Hidden Barriers to Technology use in Type 1 Diabetes

How come so many vulnerable people living with type 1 diabetes aren’t using insulin pumps or CGMs?

This is the question Ashby Walker, Ph.D., Director for Health Equity Initiatives: University of Florida Diabetes Institute and colleagues, addressed in their recent study. This powerful research reveals the core issues behind why some of the most vulnerable communities with type 1 diabetes underuse the very technology that could contribute to improved diabetes self-care.

We interviewed Dr. Walker to provide additional insights into their findings and suggestions for the future.

In their groundbreaking study, “Barriers to Technology Use and Endocrinology Care for Underserved Communities with Type 1 Diabetes“, published in Diabetes Care, August 2021, we learn through the testimonies and experiences of people living with type 1 diabetes, the surprising reasons they have a lower rate of insulin pump and CGM use than those with higher income levels and generational opportunities.

This study captured data through focus groups from underserved communities by intentional recruitment efforts aimed at including perspectives of low SES and racially diverse people living with diabetes in Florida and California. In the Florida group, 43% used pumps and 38% used CGMs. In the California group, 69% used pumps and 63% used CGMs.

The study targeted higher-risk individuals who may not see endocrinologists on a regular basis and included those with type 1 diabetes and:

  • A1Cs greater than 9%.
  • Those hospitalized for DKA in previous year and those who had no-showed to two or more visits.
  • Were seen for primary care needs at a Federally Qualified Health Center.

What is Biggest Barrier to Technology Use?

Question for Dr. Walker: When reviewing your study results, I was very surprised to discover that the most commonly identified barriers to technology use were related to information exchanged in face-to-face visits. How do you think we can best address this issue?

Raising awareness about this barrier is a critical first step as we must name something in order to address it. Addressing the issue will require multi-layered interventions.

First, industry and insurance-driven rules requiring conditions to be met prior to obtaining a devise (i.e. HbA1c under some threshold) creates barriers for providers as well as people living with diabetes and can erode communication in clinical encounters. Change at the policy-level is needed to address the issue.

Second, provider-level interventions are needed to ensure that all individuals are given the opportunity to learn about available technologies in ways that minimize any implicit bias.      

-Dr. Ashby Walker

In the study, participants shared that they were actively seeking to use technology to improve care, but were often blocked by the provider through discouraging feedback. They grasped the irony of wanting to improve glucose management but being hindered by their elevated A1cs.

Here are some participant quotes from the study:

“I have had my [endocrinologist] recommend that I get my A1C down below 7 before they will even attempt to let me use any kind of device [pump or CGM]. With my lifestyle and work and everything, the way it is, it’s super hard to manage diabetes as it is, which personally I think that would be a tool that would help me out a lot.” –Florida Focus Group Participant.

“I tried to get on the pump, and he [endocrinologist] told me I needed to lose weight and the only way I was going to get on a pump was to lose weight and to be in a lot of control.” –California Focus Group Participant.

What do the ADA Standards of Care Say?

Insulin pump therapy may be considered as an option for all adults and youth with type 1 diabetes who are able to safely manage the device.

Actually, if you read ADA Standard of Care 7 in its entirety, there is no mention of getting A1C or bodyweight to target before starting pump therapy and the same is true for CGM.

And, in the 2021 ADA Standards of Care, they acknowledge that the use of insulin pump therapy in the U.S. shows geographical variations, with pump therapy more commonly adapted by individuals of higher socioeconomic status as reflected by race/ethnicity, private health insurance, family income, and education.

Furthermore, the ADA calls out that these barriers need to be addressed to increase access to insulin pumps and other diabetes technology and decrease health disparities.

This research provides an opportunity to honestly reflect on how our face-face encounters make such an impact on an individual’s decision to seek ongoing care and collaborate with providers.

Take Home Messages to Improve Care

Question for Dr. Walker: What are some recommended communication approaches or examples so health care professionals can build trust and collaborate with high-risk populations living with type 1? 

There must be intentional efforts to listen and learn from underserved communities living with diabetes on the part of health care professionals. We gather at scientific conferences and are accustomed to believing that degrees, credentials, and publications in high-impact journals give someone merit to impart wisdom, yet, we often overlook the invaluable expertise of the most important stakeholder: people living with diabetes.

Also, the use of advocates like community health workers and peer supporters in clinical counters and as a liaison between clinical encounters can reduce the shame and feelings of judgement and creates powerful pathways for social network support and information sharing.   

