Preparing for the Exam

2008 Examination Content Outline (2009 Examination Content Outline will be available in the near future)

  1. ASSESSMENT

    1. Learning/Self-Care Behaviors

      1. Assess goals and learning needs
      2. Assess learning readiness (attitudes, developmental level, perceived learning needs, etc.)
      3. Assess learning style
      4. Assess barriers to learning (literacy level, language, cultural values, religious beliefs, health beliefs, psycho-socioeconomic, etc.)
      5. Assess physical capabilities/limitations (visual acuity, hearing, functional ability, etc.)

    2. Medical/Health/Psycho-Socioeconomic Status

      1. Collect diabetes-specific health history (duration, symptoms, complications, adherence to standards, treatment, etc.)
      2. Collect general health history (allergies, medical history, nutrition history, etc.)
      3. Assess previous and current medication regimen (prescription and non-prescription drugs, alternative remedies, adverse reactions, etc.)
      4. Assess treatment fears (hypoglycemia, hyperglycemia, needles, weight gain, etc.)
      5. Assess family/caregiver dynamics and social supports
      6. Assess substance abuse (alcohol, tobacco, caffeine, etc.)
      7. Assess psychosocial/developmental/mental health status (adjustment to diagnosis, etc.)
      8. Identify specific barriers to diabetes self-care regimen (cognitive ability, language, cultural, psychosocial, physical, economic, etc.)
      9. Conduct diabetes-specific physical assessment (lower extremities, injection and blood glucose monitoring sites, blood pressure, weight, height, body mass index, ancanthosis nigricans, etc.)
      10. Assess laboratory results and trends (blood glucose, A1C, lipid profile, renal/liver function, etc.)

    3. Current Knowledge and Practices Related to Diabetes Care

      1. Assess diabetes education, knowledge, and self-management skills
      2. Assess nutritional habits (food and beverage choices, portion sizes, timing of meals and snacks, eating environment, etc.)
      3. Assess exercise/physical activity history and/or level
      4. Assess monitoring techniques and equipment (blood glucose and ketones, etc.)
      5. Assess record keeping activities (blood glucose, food, activity, etc.)
      6. Assess medication administration (insulin administration technique and use of delivery systems, timing and dosage of medication, adherence, etc.)
      7. Assess use of health care resources (primary care physician and other health care providers, insurance, etc.)

  2. INTERVENTION

    1. Collaborate with Patient/Family/Caregiver/Healthcare Team to Develop:

      1. Individualized diabetes education plan based on assessment (learning objectives, sequence of information, selection of content, etc.)
      2. Instructional methods (discussion, demonstration, role playing, simulation, electronic media, etc.)
      3. Behavioral goals

