Bill to Expand Access to DSMT Introduced to Congress on May 22, 2018.

On May 10th, Congressman Tom Reed (R-NY) and Congresswoman Diana DeGette (D-CO) introduced the Expanding Access to Diabetes Self-Management Training Act (HR 5768) to Congress. You may read the full text of the bill here. 

HR 5768 will significantly increase Medicare beneficiaries’ access to DSMT services by:

• Expanding access to DSMT services by permitting physicians and qualified non-physician practitioners who are not directly involved in managing an individual’s diabetes to refer them for DSMT services.
• Allowing the initial 10 hours of training during the first year to remain available until used and allowing 6 additional hours of DSMT services during the year in which the initial 10 hours are used.
• Allowing 6 additional hours of DSMT each year after the initial 10 hours are used.
• Removing the restriction related to coverage of DSMT and Medical Nutrition Therapy services furnished on the same day.
• Excluding DMST services from Part B cost-sharing and deductible requirements.
• Revising the Medicare Benefit Policy Manual to allow DSMT services to be furnished in a community-based location.
• Establishing a 2-year demonstration of virtual DSMT, potentially paving the way for future Medicare coverage of virtual DSMT services.

HR 5768 cannot pass without your help! Click here to send a letter to your congressional representative urging them to support and become a co-sponsor of HR 5768. 

Take action on HR 5768 today!

Level 2 – Hospital and Hyperglycemia – updated & recorded ready for viewing! 

 Research clearly demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge.  This course reviews the evidence that supports inpatient glucose control and outline practical strategies to achieve targets in the inpatient setting.  We incorporate the latest ADA Standards and provide links to resources and inpatient management templates. 90-minute course.

Purchase Webinar to view now!

Topics include:

• The impact of hyperglycemia in the hospital setting
• The importance of inpatient glucose control
• Three strategies to get glucose to goal in the hospital setting

Economics and Diabetes; we know that other factors impact the risk of diabetes and GDM in women. Some of these factors include socioeconomic status and the environment. One in three women in the United States, especially single moms, are living in poverty or are right at the brink of it.

An estimated 1.3 million women of reproductive age have diabetes; about 500,000 of them do not know they have the disease. Type 2 diabetes accounts for most diabetes cases during this life stage.

Women of minority racial and ethnic groups are two to four times more likely than non-Hispanic white women to have type 2 diabetes. Reproductive-aged women with type 2 diabetes have fewer years of education, have lower income, and are less likely to be employed than women without diabetes.

Can we help stop diabetes before the risk is passed on to future generations?

As women consider the responsibility of bringing a new life into being, they often have a heightened sense of determination to take better care of themselves for the health of their baby.  Let’s tap into that motivation and find opportunities early on to promote healthy lifestyle before conception and throughout their lifetime.

Women have the potential to improve the Health Legacy passed on to future generations by being in their best health before, during and after pregnancy.

Health Care Professionals need to send a clear and encouraging message to girls and women that their health matters and that they are important coupled with resources and referrals to help women improve their health status.

Key Messages during different phases of life.

Message to girls and adolescents: Start building healthy habits today.

• Be active everyday. Limit screen time to 2 hours a day, engage in moderate intensity exercise daily.
• Eat healthy. Limit sweet drinks like soda and fruit juices and limit processed foods. See Joy of Six Sugar Pledge Resource Page
• Talk to girls about expected body changes over time. Encourage eating nutritionally balanced meals and snacks. Refer to dietitians and community programs.

Message to Women of Childbearing Age –  Get active and eat a healthy diet to nourish your body

• Women’s health and nutritional status BEFORE conception is very critical.
• Regular exercise before conceiving is also important –“Greater total physical activity before or during early pregnancy is significantly associated with lower risk of GDM.”And the magnitude of effect was greatest during prepregnancy = 55% risk reduction in those with highest activity rates.” (ie brisk walk >2 miles).

Message to Women During Pregnancy – Keep active and eat mindfully.

Less than 30% of women gain the recommended weight during pregnancy. Gaining excessive weight increases risk of GDM by 50% along with having a large baby. Encourage eating a healthy, and balanced approach to meal planning.

• Try not to exceed recommended weight gain, keep active, and keep connected to health care team for recommended tests and checkups.
• Refer to community programs and registered dietitians to help women meet lifestyle goals.

Message to Women After pregnancy – There is so much you can do to improve the Health Legacy of you and your child.

• Keep active, eat healthfully, get glucose tested 6-12 weeks after delivery. 

Breastfeeding has amazing benefits:

• For children: breastfeeding decreases the risk type 1 and type 2 diabetes and Obesity.
• For mother: breastfeeding decreases the woman’s of future diabetes by 50%. Plus breastfeeding decreases blood pressure, risk of breast cancer and helps with returning to prepregnancy weight.

