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

• CMS Press Release Summarizing April 30 Guidance.
• Hospitals CMS Flexibilities to Fight COVID Fact Sheet.
• Blanket Waivers for HealthCare Providers Fact Sheet
• Telehealth Information: List of billing codes are available here.

---

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!

Email Address Sign Me Up!

---

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.

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!

Email Address Sign Me Up!

---

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.

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!

Email Address Sign Me Up!

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!

Email Address Sign Me Up!

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 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:

---

Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM, has summarized key information including critical teaching points and management strategies for people with diabetes who develop a COVID-19 infection.

In addition to the webinar, we will provide attendees with useful resources to provide care and education to colleagues and community members alike.

Topics:

1. Discuss the relationship between social determinants of health, diabetes, and COVID-19.
2. List how people with type 1 and type 2 diabetes can prevent and prepare for a COVID-19 infection.
3. Describe how the COVID-19 virus can cause serious illness in people with diabetes and underlying health conditions
4. State management strategies for people with diabetes and COVID in the inpatient and outpatient settings.
5. Discuss the latest regulations regarding DSMT and Telehealth

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.

Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator and a nationally recognized diabetes expert.

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

---

Other FREE Resources we offer

See a complete listing of our upcoming FREE Webinars

---

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!

Email Address Sign Me Up!

At a local hospital, a person in their mid-40s, with type 2 diabetes was admitted for treatment of COVID-19 and Diabetes Ketoacidosis (DKA). An insulin drip was started and their SGLT-2 Inhibitor was stopped.

How do we help prepare people with diabetes for the possibility of hospitalization and what are best practices to care for people with diabetes and COVID-19 in the hospital setting?

The American Diabetes Association (ADA) is providing a flurry of webinars and Town Hall Meetings to help diabetes care professionals keep pace with the latest developments on the impact of COVID and people living with diabetes.

COVID-19 & Inpatient Care for People with Diabetes

On April 9, a panel of experts (see below) shared their clinical opinions on the best inpatient practices for treating people with diabetes and COVID-19. I have highlighted some key questions and summarized responses from the broadcast of this expert panel.

Question: If a person with diabetes gets COVID-19 and is admitted to the hospital, what should they bring with them?

Answer: People with diabetes need to bring extra supplies so they can monitor glucose levels in between nursing check-ins and alert the staff of any urgent issues. The more people with diabetes can participate in their care, the better.

Supplies people with diabetes need to bring to the hospital include:

• Glucose meter with extra strips and lancets
• Continuous glucose monitor (CGM) and supplies
• Insulin Pump and supplies

Question: What are recommendations for people with type 1 who are using SGLT-2 Inhibitors or other medications (off-label) as an adjunct to insulin therapy?

Answer: Since SGLT-2 Inhibitors are associated with increased risk of Diabetes Ketoacidosis (DKA) and people with type 1 diabetes and COVID are at a higher risk of DKA, the panel recommended that during this epidemic, people with type 1 do not use SGLT-2 Inhibitors.

Basal bolus insulin therapy is the best and safest strategy to manage diabetes.

Question: What is the link between type 2 diabetes, body weight and outcomes with COVID infection?

Answer: Most hospital admissions with COVID are for people with type 2 diabetes. Although more research is needed, there seems to be an inter-relationship between excess weight, dyslipidemia, coronary disease proinflammatory state, plus the cytokine storm from the COVID-19 infection, that is contributing to worse outcomes for people with type 2 diabetes.

In addition, those with diabetes and excess weight are at risk of decreased lung function due to restrictive lung disease. And people with hyperglycemia are at higher risk of infection due to diminished white blood cell activity and depressed immunity. All of these combined factors are impacting recovery from COVID infection.

Have your hospitals experienced more DKA in people with type 2 diabetes and COVID?

Answer: There has been an alarming number of people with type 2 diabetes and COVID-19 presenting with DKA. This is possibly due in part to a combination of the overwhelming infection and the cytokine storm.

It is important that DKA in type 2’s is quickly recognized and aggressively treated to get blood glucose target as soon as possible.

Question: How do the nursing staff safely monitor blood glucose levels and deliver insulin therapy to people with diabetes and COVID-19?

Nursing staff is combining multiple activities along with blood glucose checks (vitals, med administration, and check-ins) to limit unnecessary exposure.

In addition, in the non-critical care units, nursing is partnering with individuals and having them check their blood sugars using their own meters or CGMs, in between nursing checks, to determine if action is needed. Of course, treatment is based on the hospital point of care device results, but people can self-monitor and alert the nursing staff of blood sugars that need attention.

As a matter of fact, the FDA is supportive of the inpatient’s use of CGMs in the non-ICU setting during the COVID, especially considering the benefits of alarms that alert staff and individuals of highs or lows.