    2. Teach Principles and Integrate into Practice

      1. General issues
        1. Classifications and diagnosis (ADA guidelines)
        2. Non-modifiable risk factors (heredity, history of gestational diabetes, ancanthosis nigricans, etc.)
        3. Modifiable risk factors (lifestyle behaviors, etc.)
        4. Pathophysiology (auto-immunity, insulin resistance, fuel metabolism, etc.)
        5. Interaction of physical activity, food, medication, and stress
        6. Treatment options (choices, availability, cost, risk/benefit, etc.)
        7. Goals of treatment (blood glucose, A1C, blood pressure, lipids, quality of life, prevention, etc.)
        8. Purpose of laboratory tests (A1C, lipids, kidney and liver function tests, etc.)
      2. Living with diabetes
        1. Psychosocial adaptation (coping skills, depression, anxiety, etc.)
        2. Role/responsibilities of care (patient, family members, teach, etc.
        3. Decision making/behavior change skills
        4. Safety (sharps disposal, medical ID, driving, etc.)
        5. Hygiene (dental/skin/feet, etc.
      3. Metabolic monitoring
        1. Glucose (testing sites, meter selection, etc.)
        2. Ketones
        3. A1C
        4. Blood pressure
        5. Regimen and record keeping
        6. Lipids/cholesterol
      4. Nutrition principles and guidelines
        1. American Diabetes Association nutrition recommendations (macro/micronutrients, etc.)
        2. Carbohydrates in blood glucose control (postprandial blood glucose, food source, sugar substitutes, fiber, etc.)
        3. Lipid management (total fat, saturated fat, monounsaturated fat, etc.)
        4. Food and medication integration
        5. Food label intrepretation
        6. Alcohol
        7. Principles of weight management
        8. Changes in usual schedules (problem-solving)
        9. Special considerations (gastroparesis, renal insufficiency, celiac, etc.)
      5. Physical activity
        1. Benefits and precautions
        2. Exercise/activity plan
        3. Post-exercise delayed onset hypoglycemia
        4. Food/medication/monitoring adjustment
      6. Pharmacologic management of diabetes
        1. Medications (oral agents and insulin, administration, side-effects, etc.)
        2. Delivery systems (pump therapy, insulin delivery devices, etc.)
        3. Medication adjustment
        4. Drug interactions
        5. Non-prescription preparations (over-the-counter drugs, supplements, vitamins, minerals, etc.)
      7. Acute complications and treatments
        1. Hypoglycemia (glucose tablets, glucagon, etc.)
        2. Hyperglycemia
        3. Diabetic ketoacidosis (DKA)
        4. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
      8. Chronic complications and treatments
        1. Screening and prevention of complications (smoking, hypertension, etc.)
        2. Eye disease (retinopathy, cataracts, glaucoma, etc.)
        3. Sexual dysfunction
        4. Neuropathy (autonomic, peripheral, etc.)
        5. Nephropathy
        6. Vascular disease (cerebral, cardiovascular, peripheral, etc.)
        7. Lower extremity problems (foot ulcers, Charcot foot, etc.
      9. Special management issues
        1. Honeymoon period, dawn phenomenon, Somogyi effect
        2. Hypoglycemia unawareness
        3. Sick days
        4. Surgery and special procedures
        5. Travel
        6. Adolescents, toddlers, and infants
        7. Geriatric populations
        8. Pre-conception and pregnancy
        9. Disordered eating (bulimia, etc.)
        10. Multiple, chronic illnesses (hypertension, depression, hyperactivity, autoimmune, etc.)
        11. Dental and gum disease
        12. Skin problems (wound care, yeast infection, ulcers, etc.
        13. Changes in usual schedules (shift, religious and cultural customs, etc.)
        14. School and day-care accommodations
        15. Assistive and adaptive devices (talking meter, magnifier, etc.)

    3. Review, Evaluation, Revision, and Documentation

      1. Interpret weight changes, blood glucose, food, medication, and physical activity records
      2. Evaluate effectiveness of teaching in the following:
        1. Achievement of objectives
        2. Progress toward behavioral goals
        3. Self-management skills
        4. Psychosocial adaptation
      3. Document results of assessment, intervention, and outcomes
      4. Establish an ongoing plan for achieving and evaluating objectives and behavioral goals

    4. Follow-up and Referral Recommendations

      1. Identify problems requiring intervention by other health care professionals
        1. Medical nutrition therapy
        2. Exercise prescription
        3. Mental health
        4. Medical care (foot care, dilated eye exam, pre-conception counseling, etc.)
        5. Financial and social services
        6. Risk reduction (smoking cessation, obesity, preventative services, etc.)
        7. Medication consult
        8. Home care, community resources (visual, hearing, language, etc.)
      2. Facilitate communication between patient, providers, and referral source to ensure health care and education needs are addressed
      3. Facilitate access for diabetes support: groups, camps, community resources, etc.

  3. PROGRAM DEVELOPMENT AND ADMINISTRATION

    1. Develop and implement diabetes patient education program

      1. Perform needs assessment (target population, etc.)
      2. Develop curriculum (identify program goals, content outline, lesson plan, teaching materials, etc.)
      3. Choose teaching methods and materials for target populations
      4. Market and promote diabetes patient education program
      5. Document program for outside review (JCAHO, ADA-ERP, NCQA, etc.)
      6. Maintain patient information/demographic database
      7. Ensure patient confidentiality (HIPAA, etc.)
      8. Promote standards of care
      9. Implement infection control principles

    2. Evaluate the following:

      1. Program outcomes (number of people served, provider satisfaction, patient satisfaction, effectiveness of diabetes education materials, etc.)
      2. Patient outcomes (behavior changes, A1C, lipids, weight, quality of life, ER visits, decreased work absences, etc.)
      3. Continuous quality improvement activities

    3. Promote diabetes advocacy (third party reimbursement, schools, policy makers, health fairs, etc.)