Dr. Ashby Walker

How we communicate with people with diabetes make such an impact on their willingness to seek care.

I want to thank Dr. Walker and her team for the beauty of this study and the inclusion of lengthy, insightful testimonials from the participant focus groups, which clearly revealed some unexpected barriers for vulnerable individuals seeking diabetes care. These powerful stories reveal the emotional toll for those living with type I diabetes who are blocked from seeking to improve their well-being through the use of technology.

You can read the complete article here “Barriers to Technology Use and Endocrinology Care for Underserved Communities with Type 1 Diabetes“, published in Diabetes Care, August 2021.

If you would like to contact Dr. Ashby Walker, you can reach her via email at afwalker@ufl.edu.


Living with Type 1 can be Tough. Embark can Help!

Managing diabetes can be tough! Something that people rarely talk about is how tough type 1 diabetes can be and how many people find diabetes to be stressful and challenging.

That’s why we are excited to share an opportunity for people living with type 1 diabetes to join a new NIH-supported study that is part of a collaboration between T1D Exchange and the University of California, San Francisco (UCSF).

Note from Coach Beverly

I have had the pleasure of working as an Embark facilitator for the past year.

I can personally share with you that this program offers so much meaningful hands-on problem solving and support for those who join. Participants not only receive practical information but gain valuable insights into approaches for self-care.

I highly recommend this program to anyone with type 1 diabetes who is feeling frustrated and tired and ready to make changes with the help of a supportive team!

Embark Program Details

The program begins with a group workshop (8-12 adults with type 1 diabetes) (held virtually online on a Saturday), followed by online video group meetings and/or individual phone calls with either a psychologist or Certified Diabetes Educator.

The program interventions are strictly behavioral, meaning that participants will not be asked to change or try any new medications or devices.

Participants will receive gift cards for their time and there are no costs to you or to your insurance. There is no age limit to taking part, you just need to be 19 years or older!

If you know people living with type 1 diabetes, please share this information with them. Our hope is that they will be interested in learning more about this exciting new program.

Research Participants Needed:
Are you…
– An adult (19 years +)
– Diagnosed with Type 1 Diabetes for at least 1 year
– Unhappy with your recent Hemoglobin A1C of 7.5% or higher
– Feeling overwhelmed, frustrated, “burned out” with living with diabetes
If you answered YES to the above questions, you may qualify to participate in EMBARK. The purpose of this study is to work compassionately to help you better manage your distress with diabetes and to reach your management goals.

More info on Embark Website

Or you can call: 1-855-850-3599 (toll free) or email us at: embark@ucsf.edu. Thank you, UCSF EMBARK Team


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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.

We are Celebrating DiabetesEd Specialist Scholarship Recipients

We are so excited to announce our DiabetesEd Specialist Scholarship Recipients!

We received dozens of applications for our annual Making a Difference Scholarship and the Flower Scholarship gifted from an anonymous donor! It was a great personal joy for our team to read these scholarship applications. Each applicant is serving communities with a great need and going “above and beyond” to promote and provide accessible diabetes care and education. It is always a very difficult decision for all of the judges, and we read each application in careful detail considering the financial need, impact, volunteerism, and readiness to take the CDCES exam.

We greatly appreciate the good work of all the applicants and thank them for their service!


This year we are offered 3 Scholarship Options for our Virtual DiabetesEd Specialist Conference, October 6-8, 2021.

Congratulations Chantel Wade, his year’s Flower Scholarship Recipient!

Chantel Wade is the recipient of our “Flower Scholarship.” Chantel is an ambulatory RN and the lead in the Patient Education Department at her local health center. There she serves a diverse population of individuals from different socioeconomic backgrounds, seeing many people who are on Medicare, Medi-Cal or are uninsured. She uses a hands-on, interactive approach with those she works with; she is committed to meeting people where they are by creating custom care plans that meet their individual needs. Outside of work, she is active in her local Fellowship Church and other organizations where she volunteers her time and expertise to offer pre-diabetes and diabetes education.  


Congratulations Keira McCrary, “Making a Difference Exemplar Scholarship” Recipient!

