How Has the COVID-19 Pandemic Affected People Live with Type 1?

The Sansum Diabetes Research Institute (SDRI) is conducting a survey to learn more about the experiences of those living with Type 1 during the COVID-19 pandemic.

SDRI seeks to understand the current needs of the population with type 1 diabetes in the United States by means of voluntary, anonymous baseline and follow-up surveys. Researchers at SDRI hope to determine the extent to which this pandemic has hindered the type 1 community from access to medical attention, insulin, and other diabetes supplies. We want to also understand the warranted fears, concerns, worries, and experiences of people living with type 1 diabetes, a designated high-risk pre-existing condition, during the COVID-19 pandemic.

By learning more about the experiences of people living with Type 1 during this pandemic, we are better able to create solutions that meet their needs.

We are looking forward to the results of this survey.

Download the flyer here.


Please join us today, May 27th for our Virtual Course with Dana Armstrong, RD, CDCES, Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic.

Medical Nutrition Therapy + Meal Planning
Recorded and Ready for Viewing!
$69 | 4.0 CEs 

Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.

Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.

Webinar Dates

Session 1 – Medical Nutrition Therapy Overview | Recorded & Ready for Viewing!

Session 2 – Meal Planning – How to Eat by the Numbers | Recorded & Ready for Viewing!

All presentations are recorded and available for on-demand viewing.

These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.


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!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Vitamin D, Diabetes, & COVID-19 | Tech Thursday

Interesting findings that explore the relationship between Vitamin D levels and COVID-19 outcomes are being released.

In an article by WedMD, there have been several international studies that evaluate Vitamin D levels in people infected with COVID-19.

None of these studies indicate definitively if higher levels of Vitamin D reduce the risk of contracting or becoming severely ill with COVID-19. Though, they’ve noticed that the “sickest” people with COVID-19 had low levels of Vitamin D.

Several studies conducted across different countries indicate that a healthy level of Vitamin D might strengthen our immune system and reduce our vulnerability to disease.

Vitamin D is so important for our bones, muscles, and a nutrient our immune systems need for optimal health. An adequate blood level of Vitamin D is between 20 nanograms/milliliter to 50 mg/ml. A simple but slightly costly blood test can measure one’s level of this vitamin.

People living with diabetes (type 1 & type 2) often have lower levels of Vitamin D. Vitamin D deficiency can manifest as fatigue, depression, muscle and bone pain, and decreased overall health.

Boosting Vitamin D Levels

Lifestyle changes can be used to treat low Vitamin D levels; eating healthy foods like eggs, mushrooms, fresh fish, and getting outside in sunlight, can increase our Vitamin D levels. As a supplement, Vitamin D3 or cholecalciferol is recommended at a dose of 400-1000 IU /day.

Vitamin D is made by the body when the skin is exposed to sunlight. Often people in the Northern Hemisphere with less sun exposure have lower levels of Vitamin D. Regular sun exposure can help increase Vitamin D levels, although supplementation seems to be more effective.

In addition, improving access to healthy foods needs to be a priority for all people, but especially vulnerable populations and those with diabetes.

For more information, read the WebMD article here. We also recommend you read Vitamin D and Type 1 Diabetes: What the Research Says & Higher vitamin D levels linked to lower risk for diabetes. Click here for NIH Vita D Info page.

Update

Healio has released more information on this topic that you can find on their recent article, “Researchers caution against ‘misinformation’ on vitamin D during COVID-19 pandemic.”

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


Please join us today, May 27th for our Virtual Course with Dana Armstrong, RD, CDCES, Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic.

Medical Nutrition Therapy + Meal Planning
Recorded and Ready for Viewing!
$69 | 4.0 CEs 

Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.

Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.

Webinar Topics

Session 1 – Medical Nutrition Therapy Overview | Recorded & Ready for Viewing!

Session 2 – Meal Planning – How to Eat by the Numbers | Recorded & Ready for Viewing!

All presentations are recorded and available for on-demand viewing.

These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.


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!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Update: DPP-4 Inhibitor Not Associated with Improved Outcomes in COVID-19

In a recent post, we shared endocrinologist Gianluca Iacobellis’, MD, Ph.D. suggesting that DPP-4 inhibitors could help decrease COVID-19-related immune overreaction in people with diabetes.

However, according to Daniel Drucker, MD, Ph.D., there is “insufficient evidence” that DPP-IVs decrease the immune response during COVID-19 infections.

Daniel Drucker, MD, Ph.D., professor of medicine at the Lunenfeld Tanenbaum Research Institute of Mount Sinai Hospital and the University of Toronto and expert in the field, summarized that DPP-4 inhibitors and GLP-1 receptor agonists have not been associated with improved outcomes in critically ill individuals with diabetes and a COVID- 19 infection.


Insulin is the glucose-lowering therapy of choice for acute coronavirus-related illness in hospital.

Daniel Drucker, MD, Ph.D

Dr. Drucker states that available evidence does not currently support clinically meaningful alterations in markers of immune function after administration of DPP-IV inhibitors in humans with or without type 2 diabetes.

