CDCES practice exam: 30 questions in outline proportions

A 61-year-old with type 2 diabetes and moderate nonproliferative retinopathy says that over several weeks straight lines, like door frames, look wavy and the center of their reading vision is blurred. There are no floaters or flashes. What is the most likely cause?

Choose a letter. The key opens with a short note under each of the choices.

1. AFluid leaking into the maculaCheck

   Wavy straight lines and blurred central reading vision point to macular edema, which can develop at any stage of retinopathy and needs prompt referral to an eye specialist.
2. BBleeding into the vitreous gelCheck

   A vitreous hemorrhage brings sudden floaters or a dark curtain, which this person specifically denies.
3. CA cataract clouding the lensCheck

   A cataract causes gradual haze and glare across the whole view rather than distortion at the center.
4. DOptic nerve damage from glaucomaCheck

   Open-angle glaucoma takes peripheral vision first and does not make straight lines look wavy.

A person with end-stage kidney disease has had type 1 diabetes for 20 years. C-peptide returns elevated at 6.8 ng/mL (reference 1.1–4.4). A clinician asks whether they actually have type 2 diabetes. What most likely explains the elevated C-peptide?

1. ASevere insulin resistanceCheck

   Resistance raises C-peptide only when beta cells can still respond, which is not expected after 20 years of type 1 diabetes.
2. BDecreased renal clearanceCheck

   The kidneys clear most circulating C-peptide, so in end-stage kidney disease the level climbs even when beta-cell output is low; the result does not reclassify long-standing type 1 diabetes.
3. CInterference from injected insulinCheck

   Injected insulin carries no C-peptide and is not measured by the assay, so it cannot raise the result.
4. DRecovery of beta-cell functionCheck

   Real beta-cell recovery after two decades of autoimmune diabetes is not seen; reduced clearance accounts for the number.

At the start of an initial DSMES visit, the diabetes care and education specialist wants to choose teaching methods that fit the person. Which question best assesses their learning preferences?

1. A"Would you like a handout or a website link?"Check

   Offering a handout or a website link gives just two print or online formats and shuts out hands-on or spoken teaching, so it captures a narrow choice rather than how the person learns.
2. B"What grade did you complete in school?"Check

   Years of school estimate education level, not literacy or the preferred way of learning, and people with the same schooling learn very differently.
3. C"How have you picked up new skills before?"Check

   An open question about how the person has taken on skills before shows whether they prefer to watch, read, listen, or practice, which is what guides the teaching method.
4. D"Do you understand what I've told you so far?"Check

   Asking whether they understand so far is a yes-or-no comprehension check that belongs after teaching and is unreliable even there; it does not touch learning preferences.

A 56-year-old with type 2 diabetes for 12 years mentions having had "laser treatments for bleeding in my eyes" three years ago and says their toes have recently started burning at night, with numbness in both feet. Foot pulses are normal, and there is no leg pain on walking. What does this history most strongly suggest?

1. AMicrovascular disease involving nerves tooCheck

   Laser-treated retinopathy shows established microvascular damage, and burning, numb toes point to a new painful neuropathy, so the same small-vessel disease now involves the nerves; kidney screening is due as well.
2. BStatin-related muscle injuryCheck

   Statin muscle problems cause aching or weakness in large muscles of the thighs and shoulders, not burning and numbness in the toes, and nothing here ties the symptoms to a statin.
3. CSignificant peripheral arterial diseaseCheck

   Normal foot pulses and no leg pain on walking argue against significant peripheral arterial disease; burning with numbness in both feet fits a neuropathic pattern.
4. DAcute Charcot neuroarthropathy of the footCheck

   Active Charcot foot shows up as a hot, swollen, often red foot, not burning and numbness in the toes at night.

A person with type 1 diabetes is learning to read the ambulatory glucose profile (AGP) on their CGM report. Overnight the shaded bands are narrow, but after breakfast the 25th–75th percentile band is very wide, spanning about 90 to 260 mg/dL, while the median line peaks near 170 mg/dL. What does the wide band after breakfast mainly show?