Keira McCrary is the recipient of our “Making a Difference Exemplar Scholarship” because of her dedication to her community. Keira works as a Registered Dietician who provides direct care services to Native American tribal communities in her area. In her work, she supports people living with diabetes through all stages of life with programs such as home meal delivery for elder tribal members and the Native Youth Preventing Diabetes Organization. Through Native Youth Preventing Diabetes Organization Keira assists in the education of tribal youth in the areas of diabetes prevention, nutritional education, physical activity, behavioral health, and more. She also creates user-friendly tools for those she works with such as informational “how-to” diabetes-friendly recipe videos and a weekly newsletter.


Congratulations Logan Mumphrey, “Making a Difference Scholarship” Recipient!

Logan Mumphrey is our second recipient of our “Making a Difference Scholarship” for many reasons! Logan is currently working towards his MSN/FNP and has worked as the primary nurse and clinical coordinator for transgender health services helping to build the program from the ground up. This program provides gender-affirming care that goes beyond hormone therapy including care navigation, surgery coordination, assistance with identity document changes, peer support, and much more. Logan is passionate about diabetes care and education and hopes that by becoming a CDCES, it will allow him to provide more support for those he works with so they can manage their diabetes with a gender-affirming lens.


This year we are offered 3 Scholarship Options which include:

  1. Flower Scholarship valued at $1000 for a diabetes nurse educator who comes from an under-served community and is providing care and education to communities that lack access to Diabetes Specialists and health care resources. The nurse applicant taking their CDCES exam within a year. The donor of this scholarship is generously providing funds to cover course registration plus enrollment in our Ultimate Online Bundle, Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages, ADA 2021 Standards of Care Book DiabetesEd Services highlighters, PocketCard and Pen.
  2. Making a Difference Exemplar Scholarship valued at $1000 for a diabetes educator who exemplifies advocacy and compassionate care in their community and is pursuing their CDCES. This top-tier scholarship provides funds to cover course registration plus enrollment in our Ultimate Online Bundle, Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages, ADA 2021 Standards of Care Book DiabetesEd Services highlighters, PocketCard and Pen.
  3. Making a Difference Scholarship valued at $900 for a diabetes educator who exemplifies advocacy and compassionate care in their community and is pursuing their CDCES. This scholarship provides funds to cover course registration plus enrollment in our Ultimate Online Bundle.

The goal of these scholarships are three-fold:

  1. To support U.S. health care professionals who are going above and beyond to improve diabetes care in their community; and
  2. To support applicants’ effort to become a Certified Diabetes Care and Education Specialist (CDCES) and
  3. To provide financial assistance with the DiabetesEd Course registration fee and or sleeping rooms

Join our Virtual DiabetesEd Specialist Program!
Airs live October 6-8, 2021

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Team of expert faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!

CEs: Includes over 30 CEs
Program Info: 2021 Diabetes Educator Course Flyer & Schedule (subject to change)
Speakers: View Conference Faculty.
Dates: October 6-8. Don’t worry if you can’t make it live. YourRegistration fee includes access to FREE podcast and all recorded webinars for one year.

Two Registration Options


Virtual DiabetesEd Specialist Conference Deluxe | Oct. 6-8 | 30+ CEs

Deluxe Virtual Program for $499 includes:

  • Presentations by our team of experts
  • Q & A Session with the instructor after each webinar
  • State-of-the-art review of current diabetes care and technology.
  • Resources for each session
  • Access to FREE podcast and recorded webinars within a week of each live session for one full year.

+Plus Syllabus, Standards and Swag:

  • Diabetes Educator Course 2021 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
  • ADA 2021 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
  • DiabetesEd Services highlightersMedication PocketCard and Pen

Syllabus and Bonus Items Shipping Notice for Deluxe Virtual Conference: Our company is based in California, so if you live toward the east coast it can take more than 5 business days for the book to arrive. Please purchase the conference with syllabus no later than Tuesday, Sept 28th to ensure delivery in time for the conference.

2021 Diabetes Educator Course Flyer & Schedule (subject to change)


Virtual DiabetesEd Specialist Conference Basic | Oct. 6-8 | 30+ CEs

Basic virtual program for $399 includes:

  • Presentations by our team of experts
  • Q & A Session with the instructor after each webinar
  • State-of-the-art review of current diabetes care and technology.
  • Resources for each session
  • Access to FREE podcast and recorded webinars within a week of each live session for one full year.

2021 Diabetes Educator Course Flyer & Schedule (subject to change)


Team of Experts: Our team of expert faculty has been fine-tuning this course for over fifteen years and we know what you need to succeed! In addition to informative lectures, we also use group activities and case studies to highlight the essential knowledge, skills, and strategies needed to succeed in diabetes education today!


