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Why Actos May Be Reemerging in the Diabetes Landscape

By: Beverly Thomassian

In the ever-evolving world of diabetes care, medications come in and out of favor based on new research, shifting safety data, and individual needs. Pioglitazone (Actos), once a go-to medication for improving insulin sensitivity, fell out of favor in the early 2010s due to concerns about bladder potential side effects and newer medications.

Now, pioglitazone is gaining renewed interest, especially for individuals with increased cardiovascular risk and steatosis, who may benefit from its unique profile. Even though pioglitazone only lowers A1C by 0.5 – 1.0%, this medication’s properties compel us to consider reintroducing it into the medical management of diabetes, especially in the presence of liver and heart disease. Plus, as a generic medication, its price tag of less than $5.00 a month makes it affordable for most people.

Potent Insulin Sensitizer

Pioglitazone is one of the thiazolidinedione (TZD) class of medications that work by enhancing insulin sensitivity, primarily through activation of PPAR-γ receptors in adipose and muscle tissue.

In a recent podcast, Banting Award Recipient, Dr. Ralph DeFronzo, provides an Insulin Resistance Master Class. He notes that pioglitazone, an insulin-sensitizing medication, improves cardiometabolic health, in part, by shifting fat distribution from visceral to subcutaneous areas. This redistribution of fat, may be associated with some weight gain. But, Dr. DeFronzo explains that this weight gain is actually a sign that the pioglitazone is working to improve insulin sensitivity. Compared to other oral agents, pioglitazone remains one of the most effective insulin sensitizers, especially useful in those with significant insulin resistance.

Why the Renewed Interest?

1. Cardiovascular Benefits – Decrease stroke and MI

The IRIS trial demonstrated that pioglitazone reduced the risk of stroke and myocardial infarction in insulin-resistant patients with a history of cerebrovascular events (Kernan et al., 2016). This benefit is being re-evaluated in the context of cardiometabolic risk, especially in people with atherosclerotic disease or metabolic syndrome.

The ADA Standard #3 states, “In people with a history of stroke and evidence of insulin resistance and prediabetes, pioglitazone may be considered to lower the risk of stroke or myocardial infarction. However, this benefit needs to be balanced with the increased risk of weight gain, edema, and fractures. Lower doses may mitigate the risk of adverse effects but may be less effective.”

2. Role in MASLD and MASH

Pioglitazone has shown promise in improving liver histology in people with metabolic-associated steatohepatitis (MASH), making it one of the few medications with such benefits (Cusi et al., 2017). Studies demonstrate it improves hepatic insulin sensitivity, reduces liver fat, and may slow fibrosis progression.

The ADA Standards of Care #4, include recommendations to start pioglitazone and GLP-1’s for individuals with diabetes and steatosis to prevent progression and slow fibrosis. “In phase 2 clinical trials, pioglitazone and some GLP-1 RAs have been shown to be potentially effective to treat steatohepatitis and to slow fibrosis progression. They may also decrease CVD, which is the number one cause of death in people with type 2 diabetes and MASLD.

3. Re-Evaluating Safety Concerns

Initial concerns about the risk of bladder cancer stemmed from observational studies; however, more recent analyses suggest that the risk is low or not statistically significant (Lewis et al., 2015). Furthermore, thoughtful prescribing—avoiding use in individuals with heart failure or active bladder cancer risk—helps mitigate potential harm. In addition, this medication is not recommended for those at risk of falls and fractures.

Comparative Benefits of Diabetes Medications

Here is a visual summary comparing the relative effects of pioglitazone versus other common medications:

Clinical Considerations

When considering pioglitazone (Actos), carefully assess:

  • Cardiovascular history
    • benefit for those with insulin resistance
    • caution in heart failure
  • Liver function and history of MASLD/MASH – recommended
  • Bladder cancer history – avoid
  • Fracture Risk – avoid

Pioglitazone may also be especially helpful in combination with agents like metformin or GLP-1 receptor agonists, balancing out each other’s side effects and mechanisms of action.

Conclusion

Pioglitazone (Actos) may never regain its former status as a front-line diabetes treatment, but it has a clear and valuable role in today’s therapeutic landscape. For select individuals—especially those with insulin resistance, cardiovascular risk, or liver disease—pioglitazone offers an underutilized tool backed by strong evidence and decades of experience.