1. AGlucose is high after breakfast on nearly all daysCheck

   Calling glucose high after breakfast on nearly all days misreads the chart: the median peaks near 170 mg/dL and the lower quartile sits near 90 mg/dL, so many mornings stay in range.
2. BPost-breakfast glucose varies day to dayCheck

   The width of the 25th–75th percentile band shows how much glucose at that hour varies from one day to the next, so a wide band after breakfast means inconsistent post-breakfast readings.
3. CThe sensor is less accurate in the morning hoursCheck

   The profile pools many days of data; a wide band reflects real variation in the person's glucose, not a sensor that is less accurate in the morning.
4. DGlucose is dropping too low during the nightCheck

   The narrow overnight bands show steady nights, and nothing described points to glucose dropping too low during the night.

A 35-year-old with type 1 diabetes reports fatigue, a 4-kg weight gain, constipation, and feeling cold. Their LDL cholesterol has risen and insulin needs are unchanged. Which laboratory test is most appropriate to discuss with the provider?

1. ATissue transglutaminase IgACheck

   Tissue transglutaminase IgA screens for celiac disease, which fits diarrhea, weight loss, or unexplained lows; weight gain and constipation with a rising LDL point elsewhere.
2. BC-peptide levelCheck

   C-peptide speaks to insulin production and diabetes type, neither of which is in question when insulin needs are unchanged.
3. CSerum vitamin B12Check

   B12 deficiency tends to cause numbness, anemia, or memory change and is tied mainly to long-term metformin, which is not part of this person's care.
4. DThyroid-stimulating hormoneCheck

   Fatigue, weight gain, constipation, feeling cold, and a rising LDL fit hypothyroidism, and autoimmune thyroid disease is the most common autoimmune condition seen with type 1 diabetes.

While screening for barriers to taking medications, which statement from a person with type 2 diabetes MOST clearly indicates a structural access barrier rather than a behavioral or belief barrier?

1. A"I skip doses when my money runs short."Check

   Running out of money is a cost barrier set by the person's circumstances, a structural limit that teaching alone cannot fix and that calls for assistance programs or lower-cost options.
2. B"I worry insulin will make me gain weight."Check

   Fear of weight gain is a concern about side effects, a belief-based barrier to talk through, not a lack of access.
3. C"I forget my pills when work gets busy."Check

   Forgetting on busy days is a behavioral barrier around routines and reminders.
4. D"I don't think this pill is doing anything."Check

   Thinking the pill is not doing anything is a belief about the medicine, handled by explaining its effect rather than by improving access.

An adult with type 1 diabetes wants to bolus for lunch, but the CGM shows a number with no trend arrow after a brief signal loss. What should they do?

1. ASkip the lunch bolus until the arrow returnsCheck

   Skipping the lunch bolus until the arrow returns leaves the meal uncovered and lets glucose climb, when a meter check gives a usable number right away.
2. BCheck a fingerstick and dose from thatCheck

   A CGM value with no trend arrow after a signal gap is not reliable enough for dosing, so a fingerstick reading becomes the basis for the lunch bolus.
3. CGive a double lunch bolusCheck

   A double lunch bolus given without knowing the glucose or its direction risks a serious low after the meal.
4. DDose from the number shown on the CGMCheck

   Dosing from the number on the CGM ignores the missing arrow, which is the system's signal that its recent data are incomplete.

A 19-year-old with type 1 diabetes has an A1C of 10.8% and has lost 8 lb. She admits she sometimes skips insulin "to avoid gaining weight" and says she feels fat at a BMI of 22. Which action is most appropriate?

1. AStart a structured meal plan to stabilize her weightCheck

   A rigid meal plan can feed a preoccupation with food and weight; nutrition work belongs inside eating disorder treatment, not as a stand-alone step.
2. BReassure her that her BMI is healthy and continue routine careCheck

   Reassurance about BMI misses the danger: deliberate insulin omission with weight loss and an A1C near 11% needs specialized care now.
3. CRefer to specialists in eating disorders and insulin therapyCheck

   Skipping insulin to control weight is a recognized eating disorder pattern in type 1 diabetes, with high risk of DKA and early complications; it needs a team that understands both the eating disorder and insulin management.
4. DIncrease her insulin doses and reinforce consistent dosingCheck

   Raising doses she already skips leaves the reason for skipping untouched and can sharpen her fear of weight gain.

An adult with type 1 diabetes who uses a tubed insulin pump is planning to soak in a hot tub for 30 minutes at a spa. Which advice is most appropriate?

