantibody tests) may help clarify whether a patient has type 1 versus type 2
diabetes.
A1c ranges -
5.7-6.4% - prediabetes
6.5% and above - diabetes
What population is at risk for DM diagnosis (4) -
GDM
HIV
Exposure to high risk medications
Hx of pancreatitis
Risk factors of DM (6) -
Immediate family hx
High risk racial or ethnic groups
Hx of cardiovascular disease
High BP or treatment of HTN
PCOS
Low HDL or high triglyceride levels
Sedentary lifestyle
DM1 vs DM2 define -
DM1: pancreatic beta cell destruction (pt can't produce insulin).
DM2: insulin resistance and relative impairment of insulin secretion.
GDM define -
during pregnancy and usually resolves after childbirth. triggered by secretion of
placental hormones (Lactogen and Cortisol)
Subclassifications and secondary types of DM -
Latent Autoimmune Diabetes in Adults (LADA: a subtype of DM1, marked by slow
autoimmune B-cell destruction in adults
Maturity-onset diabetes of the young (MODY): is a type of monogenic diabetes, which means it's
caused by a mutation in a single gene. The mutation disrupts the production of insulin, a hormone
that regulates blood sugar levels
1
,Neonatal diabetes -
a rare metabolic disorder that affects an infant's ability to produce and use insulin first 6
months of life
DM1 symptoms in children -
Polyuria
Polydipsia
Nocturia
DM1 symptoms in adults (7) -
- under 35 years old
-lower BMI
-weight loss
-ketoacidosis
-serum glucose levels greater than 360 mg/dL
- presence of other autoimmune disorders
DM2 symptoms (8) -
-increased BMI
-acanthosis nigricans (a skin condition that causes dark, velvety patches to appear in body folds and
creases)
-polydipsia
-polyuria
- weight loss
-hx of prediabetes, GDM, PCOS, HTN, Dyslipidemia, HIV
- family hx
- racial and ethnic groups such as African Americans, native Americans, Hispanic/Latino Americans
and Asian Americans
LADA symptoms (3) -
- Over 30 years old
- Presence of diabetes associated autoantibodies.
- Absence of insulin requirement
MODY symptoms (5) -
- When DM is diagnosed within the first 6 months of life or and individual is 25 years
or younger
- Negative diabetes-associated antibodies
- Absence of obesity
- Lack of metabolic features seen in DM2
- Strong family hx of DM
Physical assessment for diabetes (6) -
-Weight loss or gain
-Eye examination.
-Cardiovascular examination
-Examination of extremities, including feet: report status of peripheral arteries, peripheral edema,
trophic changes, ulcers, etc.
2
,- Neurologic examination, including motor, sensory, and reflex examinations.
- Skin examination
DM1 characteristics -
- Characterized by 2 or more autoimmune markers
o Islet cell autoantibodies
o GAD65 Autoantibodies
o Insulin Autoantibodies
o Tyrosine Phosphate Islet Antigen
o Zinc Transporter 8
- Identified by the AABBCC approach
o Age: 35 or younger
o Autoimmunity: family hx of autoimmune diseases
o Body habitus: BMI of less than 25
o Background: family hx
o Control: evaluate the level of glucose control
o Comorbidities: hx of HIV, Pancreatitis, exposure to high-risk medication
DM2 characteristics -
- Does not include autoimmune markers.
- Relies on symptoms.
GDM testing -
- Administer a 75-g OGTT as a one-step process or to employ a two-step method
involving a 50-g OGTT followed by a 100-g OGTT for screening.
- Undergo screening for 4-12 weeks postpartum.