In diabetes care, what’s old can be new again—especially when paired with clinical wisdom and person-centered decision-making.

📚 References

  1. DiabetesEd Medication PocketCards
  2. ADA Standard of Care 2025 #3
  3. ADA Standard of Care 2025 #4

Want to learn more about ADA Standards?

Enroll in our upcoming webinar 

Level 2 | Microvascular Complications, Prevention & Treatment | Eye, Kidney, Nerve Disease 

Join us live on April 8, 2025, at 11:30 am PST

This course provides the need-to-know information regarding the microvascular complications of diabetes. It includes a brief overview of pathophysiology & clinical manifestations along with prevention strategies & screening guidelines. This straightforward program will provide participants with the information they can use in a clinical setting & also provides critical content for certification exams.

Register Here

Letting Go of Judgment – Embracing Curiosity

Letting Go of Judgement & Embracing Curiosity 

by Beverly Thomassian


As healthcare professionals, I believe we can let go of the assumptions and judgments that so often cloud our perception of the very person we are trying to care for and lean into curiosity.

Feelings of judgment are more commonplace than you may think – almost like an unconscious thought pattern. These feelings can block the creation of a meaningful connection and leave the healthcare professional and the person in our care feeling …disconnected, misunderstood, or unseen. When judgment takes the lead, it builds a quiet wall that can prevent trust from forming and healing from taking root.

But when we become aware of these unconscious patterns and intentionally set them aside, we create space for empathy, curiosity, and genuine connection. It’s in that space that the healthcare professional and the person in our care can feel respected, valued, and heard.

You can become more aware of feelings of judgment and notice what they are saying to you. This awareness is the first step to showing up for the people in our care with deeper authenticity and compassion.

When you meet with people, this is what feelings of judgement sound like.

  •  “They still aren’t taking their medications every day”
  • “I can’t believe they keep gaining weight”
  • “How come they can’t exercise at least once a week”
  • “Why are they still eating tortillas with each meal”
  • “Can’t they check their blood glucose more often”
  • “Don’t they understand they are going to get complications if they don’t lower their blood glucose”


If you hear yourself thinking these thoughts or something similar, at first, simply commit to noticing it. Don’t beat yourself up for having these thoughts and feelings. As healthcare professionals, we have a whole trunk full of biases and lived experiences. It’s okay; we are actively working on releasing the shackles of judgment from ourselves and the people in our care. Now, take a deep breath and see if you can reframe this thought through the lens of curiosity.


By exchanging judgment with curiosity, you actively engage in more mindful practice and start meeting people where they are – with compassion. Curiosity does not judge; it leans in with openness, seeking to understand rather than to label. It invites connection, discovery, and the possibility of seeing things, especially people—in a new and compassionate light.

After all, we all signed up for this profession to make a positive impact in people’s lives. Meeting people with the lens of curiosity brings out the best in us, matching the reason we entered health care in the first place – to help with healing.

The goal is give yourself permission to set those feelings of judgment aside so you can show up as your best self and make the difference you want.

This approach has numerous benefits for the caregiver and the person receiving care.
When you provide nonjudgmental care infused with curiosity and compassion, you honor the strengths of the people you’re serving. You’re also infusing your consciousness with kindness in place of judgment. This approach, based on curiosity and compassion, leads to more effective care and healing that flows both ways.

Join our Group – Healing Through Connection

We know these unconscious feelings can get in the way, yet no one talks about them. Let’s start an open and honest dialogue about these feelings. The best caregiver in the world experiences moments of judgment that can get in the way of how they show up for people. The solution is to talk about these feelings with colleagues and friends in a safe space.
We’ve developed a community to do just that. It’s a community for healthcare professionals involved in caring for people with chronic diseases. We all want the same things – which is to provide more effective care based on compassion. When you meet other people in this community, you’re going to realize that you’re not alone and that other people experience the same feelings you do. And instead of you dealing with it by yourself, there is going to be an entire community of healthcare professionals supporting each other.

Benefit of this “Healing Through Connection” FaceBook Group

– Professionals can share authentic feelings around caregiving and find connection
– Give permission to these common feelings that you and other people experience
– Know that you’re not alone in this – you don’t need to feel bad or judge yourself
– these are normal human feelings that caregivers have and it’s time that we acknowledge them

Ignite your passion & prepare for Diabetes Certification!​

Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025

Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!