This is important news as it clears up medication misconceptions and further highlights the importance of administering insulin for people with type 2 diabetes and active COVID-19 infection.

Considering the fact that people with type 2 diabetes have a higher chance of developing complications from COVID-19 than people without diabetes, it is critical to use the most effective method of treatment.

Read More

  • For more information on DPP4-Inhibitors, click here.
  • To read our previous article about DPP-4 Inhibitors, click here.
  • To read more about the risks associated with Type 2 diabetes and COVID-19, click here.

Medical Nutrition Therapy + Meal Planning
$69 | 4.0 CEs 

Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.

Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.

These sessions are also included in our Virtual Conference.


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!

Update for CMS Guidelines for CGM Coverage | Tech Thursday

Last week we posted a blog titled “CMS Updates For CGM Coverage,” which on the surface seemed like very exciting, impactful changes on CMS regulations for CGM coverage during the COVID-19 pandemic.

After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.

What do these changes actually mean?

To learn more we dove into the interim final rule with comment period (IFC) that was released by the Department of Health & Human Services – Centers for Medicare & Medicaid Services.

 In the March 31st COVID-19 IFC, we finalized on an interim basis that we will not enforce the clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump NCDs (Nation Coverage Determinations) and LCDs (Local Coverage Determinations) (including articles) allowing for more flexibility for practitioners to care for their patients. This enforcement discretion will only apply during the PHE for the COVID-19 pandemic. 

The language in the IFC is vague and ambiguous regarding what it means to have less stringent and “more flexible” requirements of obtaining a CGM in the time of the COVID-19 for people with diabetes. Though we have found a few highlights from the document based on feedback by our community on what is unclear.

The Highlights

  1. These changes are only applicable to those who are COVID-19 positive and living with diabetes.
  2. The type of diabetes one has is no longer relevant in coverage determinations.
  3. These guidelines do not automatically expand to Medicaid coverage. For more details on Medicaid coverage, contact your local state.

In this IFC, we are finalizing on an interim basis that we will not enforce the clinical indications for therapeutic continuous glucose monitors in LCDs. For example, we will not enforce the current clinical indications restricting the type of diabetes that a beneficiary must have or relating to the demonstrated need for frequent blood glucose testing in order to permit COVID-19 infected patients with diabetes to receive a Medicare-covered therapeutic continuous glucose monitor.  

Overall, there is still much to learn about these changes as they apply to real-life situations. This is an unprecedented time for all of us and there is a lot of unknowing. We hope as things develop to keep you informed.

To read the full IFC click here. For more information about Medicaid Guidelines, click here.

If you have any more information on these changes, please click here to visit our survey to update us.

Update from Michael Christian breaking down the CMS changes.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Telehealth and DSMT | Latest Updates from CMS

As Diabetes Specialists, we want to ensure the safety of patients and colleagues, while providing diabetes care to those who may be the most vulnerable and isolated during this pandemic.

According to the CARES Act, Diabetes Self-Management Training (DSMT) can be provided to patients via telehealth during the pandemic. Though the original regulations had many gaps.

Previously, the CARES Act required that telehealth visits must include both audio and video, while many hospital outpatient clinics were running into billing barriers. In addition, under the original guidelines, RNs and Pharmacists were not included in the approved list of telehealth DSMT Providers.

See: ADCES Summary Sheet of DSMT and Telehealth FAQ for more information.

Though as of April 23, 2020 the guidelines have been updated.

Good News – these updates to the CARES Act now expand blanket waivers under the 1135 waiver.

For any of the information below, please check with your compliance team for clarification and share the important resource links below with your billing department.


How do CMS Updates Affect Our Ability to Provide DSMT Training?

DSMT Can Now be Audio-Only

DSMT services may be billed for audio-only, but only if the video is not available or possible. Make sure to document the mode of instruction and the rationale if using audio-only. 

See: COVID-19 Emergency Declaration Waiver for more information.

Can RNs & Pharmacists Now Provide Telehealth and Bill for DSMT?

The ADA and ADCES have been working hard to decipher the language and intent in the updated guidelines. It seems that RN and Pharmacists are now included based on an assessment of the wording in the new documents. CMS continues to expand the definition of providers eligible to furnish telehealth services during the COVID-19 public health emergency.

As DSMT programs bill as an entity, rather than at the individual provider level, the American Diabetes Association is seeking confirmation that DSMT programs that are eligible through Medicare Part B, are considered distant site practitioners approved to furnish telehealth services.

See: Blanket Waivers for HealthCare Providers Fact Sheet for more information.

Hospital-Based Programs Can Bill for Telehealth DSMT on the UB-04 (Medicare Claims) Form

Hospitals may now bill for education and management services (i.e. DSMT) as if they were furnished in the hospital and consistent with any specific requirements for billing Medicare in general, including any relevant modifications in effect during the COVID-19 PHE.

