Free Resource Friday – Preparing for the CDCES Exam Webinar!
Join us for free on November 8th @ 11:30 am PST
Join us to get ready to succeed a the CDCES Exam. This course will transform your test anxiety into calm self-confidence and test taking readiness.
Topics covered include:
- Changes in requirements for 2018
- Exam eligibility and test format
- Strategies to succeed
- Review of study tips and test taking tactics.
We will review sample test questions, and the reasoning behind choosing the right answers.
After registering, you will receive a confirmation email containing information about joining the webinar.
Intended Audience: This FREE webinar is designed for individual or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants and other health care providers interested in achieving excellence in diabetes care and becoming Certified Diabetes Care and Education Specialists®.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator who has passed her CDCES Exam 6 times. She is a nationally recognized diabetes expert for over 25 years.
See our Preparing for CDCES Resource Page >>
Mindful Monday | “Social Jet Lag” and Risk of Heart Disease
An abundance of research supports getting adequate sleep for adequate growth and overall health. Health risks increase when an individual is sleep deprived. Sleep deprivation increases risk for type 2 diabetes, high blood pressure, heart disease, and insulin resistance.
In addition, new research by the academic journal “Sleep,” has shown that,”Social Jet Lag” waking up at different times on the weekends vs. weekdays, may increase the risk of heart disease.
Current research by Duke University Medical Center demonstrated that individuals with what is referred to as “social jet lag” may also have an increased risk of depression and stress than subjects who woke up at the same time consistently. The connection thus far is not clear as some researchers believe that, “poor sleep interferes with the body’s metabolism which can lead to weight gain” which creates a vicious cycle of poor sleep and weight gain. Previous studies have also shown that a varied sleep schedule can lead to the development of obesity and type 2 diabetes.
The authors conclude that further research is needed to determine why individuals who get less sleep are gaining weight and increasing their risk for cardiometabolic conditions.
For more information on “social jet lag” and its effects on cardiometabolic health, visit A regular bedtime may benefit your heart and metabolism”
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Free Resource Friday – DiaBingo Game
This Friday, we are happy to offer our student favorite, DiaBingo – Makes Learning about Diabetes fun!
An educational tool to increase knowledge of diabetes self-management terms and goals of care. In Spanish and English.
Players learn about diabetes management while having fun! A must have for support groups and in the classroom setting.
Perfect for Diabetes Awareness Activities. Up to 30 Can play! English on one side, Spanish on the other.
- 2 DiaBingo Master Question and Answer Sheets
- 30 DiaBingo Answer Cards
. DiaBingo is now available to download for free in English and Spanish!
Simply print out the player cards and choose items to use as markers to get started.
The questions are designed by our experts to help players become informed about diabetes and self-care in an upbeat and entertaining way. You are welcome to customize these questions as needed to make it relevant to your group.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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Free Webinar | Mindfulness Webinar for Diabetes Specialists
Management of Hyperglycemia – Keeping it Person Centerered
Click here to download image
Management of Hyperglycemia in Type 2 Diabetes, 2018. https://doi.org/10.2337/dci18-0033
A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
This new consensus statement is a summary of findings based on a comprehensive literature search of peer reviewed articles published from 2014 to February 2018.
Here are some key statements from the Principles of Care Section that really stood out. In addition, the Decision Cycle Chart below, is an excellent summary of person centered considerations to determine the best path to take when deciding upon lifestyle and medication therapy.
Key concepts that I found intriguing and helpful from this section:
- The greatest risk reduction comes from improving poor glycemic control. There is a more modest risk reduction with near normalization. This statement helps educators to prioritize where we put our efforts, knowing that the greatest health improvement comes when we help PWD with higher A1cs levels get to target.
- Keep the care centered around the person with diabetes. Acknowledge that they often have multi-morbidities and other real barriers to self care including cost of therapy, mental health issues and competing priorities.
- All people with type 2 diabetes need access to ongoing DSMES Programs. DSMES programs are evidenced based and cost effective. They promote medication adherence, healthy eating, activity and improve self-efficacy.
Therapeutic inertia, also called clinical inertia, refers to the lack of action even when blood glucose targets are above target. This is something I have frequently seen in my diabetes practice. A common example of this is a PWD on two to three different diabetes medication and basal insulin, with an A1c is greater than 9%, yet no changes in therapy are made for months or years. The causes of this inertia may complex, but can be a result of the provider, person with diabetes or the health care system.
To avoid or stop Clinical inertia, here are recommended strategies:
- Evaluate the PWD medication taking persistence. Are they taking their medication at least 80% of the time? If not, explore the barriers and engage in problem solving.
- Reassess and modify treatment at least every three months to avoid clinical inertia
- Engage multidisciplinary teams that include nurse practitioners, pharmacists and diabetes educators who can suggest or implement therapeutic changes to improve A1c levels.
- Create coordinated care models, which include the person with diabetes as an active participant.
Diabetes Remission after Intensive Weight Loss
Remission of type 2 diabetes: Mission Not Impossible.
In the Management of Hyperglycemia in Type 2 Diabetes, 2018.A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), on page 12 and 18, they reference the results of the DiRECT study below. They recommend that all overweight and obese PWD be advised of the health benefits of weight loss and encouraged to engage in an intensive lifestyle program to achieve weight loss reduction.
The DiRECT study, published in the Lancet in February 2018, aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes.
Goals of the study were weight loss of 15 kg or more and remission of diabetes, defined as A1c less than 6·5%, after at least 2 months off all antidiabetic medications, from baseline to 12 months.
