Preparing for the Exam

Examination Content Outline (effective beginning with 2009 Examinations)

1/14/2009

I.    Assessment (45)
      A. Assess Learning/Self-Care Behaviors (15)

          1. Goals and learning needs
          2. Learning readiness (attitudes, developmental level, perceived learning needs, etc.)
          3. Learning style
          4. Barriers to learning (literacy level, language, cultural values, religious beliefs, health beliefs,

              psycho-socioeconomic, family dynamics, etc.)
          5. Physical capabilities/limitations (visual acuity, hearing, functional ability, etc.)
          6. Readiness to change behavior (confidence in ability to change, value in change, etc.)
     B. Assess Medical/Health/Psycho-Socioeconomic Status (10)
          1. Collect diabetes-specific health history (duration, symptoms, complications, adherence to

               standards of care, treatment, etc.)
          2. Collect general health history (family history, allergies, medical history, nutrition history, etc.)
          3. Assess previous and current medication regimen (prescription and nonprescription drugs,

              herbals, 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 use (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, acanthosis nigricans, etc.)
          10. Assess laboratory and patient collected data (blood glucose, A1C, lipid profile, renal/liver

              function, trends, meter, pump, sensor, etc.)
      C. Assess Current Knowledge and Practices Related to Diabetes Care (20)
          1. Diabetes knowledge and self-management skills
          2. Nutritional habits (food and beverage choices, portion sizes, timing of meals and snacks, eating

               environment, etc.)
          3. Exercise/physical activity history and/or level
          4. Monitoring techniques and equipment (blood glucose and ketones, etc.)
          5. Record keeping activities (blood glucose, food, activity, etc.)
          6. Medication administration (oral and injectable medications administration technique, use of

              delivery systems, timing and dosage of medication, adherence, etc.)
          7. Use of health care resources (health care professionals, insurance, etc.)


II.   Intervention (112)
      A. Collaborate with Patient/Family/Caregiver/Healthcare Team to Develop: (14)
          1. Individualized diabetes education plan based on assessment (learning objectives, sequence of

              information, selection of content, communication, etc.)
          2. Instructional methods (discussion, demonstration, role playing, simulation, electronic media, etc.)
          3. Behavioral goals
      B. Teach/Counsel Regarding Principles of Diabetes Care (70)
          1. General issues
              a) Classifications and diagnosis (ADA Guidelines)
              b) Modifiable risk factors (lifestyle behaviors, etc.)
              c) Pathophysiology (auto-immunity, MODY, insulin resistance, fuel metabolism, etc.)
              d) Interaction of physical activity, food, medication, and stress
              e) Treatment options (choices, availability, cost, risk/benefit, etc.)
              f) Goals of treatment (blood glucose, A1C, blood pressure, lipids, quality of life, prevention, etc.)
              g) Purpose of laboratory tests (A1C, lipids, kidney and liver function tests, etc.)
          2. Living with diabetes
              a) Psychosocial adaptation (coping skills, depression, anxiety, etc.)
              b) Role/responsibilities of care (patient, family members, team, etc.)
              c) Decision making/behavior change skills
              d) Safety (sharps disposal, medical ID, driving, etc.)
              e) Hygiene (dental/skin/feet, etc.)
              f) Social/Financial issues (employment, insurance, disability, etc.)
          3. Metabolic monitoring
              a) Glucose (testing sites, meter selection, sensor, etc.)
              b) A1C
              c) Blood pressure
              d) Regimen and record keeping (pattern management, etc.)
              e) Lipids/cholesterol
              f) Liver/Renal monitoring (liver function studies, microalbuminuria, creatinine, etc.)
          4. Nutrition principles and guidelines
              a) American Diabetes Association nutrition recommendations (meal planning,

                  macro/micronutrients, etc.)
              b) Carbohydrates in blood glucose control (postprandial blood glucose, food source, sugar

                   substitutes, fiber, carbohydrate counting, etc.)
              c) Lipid management (total fat, saturated fat, monounsaturated fat, etc.)
              d) Protein intake (renal disease, wound care, etc.)
              e) Food and medication integration
              f) Food label interpretation (nutrition facts, ingredients, health claims, etc.)
              g) Alcohol
              h) Principles of weight management
              i) Changes in daily schedules (problem-solving)
              j) Special considerations (gastroparesis, celiac, etc.)
          5. Physical activity
              a) Benefits, barriers, and precautions
              b) Exercise/activity plan
              c) Post exercise delayed onset hypoglycemia
             d) Food/medication/monitoring adjustment
         6. Pharmacologic management of diabetes
             a) Medications (insulin, oral and injectable medication administration, side effects, etc.)
             b) Delivery systems (pump therapy, devices, etc.)
             c) Medication adjustment
             d) Drug interactions
             e) Non-prescription preparations (over the counter drugs, supplements, vitamins, minerals,

                 herbals, etc.)
         7. Acute complications: prevention and treatment
             a) Hypoglycemia (glucose tablets, glucagon, etc.)
             b) Hyperglycemia (inpatient, outpatient, etc.)
             c) Diabetic ketoacidosis (DKA)
             d) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
         8. Chronic complications: prevention and treatment
             a) Screening and prevention of complications (smoking, hypertension, etc.)
             b) Eye disease (retinopathy, cataracts, glaucoma, etc.)
             c) Sexual dysfunction
             d) Neuropathy (autonomic, peripheral, etc.)
             e) Nephropathy
             f) Vascular disease (cerebral, cardiovascular, peripheral, etc.)
             g) Lower extremity problems (foot ulcers, Charcot foot, etc.)
         9. Special management issues
             a) Honeymoon period, dawn phenomenon, Somogyi effect
             b) Hypoglycemia unawareness
             c) Sick days
             d) Surgery and special procedures
             e) Travel
             f) Geriatrics populations
             g) Pre-conception planning, pregnancy, and gestational diabetes
             h) Co-morbidities (hypertension, depression, thyroid disease, celiac, obesity, etc.)
             i) Dental and gum disease
             j) Skin problems (wound care, yeast infection, ulcers, etc.)
             k) Changes in usual schedules (shift, religious and cultural customs, etc.)
             l) Assistive and adaptive devices (talking meter, magnifier, etc.)
            m) Sleep apnea
        10. Interpret current diabetes research and translate findings into practical applications
    C. Review, Evaluation, Revision, and Documentation (14)
         1. Interpret weight changes, blood glucose, food, medication, and physical activity records
         2. Evaluate effectiveness of teaching in the following:
             a) Achievement of objectives
             b) Progress towards behavioral goals
             c) Self-management skills
             d) Psychosocial adaptation
         3. Document results of assessment, intervention, and outcomes
         4. Establish an ongoing plan for achieving and evaluating objectives and behavioral goals
     D. Follow-up and Referral Recommendations (14)
         1. Identify problems requiring intervention by other health care professionals
             a) Medical nutrition therapy
             b) Exercise prescription
             c) Mental health
             d) Medical care (foot care, dilated eye exam, preconception counseling, etc.)
             e) Financial and social services
             f) Risk reduction (smoking cessation, obesity, preventative services, etc.)
             g) Medication consult
             h) Discharge planning, 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.


III.  Program Development and Administration (18)
      A. Diabetes Patient Education Program (8)
          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. Maintain patient information/demographic database
          6. Ensure patient confidentiality (HIPAA, etc.)
          7. Promote standards of care
          8. Implement infection control principles
      B. Evaluate Outcomes and Quality (6)
          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
      C. Promote Diabetes Advocacy (4)
          1. Health fairs
          2. Workplace (identify and eliminate discrimination)