With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!

Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:

  • Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
  • Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
  • Christine Craig, MS, RD, CDCES
Registration Fee includes:
  • 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
  • 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Register Now

Diabetes Mentorship Program Kicks-Off in Northern Cal

Dignity Health Mercy Medical Center Redding Steps Up with a Diabetes Mentorship Program!

We are thrilled to announce the launch of the Diabetes Mentorship Program at Mercy Medical Center in Redding, designed to support and guide the next generation of diabetes educators. This unique opportunity is tailored for eight motivated mentees who are eager to gain hands-on experience in diabetes care, all while learning from Janelle Revnak, MS, RDN, CDCES, an experienced diabetes care and education specialist, with 10 years practicing as an RDN and 5 years as a CDCES. Janelle is passionate about sharing her expertise with the next generation of diabetes professionals. Her extensive background in both outpatient and inpatient diabetes education will ensure that mentees receive comprehensive training and valuable insights into the world of diabetes care.  

Over the course of the program, mentees will attend monthly educational sessions led by Janelle, coupled with didactic learning sessions and job shadowing, providing an immersive experience in the inpatient setting. As part of our mentoring partnership, the trainees will also have access to our Diabetes Boot Camp series. Janelle decided to start this program after realizing that the need for diabetes education in her rural community was larger than what one person could realistically deliver. She reached out and identified colleagues in her hospital who were interested upping their diabetes knowledge and improving care.

“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” – Mother Teresa

Increasing Demand for Diabetes Care and Education Specialists

As the number of people living with diabetes continues to rise, the demand for skilled diabetes educators is paramount. According to the latest CDC Data, the prevalence of diabetes has increased dramatically over the past decade, with more than 37 million Americans now living with diabetes—an increase of nearly 30% over the past 10 years. This growing population needs more than just medical care; they require specialized education and support to effectively manage their condition. Current diabetes care and education specialists (DCES) are uniquely positioned to assist in equipping future professionals with the knowledge and experience needed to meet the needs of this expanding patient population.

The mentorship program will be held once a month and is designed to create a balanced approach to learning. Mentees will dive deep into didactic topics, such as advanced diabetes management, behavior change strategies, and innovative approaches to diabetes care. In addition to classroom-style learning, they will have the opportunity to job-shadow Janelle, gaining firsthand experience in how diabetes education is applied in real-world inpatient clinical settings. This combination of theory and practice ensures mentees are well-equipped to make an impact in the field.

Participants will also have the chance to engage with a wide range of diabetes-related cases during their job shadowing. From inpatient diabetes clinical management to individualized patient education, they will develop a well-rounded understanding of the crucial role diabetes educators play in improving care outcomes while helping individuals feel emotionally supported through this challenging disease. This hands-on approach allows for active learning and real-time feedback, which is vital for shaping confident and competent DCES.

The mentorship program is not just about learning—it’s about making connections, fostering growth and building a community of passionate diabetes care professionals. We are excited to offer this incredible opportunity to those who are committed to advancing their skills and knowledge in diabetes education. Together, we can make a real difference in the lives of those living with diabetes. In the spirit of Mother Teresa, it is not one person alone that can impact the growing population affected by diabetes, but working together, we can achieve meaningful change.

If you have questions, you can reach Janelle at [email protected].  

Are you Interested in Starting a Mentorship Program?

As part of our Bridge Program, Coach Beverly wants to support YOUR efforts to mentor a new generation of Diabetes Care and Education Specialists. If you are a mentor, we are offering significant discounts off of our Diabetes Boot Camp or Virtual 3 Day Program for groups of mentees who are practicing in underserved regions of our country.  Please email us for more information at [email protected]

Want more expert insights & hands-on learning?           

A perfect program for healthcare professionals entering the field of diabetes!

Join us for our 2025 Virtual Conference!!!

🎉 Join Our Virtual DiabetesEd Training Conference! 🎉

🗓️ Date:April 16th-18th, 2025
⏰ Time: 8:00am PST

Get ready for 2.5 days of engaging sessions on the latest in person-centered diabetes care, covering ADA Standards, medications, technology, and more! Learn from Diana Isaacs, Coach Beverly, and other experts.

