Rationale of the Week | Low carb diets and SGLT-2’s a good mix?
For last week’s practice question, we quizzed participants on SGLT-2’s & low carb diets. 60% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: ST is a 56-year-old presenting for MNT and diabetes education. Their last A1c was 7.4%, and they are currently taking 1000 mg of Metformin and 10 mg of empagliflozin daily for glucose management. They recently read that a very low-carbohydrate eating pattern can help individuals with type 2 diabetes reduce A1C and the need for additional medications and are motivated to implement diet changes.
What would be your primary considerations and guidance in response to ST?
Answer Choices:
- ST is motivated for change, encourage their desire to implement a very low-carbohydrate diet as it is safe for all individuals with diabetes.
- ST should avoid a very low-carbohydrate diet.
- A very low-carbohydrate diet may be appropriate if ST transitions off the SGLT2 inhibitor.
- ST should follow a fixed carbohydrate intake at each meal to align with their medication regimen.
Getting to the Best Answer
Answer 1 is incorrect. 10.61% chose this answer. “ST is motivated for change, encourage their desire to implement a very low-carbohydrate diet as it is safe for all individuals with diabetes.” While very-low-carbohydrate diets has evidence for reducing A1c and need for additional medications, they may not be universally safe for all individuals. Keep reading to learn more.
Answer 2 is incorrect. 12.77% of you chose this answer. “ST should avoid a very low-carbohydrate diet.” A very-low-carbohydrate diet is not inherently contraindicated for individuals with diabetes, but careful planning and potential discontinuation of the SGLT2 inhibitor is recommended to reduce the risk of euglycemic ketoacidosis.
Answer 3 is correct. About 59.53% of respondents chose this. “A very low-carbohydrate diet may be appropriate if ST transitions off the SGLT2 inhibitor.” Use SGLT2 inhibitors with caution when implementing a low carbohydrate diet and strong consideration should be made to cease this medication if implementing a very low carbohydrate diet, less than 50 grams of carbohydrate per day. Very low carbohydrate diets may increase the risk of euglycemic ketoacidosis by lowering insulin levels. After additional clinical review, a very-low-carbohydrate diet can be considered for ST if they transition off the SGLT2 inhibitor. Educating ST about the difference between physiological ketosis and pathological ketoacidosis may also be considered.
Finally, Answer 4 is incorrect. 17.09% chose this answer. “ST should follow a fixed carbohydrate intake at each meal to align with their medication regimen.” While fixed carbohydrate intake can sometimes simplify diabetes management, it does not align with ST’s interest in very-low-carbohydrate eating patterns. The current medication regimen does not necessarily require a fixed carbohydrate plan. Simply educating on this approach without additional shared decision making may not provide an individualized dietary intervention.
Reference: American Diabetes Association Professional Practice Committee; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S77–S110. https://doi.org/10.2337/dc24-S005
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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Entering the Field of Diabetes Education – Building a Bridge Program
Building a Bridge to Welcome New Diabetes Specialists
We are geared up to help grow and mentor future diabetes specialists to meet the increasing and varied needs of our diabetes community, but we need your help.
Over the next 10 years we are “Building a Bridge” to welcome a thousand new diabetes educators into the field. If you know a healthcare professional seeking a new challenge and eager to pursue a meaningful and rewarding specialty, please invite them to consider becoming a Certified Diabetes Care and Education Specialist (CDCES).
To reach the goal of encouraging healthcare professionals to enter the field, we have created a new FREE webinar that outlines the benefits and steps involved in “Becoming a Diabetes Specialist.” We want to share this information with as many healthcare professionals as possible to encourage them to consider specializing in diabetes.
Our goal is to cast this net far and wide to address the rising prevalence of diabetes. Currently, 16% of people in the United States live with diabetes, and over 38% live with prediabetes according to the CDC. Diabetes is more prevalent in communities of color and impacts individuals with less income and resources. CDCES’s are influential in addressing health disparities and promoting equitable care through their work in health care settings across the country.
Why Become a CDCES?
On a personal note, becoming a CDCES is one of the best professional decisions I have ever made. This certification has opened the door to many opportunities and dramatically increased my job satisfaction.
Currently, there are 19,500 healthcare professionals with the CDCES credential, including registered nurses (RNs), nurse practitioners (NPs), registered dietitian nutritionists (RDNs), pharmacists, physicians, and physician assistants (PAs)es. At Diabetes Education Services, we are trying to enhance diversity within the CDCES community through our scholarship programs, to encourage a broader range of applicants to pursue certification. We are planning to offer more scholarships in the future to reach our goal of welcoming a thousand new educators into this profession.
There is more to be done, and we appreciate your help speaking to colleagues and letting them know about the benefits of becoming a CDCES. If you are part of a healthcare organization and want Coach Beverly to present the steps involved in becoming a Diabetes Specialist, we are happy to provide a virtual presentation at no cost. Please reach out to discuss details at [email protected].
