CDCES Exam 2021 - Diabetes Medications & Other
Important Info fully solved(updated)
Expectancy Theory and Language
When we label people, we form biases.
We act out behaviors based on this label. Providers also modify behavior in response to
label
The person labeled may take on attributes of that label
Do our language choices lead to clinical inertia?.
Adult Learners
Self-directed must feel need to learn
Problem oriented rather than subject oriented
Learn better when own experience is used
Prefer active participation
Facilitating Self-Care - Specific Skills Training
Most effective education
includes:
demo of skills
practice
direct practical feedback for efforts
Didactic: less effective
Provides knowledge without skill
Talk Less - Encourage more participation
Make the Behavior Real for that
person
Health Belief Model - Cost vs Benefit
Individuals perceived risk and seriousness of illness determines the likelihood of
adopting preventive behaviors.
The more perceived risk, the more likely to take make necessary changes.
Influencing factors:
,Level of personal vulnerability about developing illness
How serious person believes the illness is
Efficacy of behavior in preventing or minimizing consequences of illness
Costs or deterrents associated with making changes
Social Cognitive Theory
People learn from own AND observing "others" behaviors and consequences.
Health behavior is a constantly changing and evolving interaction between their
environment.
Environment
Behavioral capability
Expectations
Observational Learning
Reinforcement, Self-efficacy
Empowerment Defined
"Helping people discover and develop their inherent capacity to be responsible for their
own lives and gain mastery over their diabetes".
Posits:
Choices made by individuals (not HCPs) have greatest impact.
Individuals are in control of their self- management
The consequences of self-management decisions affect the individual most. It is their
right and responsibility to be the primary decision makers.
Empowerment Based, Self-Directed Behavior
Change Protocol
Define problem
-What part of living with diabetes is most difficult or unsatisfying for you?
Identify feelings
-How does the situation make you feel?
Identify long term-goal
-How would this situation have to change for you to feel
better about it?
-What barriers will you face?
-How important is it for you to address this issue?
-What are the costs and benefits of addressing or not
addressing this problem?
Identify short-term behavior change
experiment
-What are some steps that you could take to bring you
closer to where you want to be?
-Is there on thing that you will do when you leave to
improve things for yourself?
,Implement and evaluate plan
-How diet the plan we discussed at your last visit work
out?
-What did you learn?
-What would you do differently next time?
-What will you do when you leave here today?
Transtheoretical Theory
"Readiness" Level determines the approach!"
Individuals pass through similar stages as they prepare for change (eating better,
decreasing drinking)
Simplified version of the Stages of Change:
Not ready -no intentions.
Unsure: Ambivalent
Ready: Committed, just needs to know HOW!
Transtheoretical Model
1.Precontemplation (the stage at which there is no intention to change behavior in the
foreseeable future. Many individuals in this stage are unaware or underaware of their
problems.)
2.Contemplation (the stage in which people are aware that a problem exists and are
seriously thinking about overcoming it but have not yet made a commitment to take
action.)
3.Preparation (the stage that combines intention and behavioral criteria. Individuals in
this stage are intending to take action in the next month and have unsuccessfully taken
action in the past year.)
4.Action (the stage in which individuals modify their behavior, experiences, or
environment in order to overcome their problems. Action involves the most overt
behavioral changes and requires considerable commitment of time and energy.)
5.Maintenance (the stage in which people work to prevent relapse and consolidate the
gains attained during action. For addictive behaviors this stage extends from six months
to an indeterminate period past the initial action.)
6.Termination (relapse, recycle)
Tests to Dx Diabetes
Diabetes
1) A1c >= 6.5%,
2) Fasting Plasma glucose (FPG) >= 126 mg/dl
3) Random Plasma Glucose (RPG) >=200 mg/dl
4) Oral Glucose Tolerance Test (OGTT) 75g - 2 hour plasma glucose (2hPG) >=200
mg/dl
, *Random = any time of day w/out regard to time since last meal; symptoms include
usual polyuria, polydipsia, and unexplained wt loss.
Prediabetes
1) A1c = 5.7-6.4%,
2) Fasting Plasma glucose (FPG) >= 100-125 mg/dl
3) N/A
4) Oral Glucose Tolerance Test (OGTT) 75g - 2 hour plasma glucose (2hPG) >=140-
199 mg/dl
NORMAL
1) A1c < 5.7%,
2) Fasting Plasma glucose (FPG) < 100 mg/dl
3) N/A
4) Oral Glucose Tolerance Test (OGTT) 75g - 2 hour plasma glucose (2hPG) <140
mg/dl
Criteria for testing for Diabetes in Asymptomatic Adults and Children
Type 1 diabetes: Screening for type 1 diabetes risk with a panel of islet autoantibodies
is currently recommended in the setting of a research trial or can be offered for relatives
of those with type 1 diabetes (www.trialnet.org)
Type 2 diabetes:
Screen all adults for prediabetes and diabetes starting at age 45 and all adults of any
age who are overweight (BMI ≥ 25) or BMI ≥ 23 in Asian Americans with 1 or >
additional risk factor:
• History of cardiovascular disease
• habitual physical inactivity
• first degree relative with diabetes
• History of GDM*
• polycystic ovary syndrome
• HTN ≥ 140/90 or on meds
• HDL ≤ 35 mg/dl or triglyceride ≥ 250 mg/dl
• A1c ≥ 5.7%, IGT or IFG*
• Other clinical conditions associated with insulin resistance (obesity, Acanthosis
Nigricans)
• high risk ethnic population (African American, Latino, Native American, Asian
American, Pacific
Islanders)
2. If results normal, repeat test at 3-year intervals or more frequently based on risk
status
3. *Lifelong annual testing if diagnosed with Prediabetes, at least every 3 years with
GDM
Important Info fully solved(updated)
Expectancy Theory and Language
When we label people, we form biases.