💡 Can’t attend live? Access recordings, podcasts, and resources for 1 full year.

🎉 Special Offer: Register 3 or more and save $50 each!

Register now and take your diabetes expertise to the next level!

Register for Virtual Conference

January 2025 E-Newsletter

At the beginning of each year, Coach Beverly excitedly scans the new ADA Standards to discover updates and advances in diabetes care. She then integrates these new findings into our courses and web content to ensure we accurately reflect the latest guidelines.

In our first newsletter of 2025, we are excited to share our library of annually reviewed Cheat Sheets that integrate the 2025 Standards! They are available on our website and CDCES Coach App for easy access, with the option to download and share with your colleagues and people living with diabetes alike.

We are thrilled to recognize a trailblazer in Northern California who is mentoring eight new diabetes care and education specialists. Janelle Revnak, MS, RDN, CDCES, realized that more educators were needed to meet the needs of her rural community and took action. Read more about her story and bold plan below.

Christine Craig, MS, RD, CDCES, highlights the importance of sleep in improving health and suggests actions that diabetes care and education specialists can take to address sleep health as a vital component of diabetes care. 

Coach Beverly addresses commonly asked questions for those taking the CDCES Exam, including information on our practice hours tracker and which ADA Standards year to study.

We encourage you to test your knowledge with our Question and Rationale of the Week. January kicks off our Level 1 Fundamental Series, followed by our annual ADA Standards of Care update and Level 3 Mastery Course Series in February. We hope to see you there!

Here is to a 2025 filled with self-compassion and moments of awe.

Coach Beverly, Bryanna, Tiffany, and Christine

Announcements

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Upcoming Programs

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Click here to read our full January 2025 Newsletter

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The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.

Bold Front-of-Food Labeling Proposal

-Christine Craig, MS, RD, CDCES

Clarifying “Healthy” on Food Labels 

To address nutrition’s role in chronic disease, the FDA proposes a bold new front-of-package nutrition labeling law aimed at helping consumers make healthier food choices.

The proposed nutrition label is intended to complement the nutrition facts label and would categorize saturated fat, sodium, and added sugars as low, medium, or high. This proposal comes on the heels of the December 2024 definition update of the nutrition claim “healthy.”

To be labeled as “healthy”, products must contain fruit, vegetables, protein, dairy, or grains and meet certain nutrient limits. As diabetes care and education specialists, it is essential to be aware of this FDA initiative, since it aligns with the 2025 ADA Standards of Care nutrition therapy recommendations3 and global efforts to address diet-related health issues.

Front-of -Package Food Labeling decreased High Sugar Purchases

In Fall 2023, my family and I spent five months in Chile, offering a firsthand view of the impact of front-of package policies on the grocery landscape. Similar to global trends, over the past twenty years, Chilean diet patterns have shifted toward packaged and fast-food consumption.

Recognizing the connection between diet and chronic disease, Chile implemented ambitious food policies. Key measures included increased taxation on sugar-sweetened beverages, front-of-package warning labels, restrictions on child-targeted food marketing, and bans on unhealthy food sales in schools.4 In 2016, Chile became the first country to require front-of-package warning labels for foods high in calories, saturated fat, added sugars, and sodium. Outcomes from these measures significantly reduced purchases of sugar-sweetened beverages by nearly 24% within two years and reduced overall purchases of “high in sugar” food and beverage-labeled foods.4 Countries throughout South America, Israel, and Canada have followed suit with required front-of-package warning or stop light labeling.5 They have all shown improved consumer awareness and changes to diet intake, which has also influenced manufacturers’ food reformulation.

Unintended Consequences – More Non-Caloric Sweeteners

Despite the progress in Chile’s nutrition policy efforts, unintended consequences emerged. To avoid warning labels, food companies reformulated products, especially those “high in sugar.” By 2020, Chile’s total percentage of non-caloric sweeteners increased to be within over 50% of all products.6

The FDA is encouraged that its’ proposed front-of-package nutrition labeling system will encourage product reformulation to align with new policies.2  While reformulations can be beneficial, they also raise concerns about continued reliance on low nutrient-density processed food consumption and additives such as non-nutritive sweeteners, which the World Health Organization and the American Diabetes Association discourage.3

It will be important to monitor behavioral purchasing changes along with the long-term health benefits or implications of reformulated products to ensure U.S. new labeling guidance actually achieve healthier dietary patterns.

