Impacts of Healthcare Inequities & How We Can Change Them
As Diabetes Education Specialists and advocates, we see first-hand how healthcare inequalities impact the health of under-resourced communities.
Just as diabetes is systemic, affecting the entire body, so are the disparities in our public and private healthcare systems.
This is not only a result of public policies, healthcare education, medical racism, and medical classism, but also access to nutritious whole foods, stable housing, insurance coverage, and even enough time in the day to focus on one’s health.
Under the COVID-19 pandemic, these disparities have become even more apparent.
“Black and Latino patients are two to three times as likely as white patients to be diagnosed with COVID-19, and more than four times as likely to be hospitalized for it. Black patients are more than twice as likely to die from the virus. They also die from it at younger ages“ wrote Ezekiel J. Emanuel, Oncologist, bioethicist, and vice provost of the University of Pennsylvania and Risa Lavizzo-Mourey, Professor at the University of Pennsylvania for The Atlantic.
Acknowledging these perforations of care is an important first step towards a more inclusive healthcare system. This reparative practice can result in more positive outcomes and improve the quality of life for many.
Insurance Coverage & Reimbursement Rates
Equal access to healthcare coverage is key.
The economic impacts of the pandemic have widened the gap in insurance coverage. Around 12 million people living in the U.S. lost employer insurance due to the pandemic, with higher unemployment rates for Black and Latino workers (see above graph).
Since the implementation of the Affordable Care Act (ACA) the number of uninsured individuals and families was reduced. However, 15 states opted out of the widening of programs like Medi-Caid under ACA.
For those insured under Medi-Caid, there is still the hurdle of finding a provider that accepts their insurance. This is because many healthcare professionals do not accept Medi-Caid due to low reimbursement rates.
Initially, the ACA increased rates for providers who accepted Medicare and Medi-caid. But they have decreased over time and with that decrease, the number of doctors accepting or even scheduling individuals with Medi-Caid decreased, as well.
“A 2014–15 survey showed that only 68 percent of family-practice physicians accepted new Medicaid patients, while 91 percent accepted those with private insurance,” Ezekiel J. Emanuel and Risa Lavizzo-Mourey.
In addition to raising overall fees for service, implementing a system in which healthcare providers are reimbursed based on health outcomes can be a way to hold us accountable to provide a high level of care, despite factors such as race, gender, sexuality, or class.
Unlearning Medical Biases & Increasing Representation
Medical discrimination is pervasive.
A study conducted earlier in the pandemic found “that doctors were less likely to refer symptomatic Black patients for testing than they were to refer white ones.”
It has also been studied that white medical students and residents rate pain lower for Black people who are experiencing similar symptoms to white people. This bias impacts their care recommendations and the study found lower accuracy of treatment plans for the Black person’s case example.
Educating ourselves on the history of medical racism and classism while engaging in implicit bias training can help us unlearn these inaccurate assumptions.
Representation matters for Healthcare Providers.
Lack of representation often stems from a multitude of factors, such as discriminatory admissions or hiring practices.
An experiment conducted in Oakland found that involving Black doctors in treatment plans reduced the cardiovascular mortality gap by 19% for Black and white men.
Another example of why representation matters are reflected in how commonly medical texts only show white skin tones. Because of this, Malone Mukwende, a 20-year-old medical student is working on a book to show what symptoms look like on darker skin.
Systemic changes begin with each of us.
Educating ourselves on discriminatory medical practices both for healthcare professionals and the people living with diabetes with whom we work with is a great first step to moving towards a more inclusive medical system.
Written by Bryanna, our Director of Operations & Customer Happiness
Read more from The Atlantic article by clicking here. For more information on racial disparities in the treatment of pain click here. For Malone Mukwende’s story click here.
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Accreditation: Diabetes 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.
Question of the Week | Sept 29, 2020
LT, a 59-year old with type 2 diabetes presents to the hospital in a hyperglycemic crisis. LT has a history of hypertension, peripheral vascular disease and smokes a pack per day. LT states they have been taking 1000mg metformin BID and 10 units basaglar every night as usual. LT tells you they are stressed out and concerned about a foot sore that doesn’t seem to be getting better. LT is trying to stay home and avoid other people, to prevent getting COVID. LT’s A1C is 8.8%.
What is the most likely cause of this sudden hyperglycemia?
- Stress eating due to isolation
- Untreated infection
- Rationing medications due to financial hardship
- Insulin resistance secondary to cigarette smoking
Click here to test your knowledge!
The New Art and Science of Diabetes Care and Education Desk Reference – 5th Edition| $249
We are so excited that the 5th edition The Art and Science of Diabetes Care and Education is finally here!
This specialist’s one-volume, go-to resource for the core knowledge and skills for providing person-centered care and education to persons with diabetes and related chronic conditions. This is a core resource for those who are studying for the Certified Diabetes Care and Education Specialist® (CDCES) exam.
Updates:
- Two new chapters addressing multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII), pump therapy, continuous glucose monitoring (CGM) and intensifying therapy, pattern management, and data analysis.
- Revised AADE7 Self-Care Behaviors®, with its recognition of the impact the emotional burden of diabetes on metabolic and quality of life outcomes.
- Highlights obesity management, including the 3-step algorithm for care of overweight and obese people with diabetes.
- Expanded coverage of motivational interviewing (MI).
- Major rewrites of the kidney disease and diabetic neuropathies chapters.