We act out behaviors based on this label. Providers also modify behavior in response to
label
The person labeled may take on attributes of that label
Do our language choices lead to clinical inertia?.
Adult Learners
Self-directed must feel need to learn
Problem oriented rather than subject oriented
Learn better when own experience is used
Prefer active participation
Facilitating Self-Care - Specific Skills Training
Most effective education
includes:
demo of skills
practice
direct practical feedback for efforts
Didactic: less effective
Provides knowledge without skill
Talk Less - Encourage more participation
Make the Behavior Real for that
person
Health Belief Model - Cost vs Benefit
Individuals perceived risk and seriousness of illness determines the likelihood of
adopting preventive behaviors.
The more perceived risk, the more likely to take make necessary changes.
Influencing factors:
,Level of personal vulnerability about developing illness
How serious person believes the illness is
Efficacy of behavior in preventing or minimizing consequences of illness
Costs or deterrents associated with making changes
Social Cognitive Theory
People learn from own AND observing "others" behaviors and consequences.
Health behavior is a constantly changing and evolving interaction between their
environment.
Environment
Behavioral capability
Expectations
Observational Learning
Reinforcement, Self-efficacy
Empowerment Defined
"Helping people discover and develop their inherent capacity to be responsible for their
own lives and gain mastery over their diabetes".
Posits:
Choices made by individuals (not HCPs) have greatest impact.
Individuals are in control of their self- management
The consequences of self-management decisions affect the individual most. It is their
right and responsibility to be the primary decision makers.
Empowerment Based, Self-Directed Behavior
Change Protocol
Define problem
-What part of living with diabetes is most difficult or unsatisfying for you?
Identify feelings
-How does the situation make you feel?
Identify long term-goal
-How would this situation have to change for you to feel
better about it?
-What barriers will you face?
-How important is it for you to address this issue?
-What are the costs and benefits of addressing or not
addressing this problem?
Identify short-term behavior change
experiment
-What are some steps that you could take to bring you
closer to where you want to be?
-Is there on thing that you will do when you leave to
improve things for yourself?
,Implement and evaluate plan
-How diet the plan we discussed at your last visit work
out?
-What did you learn?
-What would you do differently next time?
-What will you do when you leave here today?
Transtheoretical Theory
"Readiness" Level determines the approach!"
Individuals pass through similar stages as they prepare for change (eating better,
decreasing drinking)
Simplified version of the Stages of Change:
Not ready -no intentions.
Unsure: Ambivalent
Ready: Committed, just needs to know HOW!
Transtheoretical Model
1.Precontemplation (the stage at which there is no intention to change behavior in the
foreseeable future. Many individuals in this stage are unaware or underaware of their
problems.)
2.Contemplation (the stage in which people are aware that a problem exists and are
seriously thinking about overcoming it but have not yet made a commitment to take
action.)
3.Preparation (the stage that combines intention and behavioral criteria. Individuals in
this stage are intending to take action in the next month and have unsuccessfully taken
action in the past year.)
4.Action (the stage in which individuals modify their behavior, experiences, or
environment in order to overcome their problems. Action involves the most overt
behavioral changes and requires considerable commitment of time and energy.)
5.Maintenance (the stage in which people work to prevent relapse and consolidate the
gains attained during action. For addictive behaviors this stage extends from six months
to an indeterminate period past the initial action.)
6.Termination (relapse, recycle)
Tests to Dx Diabetes
Diabetes
1) A1c >= 6.5%,
2) Fasting Plasma glucose (FPG) >= 126 mg/dl
3) Random Plasma Glucose (RPG) >=200 mg/dl
4) Oral Glucose Tolerance Test (OGTT) 75g - 2 hour plasma glucose (2hPG) >=200
mg/dl
, *Random = any time of day w/out regard to time since last meal; symptoms include
usual polyuria, polydipsia, and unexplained wt loss.
Prediabetes
1) A1c = 5.7-6.4%,
2) Fasting Plasma glucose (FPG) >= 100-125 mg/dl
3) N/A
4) Oral Glucose Tolerance Test (OGTT) 75g - 2 hour plasma glucose (2hPG) >=140-
199 mg/dl
NORMAL
1) A1c < 5.7%,
2) Fasting Plasma glucose (FPG) < 100 mg/dl
3) N/A
4) Oral Glucose Tolerance Test (OGTT) 75g - 2 hour plasma glucose (2hPG) <140
mg/dl
Criteria for testing for Diabetes in Asymptomatic Adults and Children
Type 1 diabetes: Screening for type 1 diabetes risk with a panel of islet autoantibodies
is currently recommended in the setting of a research trial or can be offered for relatives
of those with type 1 diabetes (www.trialnet.org)
Type 2 diabetes:
Screen all adults for prediabetes and diabetes starting at age 45 and all adults of any
age who are overweight (BMI ≥ 25) or BMI ≥ 23 in Asian Americans with 1 or >
additional risk factor:
• History of cardiovascular disease
• habitual physical inactivity
• first degree relative with diabetes
• History of GDM*
• polycystic ovary syndrome
• HTN ≥ 140/90 or on meds
• HDL ≤ 35 mg/dl or triglyceride ≥ 250 mg/dl
• A1c ≥ 5.7%, IGT or IFG*
• Other clinical conditions associated with insulin resistance (obesity, Acanthosis
Nigricans)
• high risk ethnic population (African American, Latino, Native American, Asian
American, Pacific
Islanders)
2. If results normal, repeat test at 3-year intervals or more frequently based on risk
status
3. *Lifelong annual testing if diagnosed with Prediabetes, at least every 3 years with
GDM