Advocate for Whole Food-Based Eating Patterns

As we embark on a new era of food and chronic care policy efforts, diabetes educators can learn from other countries’ successes and challenges while advocating for policies that foster healthier dietary and socioeconomic environments. Where appropriate, we can encourage a shift toward whole food-based eating patterns and reduced reliance on processed food consumption. We can stay abreast and advocate for policy and action alerts impacting nutrition and diabetes care.

By complementing front-of-package labeling proposals with educational campaigns, community-level interventions, and policies that address quality food access, we can improve population health and address the root causes of health disparities.

Smiling healthcare professionals in scrubs and lab coat

Learn More:

Get Involved in Advocacy:

References:  

  • CDC: Diabetes. Download on January 18th, 2025 from https://www.cdc.gov/diabetes/communication-resources/1-in-3-americans.html
  • Food Labeling: Front-of-Package Nutrition Information (Proposed Rule). Downloaded on January 19th 2025 from Source.
  • American Diabetes Association Professional Practice Committee; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care1 January 2024; 47 (Supplement_1): S77–S110. https://doi.org/10.2337/dc24-S005
  • Taillie LS, Reyes M, Colchero MA, Popkin B, Corvalán C. An evaluation of Chile’s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study. PLoS Med. 2020 Feb 11;17(2):e1003015. 
  • Front-of-package labeling. Downloaded on 1/18/2025 from https://www.globalfoodresearchprogram.org/resource/front-of-package-label-maps/
  • Sambra V, López-Arana S, Cáceres P, Abrigo K, Collinao J, Espinoza A, Valenzuela S, Carvajal B, Prado G, Peralta R, Gotteland M. Overuse of Non-caloric Sweeteners in Foods and Beverages in Chile: A Threat to Consumers’ Free Choice? Front Nutr. 2020 Jun 17;7:68
  •  

Want to hear more from this expert!

Join us for our upcoming DiabetesEd Virtual Conference April 16th-18th!

Join Coach Beverly, Diana Isaacs, and Christine Craig for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference.

Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!

Our instructors co-teach the content to keep things fresh and lively. Don’t miss this once-a-year opportunity. Perfect way to get reenergized and ready for 2025 and prepare for Certification Exams.

Register for the Virtual Conference

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The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.

Renewing your CDCES – Important Updates to Keep in Mind

If you’re one of the many CDCES professionals uncertain about the latest certification renewal requirements, this article will help clarify the process.

We visited the official Certification Board for Diabetes Care and Education Website and did a little detective work and sleuthing, to help clarify the requirements so you can plan for your next renewal cycle.

The most important update is that starting in 2025, CDCESs renewing their certification must meet updated requirements aimed at enhancing diabetes care, education, and ongoing professional development.

These updates involve engaging in at least two CE activities focused on the American Diabetes Association Standard’s and completing a minimum of 75 hours of continuing education (CE) during the renewal period. The aim is to help CDCESs stay up-to-date with evolving standards, thereby improving care and fostering professional development.

New ADA Standard of Care CE Requirements:

  1. CDCESs are required to engage in CE activities—either virtually or in person—twice during their renewal period, focused on the American Diabetes Association’s annual Standards of Care for Diabetes updates.

  2. Both activities can be completed at any time within the renewal cycle. There is no set minimum duration or specific CE credit requirement for these activities. The goal is to ensure CDCESs stay current with evolving standards, which enhances care and supports professional growth.

  3. Activities recognized by CBDCE or its approved providers that pertain to the ADA Standards of Care annual updates will fulfill this obligation.

Documentation and Verification: During renewal, CDCESs will attest to completing these activities. If selected for an audit, they must provide documentation such as CE certificates or conference agendas that verify their participation in relevant sessions. For example, attending a conference on ADA updates will count, provided attendees can verify the specific sessions they attended.

Length of CE Activity: There is no specific number of CEs that one has to earn or minimum length of the activity (30 minutes, 1 hour, 1 day, etc.) for the activity to be able to be used to meet the requirement. The intent for this change is for the CDCES to keep abreast of changes, maintain current knowledge, and enhance the quality of care provided to people with diabetes. It also provides a means for CDCESs to engage in on-going professional development. 