Benefits of Becoming a CDCES
1. Improving Diabetes Outcomes and Quality of Life
- CDCES professionals advocate for effective diabetes management through person-centered care and education.
- Studies show that diabetes education improves glycemic management, reduces complications, and lowers hospitalization rates.
- Diabetes care specialists address the psychosocial aspects of diabetes and support problem-solving and well-being.
2. Addressing Health Disparities:
- CDCESs are essential in caring for diverse populations, including those disproportionately affected by diabetes.
- We are a part of advocating for equity and increased access to care.
3. Reducing Healthcare Costs:
- Diabetes education can significantly reduce healthcare costs by preventing complications such as heart disease, kidney failure, and lower extremity complications.
- CDCESs contribute to cost savings by promoting preventive care and self-management.
4. Expansion of Care Models:
- With a shift towards value-based care, there is a growing emphasis on preventive health services and chronic disease management, increasing demand for CDCESs in hospitals, clinics, and community health settings.
- CDCES professionals are vital in addressing the diabetes crisis in the U.S., improving both individual health outcomes and public health overall. Their expertise is increasingly in demand across various healthcare settings.
How to Become a Certified Diabetes Care and Education Specialist (CDCES)
- Educational Requirement: Hold a relevant degree such as in nursing, dietetics, pharmacy, or other health-related field.
- Professional Licensure: Maintain an active license in a qualifying health discipline (e.g., RN, RD, MD, etc.) or have a degree in an eligible field like public health or social work.
- Experience Requirement:
- A minimum of two years (to the day) of professional practice experience in the discipline under which one is applying for certification.
- Obtain at least 1,000 hours of diabetes education experience within the last five years, with at least 200 hours in the most recent year.
- Continuing Education: Complete at least 15 hours of continuing education in diabetes management and care within 2 years before applying.
- Exam Application and Preparation:
- Apply for the CDCES exam through the Certification Board for Diabetes Care and Education (CBDCE).
- Prepare using study materials, review courses, and practice exams related to diabetes education.
- Pass the CDCES Exam: Successfully pass the 175-question certification exam, which covers topics including assessment, care and education strategies, standards and practices.
- Maintain Certification: You can renew your certification every five years through continuing education, fulfilling practice hour requirements, or retaking the exam.
Visit the official CBDCE website or relevant professional bodies for more detailed guidance or recent updates.
Visit our CDCES Prep Page for more information and to register for FREE Webinars with lots of helpful information.
Building a Bridge Program: At Diabetes Education Services, our goal is to mentor the next generation of Certified Diabetes Care and Education Specialists (CDCES). We are committed to welcoming healthcare professionals with diverse experiences and backgrounds to enter the diabetes field. Our online programs and scholarship programs aim to provide emerging CDCES professionals with the knowledge, skills, and confidence to address the unique challenges encountered by people with diabetes from all walks of life, while also preparing them for certification.
Interested in becoming a CDCES but not sure where to start?
Our 2-Step FREE Webinars Series Will Guide You
Our FREE webinars will help you discover the steps required to become a CDCES and will transform your test anxiety into calm self-confidence and test-taking readiness.
- Want to learn more about the qualifications to take the CDCES exam? Register for our Free “Becoming A Diabetes Specialist” Step 1 Webinar.
- Taking the CDCES Exam in the next 6 months? Register for our Step 2, “Prep to Take the CDCES Exam” Free Webinar.
Step 1: Becoming a Diabetes Specialist (CDCES)
If you are a health care professional considering becoming a CDCES and want to learn more about eligibility and benefits of joining the Diabetes Education Community, this FREE webinar is for YOU. Coach Beverly will provide clarification on requirements, exam content, and study strategies to prepare for success.
Step 1: Webinar Topics
- Benefits of becoming a CDCES
- CDCES eligibility requirements for 2025
- Exam outline and study strategies to succeed
2025 Step 1 Webinar
Handouts
Step 2: Preapring to Take the CDCES Exam
We will review examination process, sample test questions, and the reasoning behind choosing the BEST answers. We will review examination process, sample test questions, and the reasoning behind choosing the BEST answers.
Step 2: Webinar Topics
- Test content updates for 2025
- Strategies to experience exam success
- Review of study tips and test taking practice questions
2025 Step 2 Webinar
Handouts
Can’t join us live?
Don’t worry, if you register, we will send you a link to the recorded version.
Instructor
Coach Beverly Thomassian, RN, MPH, BC-ADM, CDCES
Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years and has successfully passed the CDCES exam six times. As president and founder of Diabetes Education Services, Beverly is dedicated to optimizing diabetes care and improving the lives of those with diabetes.
“Becoming a Certified Diabetes Care and Education Specialist (CDCES) is one of the best professional and personal decisions I have ever made.” – Coach Beverly Thomassian
The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.
**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.ncbde.org). CBDCE does not approve of continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.
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