Bonus Courses worth 12+ CEs, FREE

When you register for our Virtual Course, you have immediate access to these Bonus DiabetesEd University Online Courses – for FREE!

  • Test Taking Toolkit – Over 200 sample test questions!
  • Level 2 – Assessing and Promoting Well-Being: From Population Health to a Person-Centered Approach 1.5 CEs
  • Level 2 – Hospital and Hyperglycemia 1.5 CEs
  • Level 2 – Hyperglycemic Crisis, DKA and HHS Standards 1.0 CEs
  • Level 2 – Meds Management Update for Type 2 – 1.5 CEs
  • Level 2 – Setting up a Successful Diabetes Program 1.5 CEs
  • Level 2 – Pregnancy and Diabetes 1.5 CEs
  • Level 2 – From Tots to Teens – Diabetes Standards 1.5 CEs
  • Level 2 – Older Adults and Diabetes 1.5 CEs
  • Mindfulness and Compassion in the Diabetes Encounter – 1.0 CE

2021 Diabetes Educator Course Flyer & Schedule (subject to change)


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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.

3 Important Reasons to Recognize and Address Trauma

As a child, LR lived with neglect and mistreatment by their parents. Escaping home as a teenager, LR couch surfed at friends but finally ending up living in their car. At the age of 23, LR showed up at our local community clinic with dysregulation, depression, and anxiety coupled with a new diagnosis of type 2 diabetes and elevated triglycerides. LR had limited access to healthy food and carried a BMI of over 35.

After a few months of getting comfortable with the clinic staff, our counselor asked LR to complete the Adverse Childhood Experiences (ACE) screening assessment. After LR finished checking off their adverse childhood experiences, they looked up with tears and said, “I scored a 9 out of 10”.

Adverse Childhood Experiences (ACEs) are common. At least two-thirds of people living in the U.S. have experienced one ACE and over 15% have experienced 4 or more.

Furthermore, a dose-response relationship exists: as the number of adverse experiences increases so does the risk of problems from childhood through adulthood.

These childhood traumas can lead to toxic stress which, over time, can change the biology of our bodiy.

People with elevated ACE scores are more likely to experience a variety of mental health issues, which is not surprising given their painful, confusing, and unsafe childhoods. Based on sound research by the CDC and Kaiser, they are also more likely to suffer from physical diseases, like heart attack and stroke, diabetes, and cancer. They are more likely to break bones and experience unintended pregnancies.


Join Coach Beverly at an Upcoming Webinar

The Impact of Adverse Childhood Experiences on Health: A Personal Story of Resilience and Hope with Coach Beverly

ADCES National Virtual Meeting – Ready for Viewing
California Coordinating ADCES Chapter – September 30, 2021 at 4:45pm PST
Diabetes Ed Services Webinars – airs October 27th at 11:30 am PST


Toxic Stress Affects us at the Cellular Level

Research shows that ACEs can lead to a cycle of toxic stress and cellular inflammation. This heightened adrenal-mediated “flight or fight” response over time, can lead to neuroendocrine dysregulation, altered immune response, affect DNA packaging and activate epigenetic tags that can alter genetic makeup.

The CDC Morbidity and Mortality Weekly 2019 report tell us that preventing ACEs could reduce:

  • 21 million cases of depression
  • 1.9 million cases of heart disease
  • 2.5 million cases of excess weight

The first Surgeon General of California, Nadine Burke Harris, MD, MPH, has made it her mission to increase awareness, identify and address ACEs with parents, children, and adults so that we can break the cycle.

Health care professionals at risk for ACEs
People who enter healing professions may be experiencing toxic stress from childhood or current trauma. They may be dealing with burnout, fear, or feelings of deep pain with their past coupled with all the intensity of providing care during the COVID pandemic. This chronic and toxic stress can lead to dysregulation while impairing our ability to cope and care for others. You are not alone.

My own personal journey of experiencing childhood trauma and holding myself together until I ended up in the hospital, has compelled me to share my story with you. And offer a message of hope.

Coach Beverly

As I work on healing and integrating the different aspects of myself, I now feel more attuned to others who have weathered and survived childhood trauma. This awareness has significantly changed the way I hear what people with diabetes are saying and interpret what they are doing. For example, knowing that LR had a very high ACE score, I was able to adjust my expectations and focus on behavior changes that support self-care and self-regulation. When LR doesn’t take their diabetes medications for a few weeks, I provide gentle strength-based coaching to help LR get back on track. I make sure LR knows that they are safe sharing the truth of their story, no matter what.

