Table 3 Proportion of healthcare workers who answered correctly on diabetes mellitus during pre and post-tests
Questions | Correct answer | Pre-test, n(%) | Post-test, n(%) | p-values | |
|---|---|---|---|---|---|
Diagnosis | |||||
A 25-year-old man presents to the OPD with weight loss and getting up at night often to urinate. You suspect diabetes. What test/s can you use to diagnose diabetes? | Random blood glucose & Haemoglobin A1c test | 11.9 | 59.5 | <0.001 | |
A 45-year-old was the previous week. On routine screening her BMI was 30 kg/m2 and blood pressure is 150/90. She denies any symptoms of diabetes. Her finger stick blood sugar (random) was 210 mg/dl (11.7 mmol/L). Does this patient have diabetes? | Maybe, but only if we repeat her random glucose and it’s ≥ 200 mg/dl. | 42.9 | 35.7 | 0.503 | |
A 30-year-old girl with Type I Diabetes presents to the OPD. She has been on insulin therapy since her diagnosis at age 25. She is recovering from a diarrheal illness and has not been eating much. She awoke this morning feeling very anxious, weak, and dizzy. She has a heart rate of 110 bpm, blood pressure 110/70, oxygen saturation 99%. Malaria test is negative. What is your next step? | Check random blood glucose for hypoglycaemia | 85.7 | 97.6 | 0.048 | |
Which statement is true | If symptomatic, a single FBS ≥ 126 mg/dL (7.0 mmol/L) is diagnostic of diabetes | 23.8 | 33.3 | 0.334 | |
Physiology | |||||
What is the effect of insulin on the blood glucose level? | Causes a decrease in the blood glucose level | 76.2 | 92.9 | 0.035 | |
Treatment | |||||
A 70-year-old woman with long-standing diabetes comes to the integrated chronic care clinic. She takes metformin 1000 mg twice daily, and enalapril 20 mg daily. She has no current complaints. She gets an I-STAT and you see that her Creatinine is 2.8. What changes, if any do you make to her medications? | Stop the enalapril | 19.1 | 19.1 | 1.000 | |
A 54-year-old woman with diabetes presents to OPD with diarrhoea and is confused and has difficulty staying awake. Blood pressure is 110/78, heart rate is 100, oxygen saturation is 99%. Blood glucose is taken and returns at 560 mg/dl. You prepare for regular glucose checks and insulin administration. What other parts of treatment of HONK are critical here? | Normal saline boluses and potassium repletion | 81 | 83.3 | 0.776 | |
A 78-year-old man presents to the chronic care clinic. He has been receiving treatment for her diabetes and hypertension. He takes metformin 1000 g twice daily, enalapril 20mg daily, and amlodipine 5mg daily. He smokes cigarettes daily. You calculate that he has a 30-40% cardiovascular risk. After you advise him on quitting smoking, what is your next step? | Start aspirin and simvastatin | 33.3 | 33.3 | 1.000 | |
A 45-year-old woman with type 2 diabetes presents to the chronic care clinic for regular follow-up. She was last seen 6 months ago and has had good control of her sugar levels on metformin 500mg twice daily. She has a heart rate of 80, blood pressure of 160/94. Random glucose measurement is 130. What medication would you like to start? | Enalapril 10mg daily | 19.1 | 19.1 | 1.000 | |
A 56-year-old man has recently been diagnosed with type 2 diabetes. Today, his heart rate is 70, his blood pressure is 120/80, and his BMI is 32. What things can you discuss with him that will improve his diabetes? | Increasing the amount of daily exercise, advise on eating more vegetables, tell him to take his medications regularly | 78.6 | 81 | 0.786 | |
Category | Stem of multiple-choice question on Diabetes Mellitus | Correct answer | Pre-test, n(%) | Post-test, - n(%) | P-values |
Physiology | What is the effect of insulin on the blood glucose level? | Causes a decrease in the blood glucose level. | 32(76.2) | 39(92.9) | 0.035 |
Diagnosis | A 25-year-old man presents to the OPD with weight loss and getting up at night often to urinate. You suspect diabetes. What test/s can you use to diagnose diabetes? | Random blood glucose and Haemoglobin A1c test | 5(11.9) | 25(59.5) | <0.001 |
Diagnosis | A 45-year-old was the previous week. On routine screening her BMI was 30 kg/m2 and blood pressure is 150/90. She denies any symptoms of diabetes. Her finger stick blood sugar (random) was 210 mg/dl (11.7 mmol/L). Does this patient have diabetes? | Maybe, but only if we repeat her random glucose and it’s ≥ 200 mg/dl. | 18(42.9) | 15(35.7) | 0.503 |
Treatment | A 70-year-old woman with long-standing diabetes comes to the integrated chronic care clinic. She takes metformin 1000 mg twice daily, and enalapril 20 mg daily. She has no current complaints. She gets an I-STAT and you see that her Creatinine is 2.8. What changes, if any, do you make to her medications? | Stop the metformin | 8(19.1) | 16(19.1) | 1.000 |
Diagnosis | A 30-year-old girl with Type I Diabetes presents to the OPD. She has been on insulin therapy since her diagnosis at age 25. She is recovering from a diarrheal illness and has not been eating much. She awoke this morning feeling very anxious, weak, and dizzy. She has a heart rate of 110 bpm, blood pressure 110/70, oxygen saturation 99%. The Malaria test is negative. What is your next step? | Check random blood glucose for hypoglycaemia | 36(85.7) | 41(97.6) | 0.048 |
Treatment | A 54-year-old woman with diabetes presents to OPD with diarrhoea and is confused and has difficulty staying awake. Blood pressure is 110/78, heart rate is 100, oxygen saturation is 99%. Blood glucose is taken and returns at 560 mg/dl. You prepare for regular glucose checks and insulin administration. What other parts of treatment of HONK are critical here? | Normal saline boluses and potassium repletion | 34(81.0) | 35(83.3) | 0.776 |
Treatment | A 78-year-old man presents to the chronic care clinic. He has been receiving treatment for her diabetes and hypertension. He takes metformin 1000 g twice daily, enalapril 20 mg daily, and amlodipine 5mg daily. He smokes cigarettes daily. You calculate that he has a 30-40% cardiovascular risk. After you advise him on quitting smoking, what is your next step? | Start aspirin and simvastatin | 14(33.3) | 14(33.3) | 1.000 |
Treatment | A 45-year-old woman with type 2 diabetes presents to the chronic care clinic for regular follow-up. She was last seen 6 months ago and has had good control of her sugar levels on metformin 500mg twice daily. She has a heart rate of 80, blood pressure of 160/94. Random glucose measurement is 130. What medication would you like to start? | Enalapril 10mg daily | 8(19.1) | 8(19.1) | 1.000 |
Treatment | A 56-year-old man has recently been diagnosed with type 2 diabetes. Today, his heart rate is 70, his blood pressure is 120/80, and his BMI is 32. What things can you discuss with him that will improve his diabetes? | Increasing the amount of daily exercise, advise on eating more vegetables and tell him to take his medications regularly | 33(78.6) | 34(81.0) | 0.786 |
Diagnosis | Which statement is true regarding diagnosis of Diabetes mellitus | If symptomatic, a single FBS ≥ 126 mg/dL (7.0 mmol/L) is diagnostic of diabetes | 10(23.8) | 14(33.3) | 0.334 |