CDE Preparation Program Topics (Accredited by CCCEP for 0.5 CEUs/Module section Total = 20 CEUs) Module 1 Pathophysiology of Diabetes 5 segments Module 2 Diabetes and Nutrition 5 segments Module 3 Medications for Management of Diabetes and Complications 6 segments Module 4 Self-Care Management 5 segments Module 5 Blood Glucose and Urine Monitoring 5 segments Module 6 Psychosocial/Lifestyle Issues and Diabetes 4 segments Module 7 Chronic Complications of Diabetes 7 segments Module 8 Theory 3 segments Total = 40 segments Segment # and Title Module 1 Pathophysiology of Diabetes 1. The Basic Pathophysiology of Diabetes - Basic pathophysiology of diabetes including characteristic signs and symptoms o Beta cell dysfunction o Metabolic syndrome o Signs and symptoms - Genetic transmission of diabetes - Identify conditions in which diabetes may be a secondary complication 2. Type 1 vs. Type 2 Diabetes: Characterizing the Differences - Etiology - Risk Factors - Defining characteristics and incidence, prevalence 3. Blood Glucose Ranges/Targets and Diagnostic Criteria for Diabetes - Abnormal and normal ranges in various circumstances o o Without diabetes With diabetes and Child Pregnancy Adult with type 1 or type 2 diabetes - Diagnostic criteria for Diabetes Relates to Competency # 1.A, 1.G, 5.E 1.B 1.C, 1.I
4. Effect of Insulin, Counter-regulatory Hormones and hormonal 1.D, 1.H Changes on Glycemic Control - Description of insulin and other hormones and pathophysiological effects on glycemic control - Effects of hormonal changes at different life stages on blood glucose levels 5. Characterizing the Complications of Diabetes and Associated Risk 1.F Factors - Nephropathy and Risk Factors - Retinopathy and Risk Factors - Neuropathy and Risk Factors - Macrovascular Disease and Risk Factors Module 2 Diabetes and Nutrition 1. Techniques to Assess a Patient s Nutrition Education Needs 2.A 2. Nutritional Issues Affecting Glycemic Control - General introduction to the effect of nutrition on blood glucose - Glycemic index - Nutrient values of food, fats, fibre and artificial sweeteners 3. Helping Patients Make Appropriate Nutrition Choices - Rationale and use of CDA s Beyond the Basics: Meal Planning for Healthy Eating, Diabetes Prevention and Management - Estimate the food choice value of foods based on nutrition information provided 4. Practical Application of Carbohydrate Counting - Outline of how carbohydrate counting is conducted - Application using examples 5. Individualizing Nutrition Planning Strategies - Individualized nutrition strategies to accommodate life cycle stage, socioeconomic and other lifestyle factors (e.g., shift work, physical activity, travel, alcohol and delayed meals) - Nutrition strategies to accommodate nutritional needs for persons with diabetes who also have secondary complications - Nutrition strategies to manage sick days 1.E, 2.B, 2.E 2.F, 2.G 2.H. 3.5.E 2.C, 2.D, 2.I, 3.5.E Module 3 Medications for Management of Diabetes and Complications 1. Characterizing Oral Antihyperglycemic Medications 3.1.A - Listing of types of oral antihyperglycemic medications according to mechanism of action - Indications for use - Side effects - Administration and precautions
2. Characterizing Options for Insulin Management - Listing of types of insulin in terms of duration of action - Indications for use - Side effects - Safe administration and precautions 3. Indications for Insulin Use and Common Regimens - Factors that affect subcutaneous absorption - Review of common regimens used for insulin administration - Current recommendations for care and storage of insulin during everyday use and travel - Review of insulin delivery systems and comparative advantages and disadvantages 4. Recommending Appropriate Insulin Adjustments - Reviews various circumstances and protocols for recommending insulin adjustment 5. Overall Approach to Pharmacological Management of Diabetes - Review of CDA approach to pharmacological management according to presenting A1C value - Principles and application of intensive diabetes management 6. Medicines Other Than Antihyperglycemics Commonly Used by People with Diabetes - Prescription medications o ACEs and ARBs o Antihypertensives o Cholesterol lowering o Antiplatelet - OTC medications o Foot care o General skin care o Glucose gel or tablets Module 4 Self-Care Management 1. Characterizing and Managing Hypoglycemia - Causes - Signs and symptoms and treatment 2. Hypoglycemia Issues and Management Strategies - Hypoglycemia unawareness presenting symptoms, potential causes, diagnostic methods and treatment plan - Somogyi effect and dawn phenomenon and appropriate interventions - Altering treatment plan to prevent or respond to hypoglycemia - MedicAlert identification information 3.1.B 3.1.C, 3.1.D, 3.1.E, 3.1.F 3.1.G, 3.5.E 3.1.A, 3.1.C, 5.H 3.1.H, 3.1.I 3.2.A 3.2.B, 3.2.C, 3.2.D, 3.2.E