In your hospital setting, do you have a person who keeps getting readmitted to the hospital in a diabetes crisis? In your outpatient setting, do you experience frequent no-shows or situations where people aren’t able to make changes in self-care? Maybe, they are struggling with the emotional impact of toxic stress.

Adults who have experienced trauma as children may exhibit the following behaviors:

  • Missing appointments
  • Not taking meds as prescribed
  • Not adopting new lifestyle changes

As Diabetes Care and Education Specialists, if we recognize these behaviors as a response to dysregulation due to toxic stress, we can provide a therapeutic response to start the healing process.

Helpful provider responses when you suspect that participants are not engaging in care due to childhood trauma and toxic stress:

  1. Refrain from harsh language or judgement
  2. Be curious, ask open ended questions
  3. Provide the ACE screening tool to start the conversation
  4. Encourage collaboration using a person centered approach
  5. Identify mental health resources in you community

Diabetes Care and Education Specialists recognize that the mind and body are a deeply connected, dynamic, and powerful force when they are working together in harmony. When trauma and toxic stress are not recognized or treated, there can be devastating health consequences. We can make a difference in preventing, recognizing, and helping people heal from adverse childhood experiences.

Want to learn more about the ACEs and Healing?

Join Coach Beverly at an Upcoming Webinar

The Impact of Adverse Childhood Experiences on Health:
A Personal Story of Resilience and Hope with Coach Beverly

ADCES National Virtual Meeting – Ready for Viewing
California Coordinating ADCES Chapter – September 30, 2021 at 4:45pm PST
Diabetes Ed Services Webinars – airs October 27th at 11:30 am PST

Resources

ACE Resource Network

ACE Screening Tool and Resilience Inventory

Becoming ACE-Aware Training Program

Nadine Burke Harris, MD TED Talk on How Childhood Trauma affects health

NPR Article – Take the ACE Score and Learn what it does and doesn’t mean

Trauma-Informed Care Fact Sheet

Why should I care about my number?

CDC Vital Signs – Impact of ACES

CDC Mortality and Morbidity Weekly Report on ACEs – 2019

What happened to you? Conversations on Trauma, Resilience, and Healing – authors Oprah Winfrey and Bruce D. Perry, M.D., Ph.D.


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.

Diabetes in the US: Could we be doing better?

I felt pretty discouraged reading through the New England Journal of Medicine (NEJM) summary of the state of diabetes treatment and control in the U.S. from 1999-2018. We have stalled in improving diabetes outcomes in spite of exciting new therapies and dazzling technologies.

Based on this “Diabetes Report Card” for the U.S it seems pretty clear that changes in our care delivery system are urgently needed. First, let me share the data, then we consider how Diabetes Care Specialists (you and me) can drive the improvement arrow in the right direction.

The data summarized below is extracted from the National Health and Nutrition Examination Survey (NHANES) which assesses national trends in diabetes care and outcomes for the past decade.

Summary of the major findings of the Diabetes ABC’s.  A1C, Blood Pressure and Cholesterol.  
Data is compared from the 2007 -2010 period to the 2015-2018 time period.

Reaching A1c Target of less than 7%?

  • The percentage of people with diabetes and an A1c of less than 7%, declined from:
    • 57.4% in 2007-2010 to
    • 50.5% in 2015 to 2018

Coach Bev’s Report Card Comment: Blood glucose levels trended up.  GRADE C-

Reaching LDL target of less than 130 mg/dL?

  • The percentage of people with diabetes and an LDL of less than 130 leveled off, with slight movement in the right direction.
    • 52.3% in 2007-2010 to
    • 55.7% in 2015 to 2018

Coach Bev’s Report Card Comment: Lipid levels improved slightly.  GRADE B-

Reaching blood pressure goal of less than 140/90 mm Hg?

  • The percentage of people with diabetes and blood pressure below the target of 140/90 worsened.
    • 74.2% in 2007-2010 to
    • 70.4% in 2015 to 2018

Coach Bev’s Report Card Comment: Blood pressure control achievement dropped slightly.  GRADE C-

The percent of participants who achieved all 3 targets of A1C, BP, and lipids?

