The CDE exam is a difficult and comprehensive assessment for men and women who wish to enter the fast-growing and rewarding field of diabetes education. The exam is prepared by the National Certification Board for Diabetes Instructors in cooperation with a team of testing experts.
The CDE exam features 200 multiple-choice questions, which must be completed within a total of four hours. Every version of the test includes 25 pretest questions that are used to develop future versions of the exam. These questions, impossible to identify, do not count toward the final score.
The CDE exam is divided into three parts: assessment (45 questions); intervention (112 questions); and program development and administration (18 questions).
Within the assessment domain, the exam addresses the assessment of learning and self-care behaviors; the assessment of medical, health, and psychosocioeconomic status; and the assessment of current knowledge and practices related to diabetes.
In the intervention domain, questions cover collaboration with the patient, family, caregiver, or healthcare team to develop a program; teaching and counseling related to the principles of diabetes care; review, evaluation, revision, and documentation; and follow-up and referral recommendations.
The program development and administration category reviews diabetes patient education programs, the evaluation of outcomes and quality, and the promotion of diabetes advocacy.
Immediately after completing the CDE exam, candidates will receive a score report from the test proctor. The score report will include the raw score (the number of questions answered correctly) and the scaled score (which takes into account the relative difficulty of the test version). The scale runs from 0 to 99, and the minimum passing score is 70. Those who do not pass the exam may retake it as many times as necessary.
1. Acanthosis nigricans presents as a brown to black pigmentation usually seen in the neck or armpit areas. In relation to diabetes, this may indicate
a. granuloma annulare.
b. diabetic dermopathy.
c. type 1 diabetes.
d. insulin resistance.
2. The large fluid-filled blister that is most often seen on the hands and the feet of individuals with diabetes is a
a. diabetic bulla.
b. diabetic dermopathy.
c. granuloma annulare.
d. diabetic thick skin.
3. Which of the following are current diagnostic criteria used for the diagnosis of diabetes?
a. fasting plasma glucose (PG) >126 mg/dl, casual PG >200 mg/dl with symptoms of diabetes, and/or glycated hemoglobin A1c (A1c) >6.0%
b. oral-glucose-tolerance test (OGTT) with 2 hour PG >200 mg/dl and/or A1c >6.0%
c. OGTT with 2-hour PG >200 mg/dl, fasting PG >126 mg/dl, and/or casual PG >200 mg/dl with symptoms of diabetes
d. fasting PG >100 mg/dl, A1c >6.5%, OGTT >200 mg/dl with symptoms of diabetes, and/or casual PG > 200 mg/dl with symptoms of diabetes
4. Which statement is part of the key concepts for setting glycemic goals in children with type 1 diabetes?
a. Goals should be individualized, and lower goals may be reasonable based on benefit-risk assessment.
b. Plasma glucose goals should be higher than those listed for children with frequent hypoglycemia or hypoglycemia unawareness.
c. Postprandial blood glucose values should be measured when a disparity exists between preprandial blood glucose values and A1c levels.
d. All of the above.
5. PG goals in pregnancy are
a. <100 mg/dl fasting and <120 mg/dl 2 hours postprandial. b. <105 mg/dl fasting and <120 mg/dl 2 hours postprandial. c. 60-90 mg/dl before each meal and at bedtime and <120 mg/dl 1 hour postprandial. d. 70-90 mg/dl before each meal and at bedtime and <120 mg/dl 2 hours postprandial. Answers 1. D: There are eight types of acanthosis nigricans. When seen in young adults, this can alert the clinicians caring for these individuals of the need for diabetes screening. When seen with type 2 diabetes, it is usually related to obesity; weight loss to decrease insulin resistance and improve blood glucose control can improve it. Acanthosis nigricans should always be evaluated because it can also be an indication of cancer in an internal organ, particularly when it occurs in older individuals. 2. A: A diabetic bulla is a large fluid-filled blister seen in individuals who have had diabetes for many years and in those who have neuropathy. The blister can be aspirated while preserving the skin over the blister. Treatment involves cleaning and topical antibiotics to reduce the chance of infection. Infection prevention should be the main focus of treatment. 3. C: This answer includes all of the ADA criteria for the diagnosis of diabetes. The tests used to diagnosis diabetes must be confirmed through retesting on another day. 4. D: These are the key concepts set forth by the ADA: standards of medical care in diabetes – 2009 position statement. 5. C: This answer includes the ADA’s most recent recommendations for PG control in pregnancy. It is well established that the children born to women with diabetes have an increased risk of congenital malformations, macrosomia, and other medical issues. Maintaining PG as near to normal as possible during the pregnancy is indicated to reduce risk.