- DM screening every 3 years
Pre-diabetes criteria -
- A1c between 5.7-6.4%
OR
- Fasting plasma glucose levels are between 100-125 mg/dL
OR
- 2-h plasma glucose during a 75 g oral glucose tolerance test is between 140-199 mg/dL
when should testing for diabetes or prediabetes be considered? -
.-Testing should be considered in adults with overweight or obesity (BMI ≥25 kg/m2 or
≥23 kg/ m2 in Asian American individuals) who have one or more of the following risk factors:
-First-degree relative with diabetes
-High-risk race and ethnicity (e.g., African American, Latino, Native American, Asian American,
Pacific Islander)
-History of cardiovascular disease
-Hypertension (≥130/80 mmHg or on therapy for hypertension)
-HDL cholesterol level <35 mg/dL (<0.9 mmol/L) and/or a triglyceride level >250 mg/dL (>2.8
mmol/L)
-Individuals with PCOS
-Physical inactivity
-Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis
nigricans)
3
, people with prediabetes should be tested: -
yearly
people who were diagnosed with GDM should be tested: -
at least every 3 years
for individuals over 35 years old and with normal results should be tested -
every 3 years
consequences of elevated glucose -
- Stroke
- Retinopathy
- Kidney failure
- Neuropathy
- Heart attack
- Increased risk for cancer
lifestyle alterations to limit changes of DM -
- Eating plan
- Exercise
- Weight management - for every 1 kg of wt loss, there is a 16% reduction in the progression to
DM2.
Pharmacotherapy considerations/options -
- GLP-1
- Metformin
o Start with 500-1,000 mg once daily for 1 month, if well tolerated, increase to 1,000 mg twice
daily (may prefer to start low and go slow)
o Monitor B12 levels.
o Addresses the dysfunction in the ominous octet (beta cells of the pancreas, liver, muscle cells, gut,
brain, adipose cells, kidney and malfunctioning of alpha cells causing hyperglucagonemia).
- SGLT2 (sodium-glucose cotransporter 2) inhibitors
- Other agents: evaluated for weight loss
o Orlistat
o Phentermine topiramate
o Liraglutide
o Semaglutide
o Bupropion-naltrexone
o Tirzepatide
Mental health and wellbeing with diabetes -
-2 to 3 times more likely to have depression
-20% more likely to have anxiety sometime in their life.
-Eating disorders can also be more common.
- Denial
honeymoon period -
4
What tests are done to diagnose pt's with DM -
need 2/4
- Fasting plasma glucose ≥ 126 mg/dL
- 2-H plasma glucose ≥ 200 mg/dL
- A1c ≥ 6.5%
- Random plasma glucose ≥ 200 mg/dL
- Blood tests (i.e. autoantibody tests) may help clarify whether a patient has type 1 versus type 2
diabetes.
A1c ranges -
5.7-6.4% - prediabetes
6.5% and above - diabetes
What population is at risk for DM diagnosis (4) -
GDM
HIV
Exposure to high risk medications
Hx of pancreatitis
Risk factors of DM (6) -
Immediate family hx
High risk racial or ethnic groups
Hx of cardiovascular disease
High BP or treatment of HTN
PCOS
Low HDL or high triglyceride levels
Sedentary lifestyle
DM1 vs DM2 define -
DM1: pancreatic beta cell destruction (pt can't produce insulin).
DM2: insulin resistance and relative impairment of insulin secretion.
GDM define -
during pregnancy and usually resolves after childbirth. triggered by secretion of
placental hormones (Lactogen and Cortisol)
Subclassifications and secondary types of DM -
Latent Autoimmune Diabetes in Adults (LADA: a subtype of DM1, marked by slow
autoimmune B-cell destruction in adults
Maturity-onset diabetes of the young (MODY): is a type of monogenic diabetes, which means it's
caused by a mutation in a single gene. The mutation disrupts the production of insulin, a hormone
that regulates blood sugar levels
1
,Neonatal diabetes -
a rare metabolic disorder that affects an infant's ability to produce and use insulin first 6
months of life
DM1 symptoms in children -
Polyuria
Polydipsia
Nocturia
DM1 symptoms in adults (7) -
- under 35 years old
-lower BMI
-weight loss
-ketoacidosis
-serum glucose levels greater than 360 mg/dL
- presence of other autoimmune disorders
DM2 symptoms (8) -
-increased BMI
-acanthosis nigricans (a skin condition that causes dark, velvety patches to appear in body folds and
creases)
-polydipsia
-polyuria
- weight loss
-hx of prediabetes, GDM, PCOS, HTN, Dyslipidemia, HIV
- family hx
- racial and ethnic groups such as African Americans, native Americans, Hispanic/Latino Americans
and Asian Americans
LADA symptoms (3) -
- Over 30 years old
- Presence of diabetes associated autoantibodies.