  • The percentage of people who reached all 3 targets declined slightly.
    • 24.9 % in 2007-2010 to
    • 22.2% in 2015 to 2018

Coach Bev’s Report Card Comment: ABC’s of diabetes control dropped slightly.  GRADE C-

Data and Graph from Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018 | NEJM

What are the barriers and how can Diabetes Care and Education Specialists help improve the grade?

The year 1999 got off to a good start with improved diabetes control but stalled and declined as the decade moved forward. There are several possible reasons as cited by the authors.

Sluggish initiation of first-line therapies. In 2015–2018, only 56.3% of adults with diabetes were using statins, 59.5% were using metformin, and 60.3% were using an ACE inhibitor or ARB.

These results are consistent with those of previous studies and point to clinical inertia as a potential culprit.

In addition, achieving glycemic and blood-pressure control often entails the use of multiple agents. However, the study found that only 60.6% of participants with an A1C level of 7% or higher and 52.8% of those with a blood pressure of 140/90 mm Hg or higher were treated with more than one glucose-lowering or blood-pressure-lowering medication, respectively.  

Coach Beverly suggested action: Diabetes Care and Education Specialists can continue to raise awareness of the ADA Standards of Care for Diabetes and advocate for initiating first-line and add-on therapies in their work settings. Plus, we can encourage a streamlined referral process to facilitate participant access to DSMES and to RD/RDN for initial and ongoing lifestyle and nutrition counseling.

Care Gaps for Young People, Ethnic Groups and Uninsured Populations

The study found that younger people, Mexican Americans, and persons without health insurance were more likely to be untreated when risk-factor targets were not achieved. These gaps are especially magnified in under-resourced areas.

In addition, given that the rates of diabetes-related complications are higher in people of color and uninsured populations and that type 2 diabetes discovered in young adulthood have a more aggressive clinical course than diabetes, immediate action is required to improve outcomes.

Coach Beverly suggested action: Diabetes Care and Education Specialists continue to take a leadership role in intentional and unrelenting outreach to provide DSMES and MNT to under-resourced communities using novel and evidenced-based approaches. Since prediabetes rates are also higher in many of these communities, establishing easily accessed Diabetes Prevention Programs and networking with community health workers and leaders can contribute to improved health outcomes.

Medications are too expensive for many people

Even though we have a slew of new and highly effective classes of diabetes medications, they are out of the financial reach for many. As patents expire and the medications are available as generics, access and affordability will increase. In the meantime, a realistic approach to providing affordable diabetes treatment is needed.

Coach Beverly suggested action:

Diabetes Care and Education Specialists can help craft a medication plan that is realistic and affordable. For people with no insurance or large co-pays, consider using available generic diabetes medications. These medications often cost $10 or less for a 3-month prescription. They include: metformin, sulfonylureas, and pioglitazone. In addition, Walmart offers Reli-On insulins including Regular, NPH, and 70/30 insulin for $25 a vial. There are also online resources like GoodRx.com that help people find discounts on their usual medications and the different pharmaceutical companies also offer discount programs based on need.

See Insulin Cost Savings Guide for an abundance of resources and useful links.

In conclusion, Diabetes Care and Specialists are perfectly positioned to influence health delivery systems and advocate for best clinical practices. We can be catalysts for establishing DPP and DSMES programs in under-resourced communities and advocate for access to affordable medications and technologies to help participants reach their targets for A1C, Blood Pressure, and Cholesterol while improving quality of life.

With a concentrated effort, maybe our next report card will be a little bit better!

With hope, Coach Beverly


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.

July eNews | A Radical New Approach to Diabetes Care Needed

Happy July!

Did you know that only about 50% of people in the U.S. are reaching the A1C target of less than 7%?

And only 22% of Americans reached all 3 targets for A1C, blood pressure, and lipids.

Unfortunately, the percentage of people reaching these goals has declined or stalled over the past ten years. These disappointing results are based on an analysis of the most recent data from the National Health and Nutrition Examination Survey (NHANES) published in NEJM this June.

But I have hope for several reasons!

First, Diabetes Care and Education Specialists can continue to raise awareness of the ADA Standards of Care for Diabetes and advocate for initiating first-line and add-on therapies in their work settings. Plus, we can encourage streamlining of the referral process to facilitate participant access to DSMES and to RD/RDN for initial and ongoing lifestyle and nutrition counseling. Plus, we discuss lots more ideas to improve care in the article below.