2020 Boot Camp Live Stream Webinar Schedule with Coach Beverly
All courses air at 11:30 a.m. (PST)
- Diabetes – Not Just Hyperglycemia | Recorded & Ready for Viewing.
- ADA Standards of Care | Recorded & Ready for Viewing.
- Insulin Therapy – From Basal/Bolus to Pattern Management | Sept 30
- Insulin Intensive – Monitoring, Sick Days, Lower Extremities | Oct 7
- Meds for Type 2 | Oct 14
- Exercise and Preventing Microvascular Complications | Oct 21
- Coping & Behavior Change | Oct 28
- “The Big Finish” Test Taking Boot Camp | Nov 4
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!
Accreditation: Diabetes 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.
Coach Bev’s Diabetes Cheat Sheets
We know that a great resource page full of accurate and helpful cheat sheets can save busy diabetes specialists time and energy.
That’s why we have put together our entire list of cheat sheets so you can access them with ease.
These sheets and cards include information to study for certification exams and to use in your clinical setting. Plus, we have included teaching sheets for people with diabetes.
Our Summer 2020 Boot Camp begins September 16th!
In each webinar, either Coach Beverly, Dr. Isaacs, or Ms. Armstrong, highlight the critical content of each topic area, so you can focus your study time most efficiently. They also launch multiple poll questions to help participants focus on key concepts and assess their knowledge while learning the best test-taking strategies.
2020 Boot Camp Live Stream Webinar Schedule with Coach Beverly
All courses air at 11:30 a.m. (PST)
- Diabetes – Not Just Hyperglycemia | Sept 16
- ADA Standards of Care | Sept 23
- Insulin Therapy – From Basal/Bolus to Pattern Management | Sept 30
- Insulin Intensive – Monitoring, Sick Days, Lower Extremities | Oct 7
- Meds for Type 2 | Oct 14
- Exercise and Preventing Microvascular Complications | Oct 21
- Coping & Behavior Change | Oct 28
- “The Big Finish” Test Taking Boot Camp | Nov 4
Can’t make it live?
No worries! All video presentations and podcasts will be available now on-demand.
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!
Accreditation: Diabetes 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.
DSMT and Telehealth Approval Update – Good News
The provision of Diabetes Self Management and Training (DSMT) has drastically changed since the COVID-19 pandemic.
In most health settings, in-person visits have been dramatically reduced. This is particularly difficult during a time of crisis when people with diabetes most need to connect with health care professionals for sound advice and coaching.
In addition, there has been confusion about which professionals are eligible to offer and bill for DSMT via telehealth.
Good News!
CMS has updated guidance to clarify that all accredited diabetes self-management training providers may furnish and bill for telehealth services during the COVID-19 public health emergency.
ADCES Advocacy Group
In early August the Centers for Medicare and Medicaid Services (CMS) released updated Guidelines that expand and clarify who is eligible to provide DSMT in a variety of health care settings. Now, there is more clarity about eligible telehealth providers and billing
By adding DSMT programs to the list of eligible providers of telehealth services, the final regulatory barriers preventing registered nurses and pharmacists from furnishing DSMT services via telehealth has been removed.
This means, that no matter the health care setting, recognized DSMT programs that are eligible to bill Medicare Part B directly for DSMT services, can be provided and bill for self-management training by accredited providers. In addition, the telehealth approval includes audio (if that is all that is available) as well as video platforms.
This clarification and expansion is in part due to the excellent work by the Association of Diabetes Care & Education Specialists (ADCES) Advocacy Team. Thank you for your excellent work.
The hope is that the ability to provide telehealth services to people living with diabetes will extend past the COVID pandemic since it is offering many participants an alternate way to receive valuable care and education.
For some very helpful information on eligible staff and telehealth billing, click here to review ADCES’ updated FAQ page.
Other Helpful Telehealth Resources
These tools can be implemented with individuals before and after DSMES engagement to assess the effectiveness of telehealth services.
TUQ: Telehealth Usability Questionnaire:
DES: Diabetes Empowerment Scale Short Form:
SDCA: Summary of Diabetes Self Care Activities Measure:
Setting Up a Successful Diabetes Program | FREE Webinar
Join live August 26th from 11:30 am to 1:00 pm (PST)
Watch for Free or 1.5 CEs | $29.00
This program provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and Support Programs. It also provides insights into the exam philosophy and also highlights critical content areas.
Topics include:
- Describe steps involved in setting up a DSMES Program
- List DSMES program essentials
- Discuss marketing strategies for success
Perfect for those planning to take the CDCES or BC-ADM or for those seeking a Standards update.
We are now offering the option to join the Level 2 Webinars live stream for free!
“Excellent as usual! Love Bev’s passion and energy. Thank you for all you do, I appreciate you plenty!! You guys are the absolute best as offering individuals that are not in need of CEs the opportunity to benefit by listening to the content without financial strain is huge, especially during these unprecedented times of furlough/layoff. Thank you and stay well”
Free viewing without CEs – This option is available for those who want to join the live stream of the Level 2 webinars(s), but don’t need CEs. More info here.
Need CEs? You can purchase the course, which includes the live stream webinar, recorded on-demand videos, podcast, handouts, and additional resources. Register here.
Watch for FREE recorded webinar (no CEs).
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!
Accreditation: Diabetes 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.
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!
Accreditation: Diabetes 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
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!
Accreditation: Diabetes 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
- These changes are only applicable to those who are COVID-19 positive and living with diabetes.
- The type of diabetes one has is no longer relevant in coverage determinations.
- 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.
Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer
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!
Accreditation: Diabetes 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.
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