Make sure CE Provider is Accredited*.  To verify the courses qualify, verify the CE provider is on the List of CBDCE Recognized Providers or has been approved by a Provider on our List of Recognized Providers. Also check that the content of the activities pertains to the annual release of American Diabetes Association’s Standards of Care for Diabetes to ensure that the activity meets the requirement. 

*Diabetes Education Services is accredited by the CDR and all CE hours earned can be applied towards renewal.

Optional CE Topics for Renewal that are encouraged but not required:

To reflect recent changes in the specialty, the Board encourages CDCESs to complete continuing education (CE) activities in at least one of the following areas during their renewal cycle (individual or program level):

  • Educational principles and teaching strategies
  • Diabetes-related technology
  • Leadership and strategy (e.g., CQI, change management, program development)
  • Population health
  • Diversity, equity, inclusion, and accessibility (e.g., social determinants of health, cultural competency)

These broad topics are designed to support evolving roles in diabetes care and education, ensuring CDCESs stay informed about emerging trends. The Board anticipates that many CDCESs will have already engaged in at least one activity within these areas during their cycle.

During the renewal process, you will be asked if you have completed any CE activities in these areas and to specify the relevant topic. Starting in 2024, this information will be collected at the end of each renewal cycle and presented to the Board to provide insights into the CE content CDCESs are engaging with in their professional roles.

ADA Standards of Care Upcoming Class!

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standard of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education

ADA Standards of Care Jan. 30 @ 11:30am PST

All hours earned count toward your CDCES Accreditation Information

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The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.

Cheat Sheet Updates – Reflect 2025 ADA Standards

With the publication of the ADA Standards of Care, Coach Beverly embarks on the yearly arduous yet rewarding task of updating our Cheat Sheet Library! As part of the new CDR Accreditation requirements, handouts and slides used as part of the educational courses and resources have to be free of commercial bias and be “logo-free.” The CDR Accrediting Committee ensures that participants attending live or online training programs are presented with content free of conflict of interest, based on evidence, and without brands, ads, and logos.

We are proud to meet the rigorous standards set by the CDR Accreditation Committee and have a 25-year history of intentionally avoiding conflict of interest by not accepting contributions or funds from diabetes-related companies or industries and creating original materials.

 

Cheat Sheet Updates based on 2025 Standards

ADA Standards of Care 2, Diagnosis and Classification of Diabetes include additional details on screening for type 1 and type 2 diabetes and diabetes in pregnancy, which is captured in our Diagnosis and Classification Cheat Sheet. The diagnostic testing methods and criteria, remained the same as in past years, with an increased emphasis on using A1C as the preferred diagnostic tool, given its accessibility, greater convenience (fasting not required), greater preanalytical stability, and fewer day-to-day perturbations during stress, changes in nutrition, or illness.

Diagnosis and Classification Cheat Sheet Highlights.

  1. Screen for presymptomatic type 1 diabetes, by testing autoantibodies to insulin, GAD, islet antigen 2, or ZnT8 for those with type 1 phenotypic risk (younger age, ketoacidosis, etc.)
  2. For Type 2 diabetes, the suggested screening age for everyone starting at age 35 remained the same as did the BMI cut-off of 23 for Asian Americans and 25 for all others.
  3. Additional risk factors for earlier screening were added and a few were modified from last year. The elevated blood pressure cut-off was decreased from 140/90 to 130/80. In addition to regular screening for those taking antiretroviral medications, ADA added monitoring for hyperglycemia in those taking high-risk medicines (steroids, antipsychotic meds) or a history of pancreatitis and re-checking glucose levels annually or if any signs of hyperglycemia.
  4. In the diabetes and pregnancy section, the ADA more strongly recommended screening all women at the first prenatal visit to help detect undiscovered hyperglycemia and initiate early treatment. Before 15 weeks of gestation, test individuals with risk factors and consider testing all individuals for undiagnosed diabetes at the first prenatal visit using standard diagnostic criteria if not screened preconception.

Insulin Storage Cheat Sheet Highlights.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Immunization Schedule for People with Diabetes 2025

This chart details the types of vaccines, when, and how often they are recommended for people with diabetes. There were two new additions this year. A single RSV dose is recommended for those 60 years and older and the COVID-19 vaccine and boosters are suggested starting at six months of age.