1. AKeep it on while soakingCheck

   Keeping the pump on while soaking exposes the device and its insulin to heat and water it is not rated for.
2. BIncrease the basal rate while soakingCheck

   Heat speeds insulin absorption, so increasing the basal rate in a hot tub raises the chance of a low.
3. CDisconnect the pump before getting inCheck

   Disconnecting the pump before getting in protects it and its insulin: pumps are not made for hot-tub heat or soaking, and hot water can damage the insulin in the tubing. A 30-minute break is short, and glucose is checked after reconnecting.
4. DWrap the pump in a towel beside the tubCheck

   A pump wrapped in a towel beside the tub is still connected by tubing and a site that sit in the hot water, and the device itself can still get wet.

An adult with type 1 diabetes starts a new warehouse job and has not told anyone about their diabetes. They sometimes have lows in the afternoon. Which step is MOST likely to keep them safe at work?

1. AKeep the diabetes private at workCheck

   Keeping the diabetes private at work leaves no one nearby able to help during an afternoon low, the very risk already showing up.
2. BDrink a large juice at the start of each shiftCheck

   A large juice early in the shift raises glucose for an hour or two and then fades, so it does nothing for lows that come in the afternoon and adds a high in the morning.
3. CSkip eating during work shiftsCheck

   Going without food on shift makes afternoon lows more likely, not less.
4. DTeach a coworker to treat hypoglycemiaCheck

   A coworker taught to spot a low and give fast-acting carbohydrate, or call for help, covers the moments when the person is too impaired to act alone.

A 27-year-old with type 1 diabetes lost insurance and says they will stretch their insulin until coverage returns. While the CDCES works on access, which harm-reduction advice is SAFEST?

1. ACut both basal and mealtime doses in halfCheck

   Cutting both basal and mealtime doses in half leaves too little background insulin in type 1 diabetes, and ketoacidosis can follow within a day or two.
2. BStop basal and keep the mealtime dosesCheck

   Stopping basal and keeping only mealtime doses leaves long stretches with no insulin at all, the setting in which ketones build fastest.
3. CKeep taking the full basal dose every dayCheck

   Keeping the full basal dose every day is the safest line: in type 1 diabetes background insulin holds back ketone production around the clock, so it is the last insulin to cut while the specialist works on access.
4. DUse only correction doses when glucose is highCheck

   Giving insulin only as corrections for highs means ketones are already building by the time each dose goes in.

An adult with type 2 diabetes injects insulin into the thick scar from a past abdominal surgery because "it doesn't hurt there." Glucose readings after those doses are unpredictable. Which advice is most appropriate?

1. AInject deeper with a long needleCheck

   Injecting deeper with a long needle risks an intramuscular dose, which absorbs faster and can cause lows, and it does nothing about the erratic absorption from the scar.
2. BMassage the scar after each doseCheck

   Rubbing the site changes absorption further and does nothing about the scar's poor blood supply.
3. CKeep injecting into the scarCheck

   The scar hurts less because the tissue is damaged, and that same damage makes absorption erratic.
4. DInject into healthy skin away from the scarCheck

   Scar tissue has poor blood flow and absorbs insulin unpredictably, which matches the erratic readings; rotating through healthy tissue gives steadier absorption.

A pediatric diabetes program is reviewing its standards of practice. Many families ask whether the brothers and sisters of children with type 1 diabetes can be checked for their own risk. Which practice is consistent with current ADA recommendations?

1. AScreen siblings with a yearly A1CCheck

   A1C stays normal until late in the process, so a yearly A1C misses the autoimmune stages that antibodies reveal years earlier.
2. BOffer islet autoantibody tests to siblingsCheck

   ADA recommends screening relatives of people with type 1 diabetes for islet autoantibodies; two or more positive antibodies mark presymptomatic disease and allow monitoring that can prevent DKA at diagnosis.
3. COffer genetic HLA typing as the main screenCheck

   HLA typing shows inherited susceptibility, but most people with risk genes never develop diabetes; antibodies, not genes, mark the disease process.
4. DWait for symptoms before testingCheck

   Waiting for symptoms before testing means many children are first diagnosed in DKA, while early detection allows monitoring, education, and in some cases therapy that delays onset.

At follow-up, a person with type 2 diabetes who injects insulin in the abdomen shows a few small bruises at injection sites. Which self-care statement is correct and should be reinforced?