To evaluate if this was possible, the research team initiated an open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. They recruited individuals aged 20-65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27-45 kg/m2, and were not receiving insulin.
All diabetes and hypertension medications were stopped and very low calorie diet was started.
- Total diet replacement (825-853 kcal/day formula diet for 3-5 months)
- stepped food reintroduction (2-8 weeks),
- and structured support for long-term weight loss maintenance.
Outcome:
For 12 months, two groups consisting each of 149 participants were followed. The intervention group received weight management support and the control group received no weight loss intervention.
At end of study (12 months), diabetes remission was achieved in 68 (46%) participants in the intervention group and six (4%) participants in the control group
Diabetes remission rates associated with weight status at 12 months:
- Six (7%) of 89 participants with 0-5 kg weight loss
- 19 (34%) of 56 participants with 5-10 kg loss,
- 16 (57%) of 28 participants with 10-15 kg loss,
- 31 (86%) of 36 participants who lost 15 kg or more.
Other interesting observations:
- Mean body weight fell by 10·0 kg in the intervention group and 1·0 kg in the control group.
- 36 (24%) participants had a weight loss of 15 kg or more in the intervention group
- In the control group, no participants reached the target of 15 kg weight loss
- Remission varied with weight loss in the whole study population. 76 participants gained weight and had no remission
- Quality of life improved by 7·2 points in the intervention group, and decreased by 2·9 points in the control group.
Nine serious adverse events were reported by seven (4%) of 157 participants in the intervention group and two were reported by two (1%) participants in the control group. Two serious adverse events (biliary colic and abdominal pain), occurring in the same participant, were deemed potentially related to the intervention. No serious adverse events led to withdrawal from the study.
What does this mean?
The results show that, at 12 months, almost half of participants in intervention group achieved, with a mean weight loss of 10%, experienced remission to a non-diabetes state without diabetes medications.
The authors conclude that remission of type 2 diabetes through a structured weight loss intervention is a practical target for primary care
Want to read more?
Lancet. 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140-6736(17)33102-1. Epub 2017 Dec 5.
https://www.ncbi.nlm.nih.gov/pubmed/29221645
Remission of type 2 diabetes: mission not impossible.
Gut Bacteria Changes Indicate Type 1 Progression
Increased knowledge of how gut bacteria ratios change as a marker of inflammation could help delay the development of Type 1 Diabetes. Researchers from the University of Queensland proposed that monitoring the microorganisms living in the gut may aid in understanding the disease better as a whole.
Participants in the study were all newly diagnosed with Type 1 Diabetes and were asked to provide a stool sample. The researchers analyzed these samples and found that, “certain proteins can be used to differentiate risk levels.”
UQ Diamantina Institute Senior Research Fellow Dr Emma Hamilton-Williams said: “By studying the stool samples of participants, we found that changes in gut bacteria weren’t just a side effect of the disease, but are likely related to disease progression.”
Research on the topic is new and fairly undeveloped. However, there are plans to carry out further research on the bacteria associated proteins, analyzing why they may signify an increased risk of Type 1 Diabetes expression.
The researchers are hoping to use this microbial information to monitor disease progression or develop therapies aimed at restoring a healthy microbiota in people at risk of type 1 diabetes.
For more information, Join our FREE Getting to the Gut, Meet Your Microbiome –
Live Webinar November 14th, 2018 at 11:30am PST
Read original article in Diabetes Care – Intestinal Metaproteomics Reveals Host-Microbiota Interactions in Subjects at Risk for Type 1 Diabetes – Diabetes Care 2018 Aug; dc180777.
And visit Monitoring gut changes could help delay type 1 diabetes.
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Electronic Charting – Keeping it HUMAN
As diabetes educators, having eye contact and listening carefully without distraction, is a critical part of our assessment. This initial meeting helps us sort out what is working with the person’s diabetes and what barriers might be getting in the way. The words we use, our body language, and how we engage in this encounter sets the stage for our ongoing working relationship. Plus, it can influence the self-perception of the person sitting across from us.
However, many providers and educators may rely on computers to review notes and labs and to document the visit. This means there may be moments spent looking at the screen instead of the person sitting across from us.
Unfortunately, people with diabetes may feel that the computer is a distraction and a barrier to effective two-way communication.
Good news! There are strategies to compassionately engage with people with diabetes during the visit, while using the computer.
At the American College of Physicians Internal Medicine Meeting, speaker Wei Wei Lee MD, assistant professor of medicine at the University of Chicago, said utilizing the mnemonic HUMAN LEVEL provide guidance on how to succeed with electronic charting.
The mnemonic HUMAN LEVEL stands for:
H stands for honoring the golden minute. “The first minute of the visit with the patient should be completely technology free. Greet the patient, start with what’s on their mind, what their agenda is and then transition into using the computer,” she said.
U – Use the triangle of trust by placing the computer so that you and the patient can see the screen at the same time.
M – Maximize interaction by engaging the patients as much as possible, as you work on the computer.
A – Acquaint yourself with the patient’s chart before entering the examination room.
N – Not focusing exclusively on the screen during the visit, especially when the patient is talking about sensitive subjects.
For the complete mnemonic and more info on establishing a collaborative relationship, here is the article by Healio – “Doctors, patients benefit when the ‘eyes’ have it”
We have also created a resource page called the ABCs of Language Use in Diabetes, which provides insights on using strength-bases language in the clinical setting.