Health Legacy and Message of Hope: Celebrating and empowering women through improving access to care, education and targeted health messaging promises to improve the health of this generation and generations to come. 

For more info, listen to our OnDemand Women and Diabetes Webinar. Learn and Earn CEs from your computer.

Learn more with our May Diabetes Ed Newsletter!

This increase may be associated with targeted marketing geared toward normalizing alcohol consumption for women and other social pressures. Unfortunately, women are more likely to suffer negative health consequences from alcohol since they make less of the enzyme alcohol dehydrogenase, which means alcohol levels can quickly reach toxic levels.

Alcohol is especially tricky for women with diabetes who take insulin or sulfonylureas, since the combination increases the risk of hypoglycemia. Yet, many people think alcohol will elevate blood sugars since it “tastes sweet”.  In addition, alcohol contributes to unwanted weight gain.

Key Message – Let’s ask women about their alcohol consumption and discuss limiting alcohol intake to no more than 1 drink a day (which is the recommended amount for all women, regardless if they have diabetes or not).

To learn more check out our May Diabetes Ed Newsletter!

According to an 2013 article in Diabetologia, despite remarkable improvements in life expectancy and a decline in cardiovascular mortality during the last few decades, cardiovascular disease (CVD) is still the leading cause of death in people with diabetes.

Women with diabetes have double the risk of death from heart disease than men with diabetes.

Women’s health has traditionally focused on sexual and reproductive health. Unfortunately, there is lack of awareness of CVD in women, among both clinicians and women themselves.

Yet we know that as many as six in every ten deaths from CVD are related to modifiable risk factors, even among women. See the nine risk factors that predict CV Disease in Women in the “Interheart Study.”

Key Message – As diabetes educators, we can raise awareness and advocate to treat risk factors and encourage women to take an active role in preventing heart disease through daily lifestyle changes.

Learn more via the May Diabetes Ed Newsletter!

Lower Vitamin D levels are more common in people who are overweight.

Vitamin D is a fat soluble vitamin that can be obtained through food and exposure to sunlight. Lack of outdoor activity can be partially blamed for the increase in Vitamin D deficiency which affects 40% of people in the United States. However, a recent study conducted by VU University Medical Center and Leiden University Medical Center recently found a link between Vitamin D deficiency and obesity.

The study assessed men and women from the ages of 45-65 and focused on fat in the liver, fat around the organs, and abdominal fat.

In women, the study concluded that excess abdominal fat had the greatest association with lower Vitamin D levels.

In men, there was a link between lower Vitamin D levels and excess abdominal and liver fat.

It is still unknown whether obesity lowers Vitamin D levels or if Vitamin D deficiency causes excess weight gain. More research is needed to understand the nature of this relationship.

One of the investigators, Rachida Rafiq comments, “Although we did not measure vitamin D deficiency in our study, the strong relationship between increasing amounts of abdominal fat and lower levels of vitamin D suggests that individuals with larger waistlines are at a greater risk of developing deficiency, and should consider having their vitamin D levels checked.”

Take home message for health care professionals?

• Consider evaluating Vitamin D levels in patients who are overweight.
• Encourage people with diabetes to make sure they are getting enough Vitamin D in their diet by having fun in the sun (while keeping hydrated and not getting over exposed) and consuming foods such as: fatty fish like  tuna, mackerel, and salmon, mushrooms, egg yolks, and Vitamin D fortified products!

To learn more about Vitamin D deficiency and its relationship to obesity, enjoy this article published in EurekAlert

Larger waistlines are linked to higher risk of vitamin D deficiency

We consistently hear that eating fresh and local food is best.

What if you could purchase equally nutritious fruits and vegetables that would last longer and were a fraction of the price? Studies now show that frozen food can be just as nutritional beneficial as the fresh fruits and vegetables purchased at the local market. 

When you freeze fruits and vegetables, it actually locks in the nutrients and can even improve the levels of vitamins retained over time. We are more concerned about waste then ever, buy frozen allows you to avoid having your fruits and veggies spoil before you have the change to use them!

“You can store them in the freezer for a year and the nutrient level pretty much stays the same,” says plant scientist Hazel MacTavish-West, who is a food industry consultant.

A study done at the University of California, Davis, revealed the there was not a significant difference between the nutritional value. Because the fruits and vegetables are typically frozen within hours of being harvested, they had higher levels of vitamins over time. 

Helping our community have access to convenient, affordable, but also healthy food is an important part of being diabetes advocates.

To learn more about the nutritional value of frozen food, enjoy this article published in NPR: “Frozen Food Fan? As Sales Rise, Studies Show Frozen Produce Is As Healthy As Fresh”