1. A"I press gently on the spot if there is bleeding."Check

   Light pressure for a few seconds stops minor bleeding at an injection site, and small bruises like these are common and harmless.
2. B"I reuse the same pen needle to save supplies."Check

   Reusing a pen needle dulls and bends the tip, which tears tissue and adds to bruising and pain; a new needle goes on for every injection.
3. C"I inject while the alcohol is still wet."Check

   Injecting through still-wet alcohol stings and adds nothing; if the skin is wiped, it is left to dry before the needle goes in.
4. D"I pull the needle out as soon as the button is down."Check

   Pulling the needle out the moment the button is pressed lets insulin leak back out; the needle stays in for about 10 seconds after the dose.

A 50-year-old newly diagnosed with type 2 diabetes (A1C 11.4%) started insulin 2 weeks ago and reports blurry vision that comes and goes. There is no eye pain or sudden vision loss. They plan to get new glasses this week. What is the most appropriate advice?

1. AWait for stable glucose to get glassesCheck

   A fast drop in glucose shifts fluid in the lens and changes focus for several weeks, so waiting for stable glucose before buying glasses avoids a prescription that will soon be wrong; the routine dilated eye exam still goes ahead.
2. BGet new glasses nowCheck

   New glasses fitted now, while focus is still shifting, will not match the eye after glucose levels out.
3. CStop insulin until the vision settlesCheck

   Stopping insulin sends glucose back up and makes the swings behind the blurred vision worse.
4. DGo to the emergency room todayCheck

   Blur that comes and goes without pain or sudden vision loss is an expected effect of rapid glucose lowering, so an emergency room visit is not needed.

A 33-year-old with type 1 diabetes uses a tubed insulin pump. At a visit, the specialist finds the current infusion site, placed 4 days ago, surrounded by a 2-cm area of warm, tender redness with a small amount of pus at the cannula. Glucose has run 30–40 mg/dL higher than usual since yesterday, and temperature is normal. What is the most appropriate action?

1. ALeave the set in place and apply antibiotic ointmentCheck

   The cannula is the source, so leaving it in keeps the infection going whatever ointment is applied.
2. BMove the set to a new site and report the infectionCheck

   Warmth, tenderness, and pus mean the site is infected: the cannula comes out, a fresh set goes in at a new site, and the provider decides whether treatment is needed.
3. CSwitch to a new set at the same siteCheck

   A fresh set put back into the same inflamed skin keeps the infection going; the new cannula has to go in at a different site.
4. DCover the site with a clear dressing; recheck in 3 daysCheck

   Covering an infected site and waiting lets the infection spread, and a 4-day-old set is already past its usual change time.

At a follow-up visit, a person with type 2 diabetes who screened positive for food insecurity says they did not use the food pantry they were referred to because it is open only while they are at work. What is the CDCES's BEST action?

1. ADocument that the person declined food assistance offeredCheck

   The person did not decline help; recording a refusal misstates what happened and closes the door on support.
2. BStress how regular meals help keep glucose stableCheck

   Teaching about regular meals does nothing for the lack of food the person just described.
3. CGive the same pantry referral again, with its hoursCheck

   A referral whose hours clash with work will fail again for the same reason.
4. DLook for food help available evenings or weekendsCheck

   The referral failed because of its timing, not because the person refused help, so the next step is finding food help they can reach, such as evening or weekend pantries or delivery.

An adult with type 1 diabetes who wears a tubed insulin pump is flying for the first time with it. Their pump manufacturer advises against X-ray exposure. What should they do at airport security?

1. AUse a provider letter to skip screeningCheck

   A provider letter can explain the device, but TSA does not require one and it exempts no one from screening; the pump still has to be inspected.
2. BPack it in checked luggage for the flightCheck

   Checked bags are X-rayed too, and a pump in the hold can be lost or exposed to cold, leaving the person without insulin delivery for the whole flight.
3. CStay connected and ask for a hand checkCheck

   Staying connected and asking for a hand check follows the manufacturer's advice: the officer is told about the device and inspects it by hand or with a pat-down instead of passing it through the X-ray.
4. DTake it off and pack it in a carry-on bagCheck

   A carry-on bag goes through the same X-ray machine the manufacturer advises against, and taking the pump off stops insulin delivery while it is away.

A person with type 1 diabetes compares a meter reading with their new factory-calibrated CGM while glucose is steady. The meter reads 142 mg/dL and the CGM reads 128 mg/dL with a flat arrow. What should they conclude?