3. Hyperglycemia - Differentiates between hyperglycemia, diabetic ketoacidosis and hyperosmolar hyperglycemic state (HHS) in terms of: o Pathophysiology o Etiology o Progression in signs and symptoms o Intervention and prevention - Appropriate self-care action during period of concurrent illness 4. Physical Activity and Diabetes - Benefits and risks related to various types of physical activity for individuals with type 1 and type 2 diabetes - Strategies to deal safely with physical activity - Potential effects of physical activity on blood glucose levels, in euglycemic, hypoglycemic and hyperglycemic states 5. Safety Issues in Diabetes Management - Information on safe disposal of sharps - Infection control related to diabetes equipment - Outline of activities to facilitate safe travel - Describe strategies for dealing with preparation for surgery or diagnostic tests Module 5 Blood Glucose and Urine Monitoring 1. Characterizing Self-Monitoring of Blood Glucose (SMBG) - Purpose, potential benefits and appropriate scheduling of SMBG 2. Appropriate Management of Issues in SMBG - Quality control purpose and methods - Factors contributing to variances and acceptable levels of variance between SMBG and laboratory results - Acceptable protocols for use of blood testing devices used outside of home or healthcare institutions (e.g., daycare settings) 3. Utilizing SMBG Results - Case situations with varying blood glucose levels, medication doses, meal plan and activity levels: assessment of relationship, identification of need for alteration and recommendation of appropriate course of action 4. Characterizing A1C - Definition, interpretation, purpose and recommended frequency of A1C testing - A1C targets and reason for variations 5. Urine Monitoring - Clinical recommendations for urine testing for ketones and microalbuminuria - Case studies to illustrate 3.6.A, 3.6.B 1.E, 3.3.A, 3.3.B 3.8.A, 3.8.B, 5.G, 5.H 3.5.A 3.5.B, 3.5.C, 3. 3.5.E 3.5.D 3.4.A
Module 6 Psychosocial/Lifestyle Issues and Diabetes 1. Potential Effects of Diabetes on Day to Day Living - Discuss impact of cultural background and beliefs on adaptation to diabetes and self-care practices - Identify possible feelings or attitudes held by a person with diabetes at various stages in the life cycle and describe appropriate interventions - Strategies to assess the relationship between social and socioeconomic support systems, environment and daily living with diabetes - Identification of the impact of diabetes on life events, including interpersonal relationships, vocation, education and recreation - Differentiation between characteristics of normal grieving and depression (related to diabetes) requiring psychological consultation/intervention 2. Facilitating Diabetes Patient Behaviour Change - Identification of potential psychosocial strengths and barriers to diabetes self-care - Use communication strategies to promote therapeutic interaction - Identify strategies for facilitating behaviour change o e.g., motivational interviewing 3. Lifestyle Issues and Diabetes - Potential effects of substance abuse on diabetes self-care - Identify potential destabilizing effects of stress on blood glucose and approaches to self-care - Describe possible alterations in sexual function, contributing factors and potential interventions - Describe strategies and information that can be used to facilitate decision-making for contraception 4. Diabetes and Stage of Life Issues - Identify aspects of assessment, education and management of diabetes that are unique to the elderly - Identify aspects of assessment, education and management that are unique to children and/or adolescents with diabetes, identify aspects of assessment, education and management that are unique to pregnant women with type1, type 2 or gestational diabetes Module 7 Chronic Complications of Diabetes 1. Nephropathy 4.A, 4.C, 4.D, 4.J, 4.L 4.B, 4.E, 4.M 4.F, 4.G, 4.H, 4.I 5.A, 5.C, 5.D
2. Retinopathy 3. Neuropathy 4. Cardiovascular Disease - Dyslipidemia 5. Cardiovascular Disease Hypertension 6. Cardiovascular Disease Coagulation Issues
7. Erectile Dysfunction Module 8 Education Theory 1. Principles of Education - Identify principles of education (including self-management education) - Identify principles of learning - Identify different learning styles - Identify principles of program development - Differentiate between cognitive, affective and psychomotor behavioural objectives 2. Planning for Education - Apply principles of learning to the development of teaching plans - Adapt educational strategies based on principles of motivation for learning - Acknowledge and plan activities for people with different learning styles - Describe the Standards for Diabetes Education in Canada and apply them in program development - Define components of a quality improvement process for diabetes education 3. Translating Education Principles into Practice - Describe the components of the Transtheoretical Model of Behaviour Change and apply this model in developing teaching/counselling strategies - Describe the concept of patient self-management - Identify appropriate use, advantages and disadvantages of various teaching methods and tools 6.C, 6.E, 6.G 6.A, 6.B, 6.D, 6.H, 6.I 6.F, 6.J