This standard emphasized reminding people with diabetes to avoid the live attenuated influenza vaccine and it included additional clarification on the pneumonia vaccines.

We hope you will stop by our complete
Cheat Sheet Complete Library!

Feel free to download and share these info sheets and share with colleagues and people living with diabetes!

ADA Standards of Care 2024 Webinar Update

Join us live on February 1, 2024, at 11:30 am PST

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.

Topics:

  • A review of changes & updates to the annual ADA Standards of Medical Care in Diabetes.
  • Identification of key elements of the position statement.
  • Discussion of how diabetes educators can apply this information in their clinical setting.

Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast

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. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.

Click here to Register

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession! 

The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.

National Diabetes Month – Resources

November kicks off National Diabetes Month

According to the latest CDC Data, over 16% of Americans are living with diabetes and 38% have prediabetes. This means about half of our communities are living with hyperglycemia.

Advocacy and education play essential roles in diabetes care and prevention. By equipping individuals with knowledge about diabetes management, healthy lifestyle choices, and preventative measures, we empower them to take ownership of their health and inspire change within their communities. 

Community-centered education can be incredibly powerful—when people feel informed and supported, they’re more likely to make meaningful changes and encourage others to do the same. This creates a ripple effect, fostering healthier communities and potentially reducing the prevalence of diabetes over time. 

We have put together a list of FREE Webinars and diabetes resources in English and Spanish to share with people living with prediabetes and diabetes. Thank you for your advocacy and belief that we can make a difference.

FREE Webinars to Celebrate National Diabetes Month 

Websites that offer FREE handouts & info on diabetes  

ADA’s Diabetes Food Hub – English and Spanish! Web site filled with information on healthy eating and an abundance of delicious recipes.

ADA Resources in Spanish – this newly opened information hub is perfect for those who prefer to learn and read in Spanish.

ADA’s FREE Life with Diabetes Program: ADA’s program includes six digital, printable journeys to teach how to live well with diabetes; a monthly e-newsletter with tips, stories, and more resources; six free issues of the Diabetes Forecast® magazine; access to an online community and local events. (The program is available in both English and Spanish).

ADA’s Risk Quiz: 60-second online risk assessment for type 2 diabetes. ADA created a self-assessment and a version to fill out the assessment for others. There’s also a printable version in English & Spanish that can be distributed to help ascertain risk. This is a great first step in helping individuals consider coming in for an appointment

CDC Diabetes Prevention Program Curricula and Handouts  This site offers excellent resources for those interested in offering Diabetes Prevention Education in English and Spanish.

National Diabetes Education Program is an online library of resources compiled by the NDEP to help provide accurate information and support for people living with prediabetes and diabetes.

Spanish Language Resources: language can be a barrier to adequate and quality care. ADCES has created a number of free downloads for people with diabetes and prediabetes, which have been translated into Spanish.

Type 1 Diabetes Resource Page – Includes is a list of helpful online resources for Type 1 Diabetes. It include sites for national organizations like the American Diabetes Association (ADA), sites for diabetes interest groups, and other participant organizations that provide helpful diabetes tips and opportunities to join online groups.

Tech Resources

DiabetesWisePro for Clinicians A non-biased web site for health care professionals that has a quick tool to access insurance coverage information, how to order devices, what to include and where to go for support. 

DiabetesWise A non-biased website that helps people with diabetes learn about different diabetes devices and determine the best match for their needs

Insulin Cost Savings Toolkit Resource Page – An ADCES complete listing of low cost insulin options and resources.

Technology Cost Savings Resource Page – An ADCES listing of websites and information to obtain pumps and sensors for a lower cost.

DiabetesEd FREE Resource Catalog

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See Full Free Resource Catalog

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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.

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Diabetes Education Services offers education and training to diabetes educators in the areas of both Type 1 and Type 2 Diabetes for the novice to the established professional. Whether you are training to be a Certified Diabetes Care and Education Specialist (CDCES), practicing at an advanced level and interested in board certification, or a health care professional and/or Certified Diabetes Care and Education Specialist (CDCES) who needs continuing education hours to renew your license or CDCES, we have diabetes education information, resources and training; learning and teaching tools; and diabetes online courses available for continuing education (CE). Read our disclaimer for full disclosure.

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