1. AThe two values agree within expected errorCheck

   The two values agree: CGM measures interstitial glucose and is judged against a meter with a margin of roughly 15–20%, and 128 versus 142 mg/dL is about a 10% gap.
2. BThe sensor is faultyCheck

   A 14 mg/dL difference while glucose is steady is within normal sensor performance, so nothing suggests a faulty sensor that needs replacing.
3. CThe CGM should be calibrated to 142 nowCheck

   A factory-calibrated CGM should not be calibrated for a small difference, and entering one meter value can make later readings worse.
4. DThe meter strips must be out of dateCheck

   Meters carry their own error too, and a gap this small does not point to out-of-date strips.

A person with type 1 diabetes on multiple daily injections lives in a flood-prone area and is building an emergency go-bag. Which item BEST protects continuity of care if they must evacuate to a shelter?

1. AA paper glucose log for the past monthCheck

   A glucose log shows how readings ran but names no insulin, dose, or prescription, so shelter staff could not replace supplies from it.
2. BA printed copy of the most recent A1C resultCheck

   An A1C result shows past glucose control but names no insulin, dose, or prescription, so shelter staff still could not replace supplies.
3. CA week of bottled waterCheck

   Bottled water is a general supply that does nothing to help shelter staff continue insulin therapy.
4. DA written list of doses and prescriptionsCheck

   At a shelter, clinicians and pharmacies may have no access to the person's records, so a written list of insulin types, doses, and prescriptions lets supplies be replaced correctly.

A diabetes care and education specialist is teaching a person with type 1 diabetes to use their new CGM data. Which approach is MOST likely to cause data fatigue and diabetes distress?

1. AReviewing every reading in detail each dayCheck

   Scrutinizing every value turns normal fluctuations into constant decisions and wears people out quickly; useful review looks at patterns across days.
2. BSetting a few alerts for safetyCheck

   A small number of well-chosen alerts protects against lows; it is excessive alarms that drive alarm fatigue.
3. CReviewing the AGP at each clinic visitCheck

   An AGP review at each clinic visit is a periodic summary that replaces daily checking, so it lowers effort rather than raising it.
4. DTeaching how to respond to trend arrowsCheck

   Trend-arrow rules give clear actions and are part of standard CGM teaching, so they reduce guesswork rather than add burden.

A chart note from a DSMES follow-up reads: "Did not meet walking goal. New goal: reduce portion sizes." Which missing element would MOST improve this documentation?

1. AThe person's latest A1C and blood pressure valuesCheck

   The latest A1C and blood pressure values sit elsewhere in the record and do not explain why the walking goal was missed.
2. BThe barrier identified and how the plan respondsCheck

   Without the reason the walking goal failed, the next visit cannot judge whether the new goal fixes anything; recording the barrier ties the change to a cause.
3. CThe total minutes spent in the education sessionCheck

   Session length matters for billing but says nothing about the person's progress or the plan.
4. DA statement that the person verbalized understandingCheck

   "Verbalized understanding" is a stock phrase that shows nothing about the problem or the reasoning behind the new goal.

Which follow-up documentation entry by a diabetes care and education specialist BEST records outcomes and an actionable plan?

1. ABP 128/78, weight 82 kg; meter reviewed; supply list providedCheck

   Blood pressure, weight, a meter review, and a supply list are measurements and tasks with no interpretation and no next step, so the entry shows activity rather than a plan.
2. BDoing well, logs look okay; encouraged to keep up the good workCheck

   "Doing well" and "logs look okay" are vague impressions with no data and no follow-up, so progress cannot be tracked from this entry.
3. CTIR 52%, TBR 8%; basal cut 10% per protocol; CGM review in 2 weeksCheck

   This entry records measurable outcomes, the action taken under protocol, and a dated follow-up, so the next clinician can see what changed and when to check again.
4. DA1C 8.4%; admits skipping doses; stressed importance of complianceCheck

   The entry has an outcome but no plan, and "compliance" is blaming language that person-centered documentation avoids.

An adult with type 1 diabetes is driving on a highway when the CGM low alert sounds, showing 68 mg/dL with a down arrow. What should they do?

1. APull over safely and treat the lowCheck

   Pulling over and treating the low comes first: a falling low slows reactions and judgment before it feels serious, so the driver takes fast-acting carbohydrate and goes on only after a recheck shows glucose has recovered and enough time has passed to think clearly.
2. BDrive to the next exit, then checkCheck

   Driving on to the next exit only delays treatment: 68 mg/dL with a down arrow is already a low that is getting worse.
3. CSpeed up to reach home soonerCheck

   Speeding up to get home sooner adds speed to impaired reactions while glucose keeps falling, the most dangerous choice.
4. DTreat the low while driving onCheck

   Treating the low at the wheel keeps an impaired driver on the road for the 15 minutes glucose needs to work.