Second, I am excited to highlight our interview with a health care visionary and leader, Dr. Avni Shah, who is moving forward with a radical approach to providing diabetes care to our most vulnerable populations designed to improve outcomes.

Third, to improve care, we need more CDCES’s and taking the exam just got a little bit easier. By the end of the year, we will be able to take the CDCES exam from our home or other remote locations.

In this newsletter, we also dive into a Pediatric Question of the Week and explore Preparation for Surgery with our Rationale of the Week. We are thrilled by the interest & response to our Live San Diego Course in October and look forward to gathering together again in person.

Keep cool everyone,

Coach Beverly, Bryanna, Jackson, and Robert

Click here to read our full July 2021 newsletter.

Featured Blogs

Upcoming Events & Resources


We’ve Missed You!
Join us in person in San Diego, CA

October 6-8, 2021 | Earn 30+ CEs | $599

More than a course, it’s an experience!”

Whether you are new to diabetes or a seasoned expert, you’ll leave our live seminar with the latest research plus teaching tools you can immediately apply to your clinical practice.

Who should attend? Health care professionals interested in taking the CDCES or BC-ADM exam or those seeking a state of the art review of current diabetes care. We also invite those in looking for hours to renew or apply for the CDCES or BC-ADM exam.

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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.

June eNews | DiabetesEd Scholarships & 7 Reasons for Gratitude

June eNews  | DiabetesEd Scholarships & 7 Reasons for Gratitude

Happy June!

Coach Beverly is feeling grateful

For this newsletter, I am practicing my gratitude out loud and sharing it with you all.

Here are 7 things I am grateful for:

  1. My birthday is in early June.
  2. June kicks off Pride Month.
  3. We welcome a new team member and blog contributor, Monique Jackson.
  4. A new glucagon treatment is available, with updated Glucagon Cards you can download for FREE or check out on our CDCES Coach app.
  5. We are holding our first LIVE DiabetesEd Specialist Course in San Diego in over a year, which will include; Diabetes Flash Mob, DiaBingo, Prizes, fantastic meals, networking, laughing, and learning together.
  6. There are 2 scholarships available for our Diabetes Ed Live Seminar.
  7. Lastly, I am deeply grateful for my remarkable family, friends, my Diabetes Ed Team, all of YOU, and this opportunity to live and contribute every day.

In this newsletter, we address topics ranging from hemoglobinopathies to inclusion to new glucagon meds.

Bryanna and I had a lot of fun putting this newsletter together because it rings so true to the mission of our company; to be inclusive and welcoming, to celebrate each individual while leaving judgment behind. To lift each other up, especially during hard times. To offer hope, promote curiosity, and let you always know that we believe in you.

Happy June everyone,

Coach Beverly, Bryanna, and Jackson

Click here to read our full June 2021 newsletter.

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Join us in person in San Diego, CA

October 6-8, 2021 | Earn 30+ CEs | $599

More than a course, it’s an experience!”

Whether you are new to diabetes or a seasoned expert, you’ll leave our live seminar with the latest research plus teaching tools you can immediately apply to your clinical practice.

Who should attend? Health care professionals interested in taking the CDCES or BC-ADM exam or those seeking a state of the art review of current diabetes care. We also invite those in looking for hours to renew or apply for the CDCES or BC-ADM exam.

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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.

May Newsletter | Diabetes Ed Celebrates Nurses Week

May eNews  | Diabetes Ed Celebrates Nurses Week

Happy National Nurses Day and Week!

When I was considering college as a teenager, my dad offered me some simple advice, “Why don’t you become a nurse?” I rolled my eyes and said, “Nah, I am going to be a social worker.” Four years later, I stood proudly with my white cap and nursing pin securely fastened as an RN graduate.

As I reflect on my years in this noble profession, I have witnessed the most unselfish acts of love and pure heroism by my nursing colleagues. 2020 -2021 have been rough times for the four million nurses in the United States.

Nurses have not wavered from their commitment to providing care to even the sickest among us.

Like the founder of nursing, Florence Nightingale, nurses are “Holding the Lamp” and shining it in dark places that are scary and unknown to provide comfort to those who need it most.

In this newsletter, we celebrate Nurses.

Has a nurse touched your life? Check out our blog on 5 ways you can show thanks. Did you know that in addition to founding nursing, Florence Nightingale was a statistics whiz? You can discover more about this trailblazer in the blog below.

This newsletter also offers a fresh perspective on using the plate method to encourage healthy eating while promoting the pleasure of eating.