One creative idea for inpatients using CGM, who may be too ill to keep track of glucose levels, is to place someone near the nursing station and put the CGM receiver outside the door, so the nursing staff can visualize blood sugars levels and monitor trends. This strategy was well received by the nursing staff and was a win-win for safety while limiting exposure.

I personally want to thank the American Diabetes Association for their expansive and timely COVID resources that are available during this crisis. More free ADA Webinars on Diabetes and COVID are available here.

Here is an article published in Endocrine Today that explores outcomes for people with diabetes and COVID-19.

The Panel of Experts Town Hall Experts Include:

Shivani Agarwal, MD, MPH
Albert Einstein College of Medicine

Jennifer Clements, PharmD, FCCP, BCPS, CDE, BCACP
American Pharmacists Association

Robert Eckel, MD
ADA President, Medicine & Science

Irl Hirsch, MD
University of Washington

Melanie Mabrey, DNP
Co-Chair – American Association of Nurse Practitioners – Endocrine Specialty Practice Group

Jane Jeffrie-Seley, DNP, BC-ADM, CDCES
Association of Diabetes Care and Education Specialists

---

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!

Email Address Sign Me Up!

To help prevent the spread of COVID-19, the CDC recommends everyone wears a cloth face-mask when in public.

In addition to washing our hands frequently and maintaining a 6ft. distance from others, cloth masks can help in situations where social distancing is more difficult, such as the grocery store.

Cloth face-masks can easily be made at home with a scarf, bandana, hand towel, or t-shirt, just be sure to wash them frequently. Here are a few tips for making your mask:

Best materials for your mask

Click here to read more.

---

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

Email Address Sign Me Up!

Click here to read our entire April Newsletter

At a local hospital, a person in their mid-40s, with type 2 diabetes was admitted for treatment of COVID-19 and Diabetes Ketoacidosis (DKA). An insulin drip was started and their SGLT-2 Inhibitor was stopped. Why are people with type 2 and COVID-19 going into DKA and how is this impacting outcomes?

A person with type 1 diabetes calls into a rural health clinic and says they are running a temperature, having difficulty breathing and can’t get their blood sugars below 300. The diabetes specialist instructs them to go to the hospital. What supplies should they take in case they are admitted to the hospital?

How do we help prepare people with diabetes for the possibility of hospitalization and what are best practices to care for people with diabetes and COVID-19 in the hospital setting?

What instruction do we provide for people with diabetes if they get sick and are wondering if they need to go to the hospital?

In this newsletter, our goal is to answer these questions based on the opinions of experts in the field and the best information to date.

In addition, we are excited to share information on drone delivery of insulin, mask making and the opportunity to celebrate the AADE (ADCES) Educator of the Year, Dr. Diana Isaacs.

Lastly, please let CMS (Medicare) know that RNs and Pharmacists need to be considered as providers of DSME telehealth services. Now, more than ever, we need all hands on deck.

Thank you everyone. Take extra good care of yourselves.

Beverly

Click here to read our entire April Newsletter

---

Diabetes 2020 – Virtual Conference!
Now with COVID-19 Update
7.5 CEs | $89 | April 23-30th

The COVID Pandemic is taking a toll on people with diabetes. What is the critical information Diabetes Care and Education Specialists need as we navigate this pandemic? How can take a leadership role in providing sound recommendations while helping to manage the full range of diabetes issues, including hypertension, hyperlipidemia, and cardiovascular risk reduction?

Coach Beverly has created this four-session virtual course so that participants can delve deep into the topics that are most pressing for diabetes care now and in the future. We will focus on improving population health and then drill down to individual intervention through case studies. We will discuss implementing cardiovascular risk screening and treatment in the clinical setting and more!

Download the Diabetes 2020 flyer here.

Course Schedule: Each session airs from 8:30 am—10:00 a.m. PST

Session 1 – Getting to the Heart of Care – 1.5 CEs – Recorded & Ready for Viewing!

• Our role as Diabetes Care and Education Specialists
• Diabetes and the COVID Pandemic
• ADA and 2020 Medication Management Algorithm –

Session 2 – Cardiovascular Risk Reduction Strategies – 1.5 CEs – Airs April 24th

• ADA and AACE Guidelines for CV Risk Reduction
• Implement Risk Reduction Strategies
• Addressing Hypertension, Lipids and Weight – A Case Study Approach

Session 3 – Lower Extremity Assessment and Intervention – 1.5 CEs – Airs April 28th

• Peripheral Arterial Disease vs Vascular Disease
• Lower extremity assessment techniques
• Prevention strategies and education

Session 4 – Making meaningful Connections and a Vision for the Future – 1.5 CEs – Airs April 30th

• Adverse Child Experiences – ACE and Impact of Diabetes and other Health Outcomes
• Improving health- From individuals to populations

Download the Diabetes 2020 flyer here.

---

Sign up for our newsletter!

Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. Tuesday is our Question of the Week. It’s Informative and FREE!  Sign up below!

Email Address Sign Me Up!