A 58-year-old had a total pancreatectomy for chronic pancreatitis and now uses basal-bolus insulin and pancreatic enzymes with meals. Which teaching point about hypoglycemia is most important?

1. ALows are milder because the liver adds glucoseCheck

   The liver releases stored glucose mainly when glucagon signals it, and that signal is gone once the pancreas is removed.
2. BLows are rarer because enzymes slow carb uptakeCheck

   Enzymes are taken with meals to digest fat and protein and do not protect against lows; a missed enzyme dose can even leave a bolus without absorbed food to match it.
3. CLows are more severe because glucagon is goneCheck

   Removing the whole pancreas takes the glucagon-making alpha cells along with the beta cells, so nothing counters a falling glucose; lows can come fast and be severe, and a glucagon kit and close monitoring are part of the plan.
4. DLows are unlikely on a fixed basal doseCheck

   Basal insulin itself can cause lows, especially when meals are skipped, and a fixed dose does nothing to prevent them.

A person with type 1 diabetes who feels worn down by daily management decides to join a monthly peer support group and practice a 10-minute breathing exercise at night. Which ADCES7 self-care behavior does this plan address?

1. AReducing RisksCheck

   Reducing Risks centers on preventing complications through screenings, foot care, vaccines, and stopping smoking, not on emotional strain.
2. BBeing ActiveCheck

   A 10-minute breathing exercise is a relaxation practice, not physical activity.
3. CProblem SolvingCheck

   Problem Solving deals with specific situations such as lows, sick days, or travel rather than with stress and burnout.
4. DHealthy CopingCheck

   Peer support and a calming breathing practice target the emotional load of diabetes, which is what the Healthy Coping behavior covers.

A diabetes care and education specialist is teaching the Diabetes Plate Method to a person of Mexican heritage whose usual lunch is corn tortillas, pinto beans, and stewed chicken. Which instruction best adapts the plate?

1. ACount the beans as protein to allow more tortillasCheck

   Beans do carry protein, but they are starchy too; counting them only as protein and adding tortillas roughly doubles the carbohydrate on the plate.
2. BPlace the beans in the non-starchy vegetable halfCheck

   Beans are a starchy food, so putting them in the non-starchy half hides a large part of the meal's carbohydrate.
3. CServe the stewed chicken on half of the plateCheck

   Protein takes one quarter of the plate; the half is reserved for non-starchy vegetables.
4. DPut tortillas and beans in the carb quarterCheck

   On the Diabetes Plate, corn tortillas and pinto beans are both carbohydrate foods, so together they share the carb quarter while the chicken fills the protein quarter.

A new DSMES coordinator finds a policy binder organized around '10 National Standards' with ongoing support as Standard 8. Which description reflects the current National Standards for DSMES?

1. ATen standards, reworded in 2022Check

   Ten was the count of the 2017 standards, which the 2022 edition replaced with a shorter set rather than just new wording.
2. BSix standards, as revised in 2022Check

   The 2022 revision condensed the earlier ten National Standards for DSMES into six, and ongoing support is now built into the other standards instead of standing alone.
3. CEight standards, ending with ongoing supportCheck

   The 2017 set had ten standards and the 2022 set has six; ongoing support, Standard 8 in 2017, is no longer a separate standard.
4. DSeven standards, one per ADCES7 behaviorCheck

   ADCES7 lists the self-care behaviors taught to people with diabetes; it is not the structure of the program standards.

A clinic adopts ADA-based treatment algorithms for its primary care clinicians and schedules monthly case reviews with an endocrinologist. Which Chronic Care Model element does this strengthen?

1. AClinical information systemsCheck

   Clinical information systems are registries and data tools for tracking patients and outcomes, and nothing here builds a registry or a performance report.
2. BProvider decision supportCheck

   Guideline-based treatment algorithms and ready access to specialist expertise for primary care clinicians are the core tools of decision support in the Chronic Care Model.
3. CSelf-management supportCheck

   Self-management support builds patients' skills and confidence, while these changes are aimed at clinicians.
4. DDelivery system designCheck

   Delivery system design covers team roles, planned visits, and follow-up workflows, not the evidence clinicians use for treatment choices.