- Absence of insulin requirement
MODY symptoms (5) -
- When DM is diagnosed within the first 6 months of life or and individual is 25 years
or younger
- Negative diabetes-associated antibodies
- Absence of obesity
- Lack of metabolic features seen in DM2
- Strong family hx of DM
Physical assessment for diabetes (6) -
-Weight loss or gain
-Eye examination.
-Cardiovascular examination
-Examination of extremities, including feet: report status of peripheral arteries, peripheral edema,
trophic changes, ulcers, etc.
2
,- Neurologic examination, including motor, sensory, and reflex examinations.
- Skin examination
DM1 characteristics -
- Characterized by 2 or more autoimmune markers
o Islet cell autoantibodies
o GAD65 Autoantibodies
o Insulin Autoantibodies
o Tyrosine Phosphate Islet Antigen
o Zinc Transporter 8
- Identified by the AABBCC approach
o Age: 35 or younger
o Autoimmunity: family hx of autoimmune diseases
o Body habitus: BMI of less than 25
o Background: family hx
o Control: evaluate the level of glucose control
o Comorbidities: hx of HIV, Pancreatitis, exposure to high-risk medication
DM2 characteristics -
- Does not include autoimmune markers.
- Relies on symptoms.
GDM testing -
- Administer a 75-g OGTT as a one-step process or to employ a two-step method
involving a 50-g OGTT followed by a 100-g OGTT for screening.
- Undergo screening for 4-12 weeks postpartum.
- DM screening every 3 years
Pre-diabetes criteria -
- A1c between 5.7-6.4%
OR
- Fasting plasma glucose levels are between 100-125 mg/dL
OR
- 2-h plasma glucose during a 75 g oral glucose tolerance test is between 140-199 mg/dL
when should testing for diabetes or prediabetes be considered? -
.-Testing should be considered in adults with overweight or obesity (BMI ≥25 kg/m2 or
≥23 kg/ m2 in Asian American individuals) who have one or more of the following risk factors:
-First-degree relative with diabetes
-High-risk race and ethnicity (e.g., African American, Latino, Native American, Asian American,
Pacific Islander)
-History of cardiovascular disease
-Hypertension (≥130/80 mmHg or on therapy for hypertension)
-HDL cholesterol level <35 mg/dL (<0.9 mmol/L) and/or a triglyceride level >250 mg/dL (>2.8
mmol/L)
-Individuals with PCOS
-Physical inactivity
-Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis
nigricans)
3
, people with prediabetes should be tested: -
yearly
people who were diagnosed with GDM should be tested: -
at least every 3 years
for individuals over 35 years old and with normal results should be tested -
every 3 years
consequences of elevated glucose -
- Stroke
- Retinopathy
- Kidney failure
- Neuropathy
- Heart attack
- Increased risk for cancer
lifestyle alterations to limit changes of DM -
- Eating plan
- Exercise
- Weight management - for every 1 kg of wt loss, there is a 16% reduction in the progression to
DM2.
Pharmacotherapy considerations/options -
- GLP-1
- Metformin
o Start with 500-1,000 mg once daily for 1 month, if well tolerated, increase to 1,000 mg twice
daily (may prefer to start low and go slow)
o Monitor B12 levels.
o Addresses the dysfunction in the ominous octet (beta cells of the pancreas, liver, muscle cells, gut,
brain, adipose cells, kidney and malfunctioning of alpha cells causing hyperglucagonemia).
- SGLT2 (sodium-glucose cotransporter 2) inhibitors
- Other agents: evaluated for weight loss
o Orlistat
o Phentermine topiramate
o Liraglutide
o Semaglutide
o Bupropion-naltrexone
o Tirzepatide
Mental health and wellbeing with diabetes -
-2 to 3 times more likely to have depression
-20% more likely to have anxiety sometime in their life.
-Eating disorders can also be more common.
- Denial
honeymoon period -
4