In summary:

  • DSMT services can be provided in the hospital outpatient setting remotely to a patient in their home.
  • The patient’s home can serve as a temporary provider-based department of the hospital (CMS’ Hospitals Without Walls initiative).
  • If you previously billed using the UB-04, continue to bill the same way.
  • The patient must be a registered outpatient of a hospital.
  • DSMT and scope of practice requirements must be met.

See: CMS Hospitals Without Walls Initiative for more information.

Important to note: Please consult with your organization’s billing department and compliance team if you have questions.

Sources and Links


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

May Newsletter | Insulin Savings, Telehealth Updates, and Salivary Glucose Testing

Click here to read our entire May Newsletter

As a Diabetes Nurse Specialist in a local clinic, I am providing telehealth once a week. During these visits, I am checking in with people about their food and medications.

Do you have enough food and insulin to last? Most of them answer, “yes, for now”. 

Many of them may run out of insulin and supplies in the near future, some as a result of the costs that make essential medications in-affordable. If this is the case, what can we offer them?

We are excited to thank our guest contributor and Diabetes Educator of the Year, Dr. Diana Isaacs, who has provided us with helpful information and a multitude of resources for people in need of low-cost insulin.

In light of the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS), has expanded opportunities to provide remote care to people with diabetes. We have highlighted some recent updates and provided links to helpful resources for your billing team.

Lastly, we are looking towards the future with salivary glucose testing and insights into a past Question of the Week.

I am grateful to be a part of this amazing community of diabetes specialists. Thank you for your care, concern and advocacy.

Be well! Coach Beverly

Click here to read our entire May Newsletter


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

COVID-19 & Diabetes Resource Page | Free Resource Friday

For this week’s Free Resource Friday, we want to share with you our new COVID-19 & Diabetes Resource Page!

Over the past weeks, we have been collecting resources to learn more about COVID-19 and how it affects people living with diabetes.

We have decided to gather all of these resources together into one page to share with you.

This page includes webinars, ADA & ADCES COVID-19 resource hubs, handouts, mental wellness resources, and much more!


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!

COVID-19 and Diabetes: CGMs in Hospital Improve Care | Tech Thursday

What does it feel like to be ill with COVID-19 as a person with diabetes? Much of the novel virus COVID-19 is still a mystery that we learn more about every day.

Through the stories of those who have contracted COVID-19, we know that the impacts vary. Symptoms can appear mild with a slight fever and some coughing, like Andrew O’Dwyer from the UK experienced.

While for others symptoms can be more severe, like how a secondary-school teacher living with diabetes had. She had a much longer list of symptoms including difficulty breathing, dizziness, dehydration, and vomiting.

Though even with her more severe symptoms, she struggled with whether she should go to the hospital or not.

“I’m unsure whether to go to the hospital. I feel as though I’ll be wasting valuable resources and I may be an infection risk to vulnerable patients.

As many medical systems are overwhelmed and resources continue to be limited, it’s important to think of ways to reduce the risk of transmission so individuals can get the care they need. Because despite this wide range of impact, COVID-19 continues to emerge with very severe complications for people with or without diabetes.

Reduce the Risk: Glucose control is key!

For people with diabetes who are treating COVID-19, glucose control is key! Keeping BG levels as close to the target range as possible can help reduce the inflammatory response, caused by hyperglycemia. Following the basic guidelines of sick day management will assist the type 1 person who might be diagnosed with COVID-19.

To minimize the risk of transmission, hospitals are starting to use CGM’s for glucose checks in ICUs and in COVID-19 units.

“We knew we needed to get creative” states Carol Levy, MD, Clinical Director of the Mount Sinai Diabetes Center, while discussing “a new initiative to utilize CGM for critically ill patients with COVID-19 to reduce patient-provider contact, conserve PPE, and reduce risks for virus transmission.”

For more information, please see our Emergency Preparedness Blog Post.

There is an incredible amount of information regarding COVID-19 and diabetes. These articles show a glimmer of hope for all people with diabetes that might develop COVID-19.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

To read more Mount Sinai’s efforts click here. Click here for For Arthur’s full story, or for the secondary school’s story click here.


*From ADA Treatment & Care Fact Sheet, “People with diabetes are not more likely to get COVID-19 than the general population. The problem people with diabetes face is primarily a problem of worse outcomes, not a greater chance of contracting the virus. In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications than people without diabetes.” To help friends and family keep safe, here is an excellent handout on Keeping Safe and Home and in the Workplace by the World Health Organization.


COVID-19 & Diabetes: What Healthcare Professionals Need to Know
Free Webinar

As health care professionals and Diabetes Specialists, how do we prepare people with diabetes for the possibility of a COVID-19 infection and hospitalization?

What are the best practices to care for people with diabetes and COVID-19 in the outpatient and hospital setting?

Updates:

The Telehealth guidelines for providing DSMT have been updated since the streaming of this webinar.  Please see this blog, Telehealth and DSMT | Latest Updates from CMS, for updated information.


Webinar Viewing Options:

Can’t make it live? Your webinar registration means you receive a link to the recorded version within hours of airing.


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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