Also, we all know that living with type 1 diabetes isn’t easy. We are hopeful that you can help us get the word out about a study geared toward not only supporting people with type 1 but providing them with excellent information and problem-solving coaching. Read more about the Embark Study below and thank you for sharing this unique opportunity with those living with type 1 diabetes.

Finally, we are excited to share an updated approach to managing diabetes in the hospital setting and encourage you to take a look at our question and rationale of the week.

Thank you nurses for the love and care you provide every day!

Coach Beverly, Bryanna, and Jackson

Click here to read our full May 2021 newsletter.

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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.

Remembering the “Lady with the Lamp” – Happy Nurses Week

May 6th kicks off the seven-day celebration of Nurses Week and culminates on May 12th, the birthday of the founder of the field of nursing, Florence Nightingale.

Florence established the first professional training school for nurses, the Nightingale Training School at St Thomas’ Hospital in 1860. The school is now part of King’s College London. She published over 200 books, reports, and pamphlets on hospital planning and organization which are still widely read and respected today. Her most famous work is pictured above, Notes on Nursing: What It Is and What It Is Not which still offers nurses relevant content almost two centuries later.

In nursing school, Florence Nightingale‘s history was required reading. But, in my early twenties, I didn’t really grasp the significance of “the Lady with the Lamp” and her contributions until I visited the Florence Nightingale Museum in London, England.

My most meaningful experience as a tourist in London was my stop at the Florence Nightingale Museum.

Even 200 years after her birth, we are still building upon the messages and framework that Florence established. Florence had an aptitude for statistics and applied research. She quickly realized that the root of many diseases was the lack of access to clean water, decent working conditions, a safe living environment, healthy food, clean air, and sunshine. In order to improve the health of our communities, Florence campaigned to provide these most basic needs to all people.

Let us keep the light that Florence lit so long ago glowing as we honor and celebrate the over 4 million nurses in the United States.

“The Lady with the Lamp”
Florence Nightingale

Florence was ahead of her time

Florence was born in 1820 in Italy Florence Nightingale. Born in an era when middle-class women were expected to simply make a good marriage and raise a family, Florence sensed a ‘calling’ from God at an early age and believed she was destined to do something greater with her life.

At the age of 33 Florence convinced her parents to attend a 3-month ‘nursing’ training and soon she became superintendent of a hospital in London.

In 1854, Florence went to Turkey with 38 other “nurses” to provide care to suffering and wounded soldiers during the Crimean War. She quickly set about organizing the hospitals to improve supplies of food, blankets, and beds, as well as the general conditions and cleanliness.

The comforting sight of her checking on the soldiers at night earned her the name ‘Lady of the Lamp’, along with the undying respect of the British soldiers.

Florence was a champion of sanitation and handwashing. She was determined to avoid the medical mistakes she witnessed during her two-year-long service at the military hospital.

As a skilled statistician, she vividly communicated the need for medical reform using detailed charts which showed that more men had died from disease than from their wounds. She then instigated a Royal Commission into the health of the army which led to a large number of improvements and saved the lives of many.

Early Public Health Advocate

Her attention later turned to the health of the British army in India. Through careful research, she demonstrated that bad drainage, contaminated water, overcrowding, and poor ventilation were causing the high death rate.

She concluded that the health of the army and the people of India had to go hand in hand and so campaigned to improve the sanitary conditions of the country as a whole.

First Nursing School

The Nightingale Training School was established in 1860 in London using donations from the Nightingale Fund. Its reputation soon spread and Nightingale nurses were requested to start new schools all over the world, including Australia, America, and Africa.

Nursing students worked long days and their dorms were often located on the hospital site. Graduates became invaluable leaders in the areas of infection control, comfort, sanitation, and improving quality of life.

The Field of Nursing has Come a Long Way

During her lifetime, Florence Nightingale witnessed the development of the nursing profession and created a standardized curriculum for the development of new nurses. Almost 200 years later, our profession has flourished and taken a leadership role in hospitals, teaching institutions, clinics, public health, military, research, and more. Nurses are four million strong, with a big vision for the future coupled with the art of caring for each individual.

Hat’s off to our Founder and Trailblazer, Florence Nightingale. Our lights keep shining bright forever.


Segments of this article were excerpted from Florence Nightingale Museum. Please feel free to enjoy their video stories and extensive information. And, if you go to London, make sure to stop by and let them know Beverly sent you!


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.