Disclaimer: The following guide is my best guess on what content will be on the exam. I do not know what exactly will be on the exam but I have helped over a thousand health care professionals pass the exam.
Chapter 3- Definition, Classification and Diagnosis of Diabetes
Importance: High- Re-read a few times, be familiar with chapter
Approximate time recommended: 45 min
I have highlighted what I think will be important for the exam. All areas in grey (key messages and recommendations) are also important for the exam. However you should read the entire chapter.
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Open in new tab Under the heading of: Definition of Diabetes and Prediabetes
Remember that diabetes is defined as
1) defective insulin secretion (slowly declining ß-cell function with type 2 diabetes or quick autoimmune destruction of ß-cells with type 1 diabetes)
2) defective insulin action (most commonly insulin resistance due to obesity but could also be from pregnancy or a number of other factors)
3) a combination of both. Please see my pathophysiology lectures for more details
Anyone has has impaired fasting glucose AND/OR impaired glucose tolerance AND/OR an A1c between 6.0% – 6.4% has pre-diabetes, whether they have all of the above factors or just one of the above factors.
Under the heading of: Classification of Diabetes
Type 1, type 2 and gestational diabetes are they type of diabetes most likely to be tested on the exam. I dont think I’ve ever seen a question on monogenic diabetes (MODY), latent autoimmune diabetes of adulthood or idiopathic diabetes. For MODY there is a listing of genes in Appendix 2. Do not waste time memorizing them its highly unlikely to be on the exam. The genetic testing is not available in Canada anyway.
Do memorize Table 1 and Table 2. It is important on the exam (and in real practice) to be able to distinguish type 1 diabetes from type 1 diabetes.
Under the heading of: Diagnostic Criteria
Memorize Table 3 and be familiar with Table 4
A repeat confirmatory test for diabetes should be done to remove the possibility of lab errors and other issues. Unless the person is showing symptomatic hyperglycemia or metabolic de-compensation (extreme thirst, frequent urination, weight loss, etc) then the person should be treated right away as their symptoms confirm their diagnosis. This is particularly important with people who may have type 1 diabetes as they may go into diabetic ketoacidosis if left untreated.
Under the heading of: Prediabetes
Memorize Table 5
Under the heading of: Metabolic Syndrome
Be familiar with Table 6
The below video is a nice simple summary of the different type of diabetes. For further details please see the pathophysiology lectures.
Practice Questions (press show answer to reveal answer)
Which of the following patients has diabetes, pre-diabetes or no diabetes (assume confirmatory tests have been done and show the same result)?
Patient A- 40 year old male with a FBG of 6.1 mmol/L, a 2 hrPG in a 75g OGTT of 7.8 mmol/L and an A1c of 6.0% (0.06)
Patient B- A 18 year old female with a FBG of 7.1 mmol/L, a 2 hrPG in a 75g OGTT of 6.9 mmol/L and an A1c of 5.9% (0.059)
Patient C- A 80 year old female with a FBG of 6.0 mmol/L, a 2 hrPG in a 75g OGTT of 7.7 mmol/L and an A1c of 5.9% (0.059)
Patient D- A 60 year old male who complains about rapid weight less and frequent urination who had a random glucose of 11.1 mmol/L
Your 65 year old male patient has the following parameters: an A1c of 7.6%, high c-peptide levels, negative islet antibodies, is overweight and has a multi-generational family history of diabetes. What type of diabetes does he likely have?
A) Type 1 diabetes
B) Type 2 diabetes
C) Gestational diabetes
D) Monogenic diabetes