After the initial assessment JM is scheduled for an individual visit instead of a group DSMES class.

According to Medicare guidelines, which of the following would NOT justify providing individual DSMES instead of group DSMES?

JZ is proud of their Time of Range of 89%. You notice their time below range is 7%. JZ uses a rapid-acting insulin pen 4–6 times daily to keep glucose in target range and occasionally increases the glargine dose when evening glucose is elevated.

What is your primary concern?

Maria, a 52‑year‑old woman with type 2 diabetes for 8 years, attends a follow‑up visit. Her A1C has risen from 7.8% to 9.2% over the past year. She reports feeling “overwhelmed” and says she didn’t want to start the medication her clinician recommended at the last visit. She explains, “I’m scared of side effects, and I feel like needing medication means I failed.”

Which of the following responses is the least appropriate (i.e., the WRONG thing to say) to Maria?

A 32-year-old with newly discovered diabetes is brought to the emergency department with polyuria and lethargy. They have been sleeping more than usual.

Initial labs show:

• Plasma glucose: 680 mg/dL
• Potassium 3.7 mEq/L
• Serum osmolality: 335 mOsm/kg

Based on the following labs, which feature most strongly supports a diagnosis of hyperosmolar hyperglycemic state (HHS) rather than diabetes ketoacidosis (DKA)?

KC has type 2 diabetes, diagnosed 5 years ago. They report low physical activity, frequent sugar-sweetened beverage intake, and high stress related to work. Last A1c was 8.2%. KC reports previous advice to “exercise more and drink less soda,” but reports making minimal changes. They express interest in improving health but feels overwhelmed by where to start.

Which of the following responses best aligns with the 2026 ADA Standards of Care recommendations for facilitating positive health behavior change?

J.C. is a ten-year-old female with a family history of type 1 diabetes. Her 7-year-old brother was diagnosed with type 1 diabetes two years ago. J.C. has no complaints and reports feeling well. She enjoys playing sports, including basketball and soccer. Her current BMI is 22.1 (93rd percentile for age). She denies any polydipsia, polyuria, or polyphagia. Her lab work demonstrates a fasting blood sugar of 71 mg/dL, an A1c of 5.0%, normal kidney function, and normal electrolytes. Her diabetes autoantibody panel shows positive glutamic acid decarboxylase (GAD) and islet antigen 2 (IA-2) antibodies, negative zinc transporter 8 (ZnT8) antibodies, and negative insulin antibodies.

What does her lab work reveal?

Peripheral Artery Disease (PAD) is significantly underdiagnosed. While PAD affects around 8.5 million Americans and prevalence rises with age (up to 20% over 60), only 10-20% are clinically diagnosed, highlighting a major gap in awareness and screening. 

According to the ADA Standards, what needs to be included in the initial screening for PAD?

CS is a 42-year-old with type 1 diabetes for just over 18 years. In the past year, their A1C changed from 7.4% to 9.1%, and weight increased by 20 pounds. Review of CGM data suggests missed insulin boluses more than 7 times per week, and discussion with CS reveals missed clinic visits due to feeling “burned out”. They score in the moderate range on the Diabetes Distress Scale.

Based on the ADA 2026 Standards of Care, which of the following is the most appropriate next step?