Question of the Week & Rationale

Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDCES® Exam.

To sign up to receive the question of the week, download our free CDCES Coach App or join our Facebook Page.

This week’s Rationale: Question of the Week – January 9th – test your knowledge before seeing answer below!

What a perfect way to information share and bring new concepts to light. We appreciate our community of diabetes educators and the opportunity to keep learning together!

Question: The 2018 ADA Standards of Care include updates to the Cardiovascular Disease and risk management section. Which of the following accurately reflects updates to this section?

a. All hypertensive patients with diabetes should monitor home blood pressure.

b. The new B/P goal is 130/80 to match the American Heart Association’s goal.

c. All patients with type 1 diabetes should be started on an ACE Inhibitor.

d. Beta blockers should be avoided for all patients on insulin therapy.

Correct Answer:  a. All hypertensive patients with diabetes should monitor home blood pressure.

Rationale: 

CV Disease Risk Management – ADA 2018 Update

After the American Heart Association set a new B/P target of 130/80, the diabetes world held their breath to see if the American Diabetes Association (ADA) would follow suit and lower it’s BP target.

The ADA maintains the B/P target of 140/90, based on a comprehensive review of studies measuring the cost/benefit of blood pressure control in people with diabetes. They specifically summarized the ACCORD BP trial findings (see below paragraph*).

Current ADA Recommendations are as follows:

Hypertension, defined as a sustained blood pressure more than or equal to 140/90 is a major risk factor for both CV and microvascular complications. Numerous studies demonstrate that antihypertensive therapy reduces CV events, heart failure, and microvascular complications.

Screening and Diagnosis Recommendations

• Blood pressure should be measured at every routine clinical visit. Patients found to have elevated blood pressure (more than or equal to 140/90) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension.
• All hypertensive patients with diabetes should monitor their blood pressure at home.

As far as answers c and d, they are wrong for the following reasons:

1.  The ADA no longer recommends automatically starting people with Type 1 Diabetes on an ACE Inhibitor if there is no hypertension or proteinuria.
2. For patients with diabetes post MI, beta blockers are the B/P medication of choice.  Pts with diabetes on insulin can still experience diaphoresis when hypoglycemic (breakthrough symptom). However, they should be encouraged to check BG on a regular basis and notify provider if BG is running lower than targets.

For more info, see our CV Risk Management Blog Post

Question of the Week & Rationale

Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDCES® Exam.

To sign up to receive the question of the week, download our free CDCES Coach App or join our Facebook Page.

This week’s Rationale: Question of the Week – January 3rd – test your knowledge before seeing answer below!

What a perfect way to information share and bring new concepts to light. We appreciate our community of diabetes educators and the opportunity to keep learning together!

Question:

The 2018 ADA Standards of Care includes updates to the Pharmacologic Algorithm to manage hyperglycemia for individuals with type 2 diabetes. Which of the following accurately reflects updates to the algorithm?

a. Start insulin therapy if A1c is 9% or greater (26% guessed)

b. Try Lifestyle Management for 3 months before starting metformin (10% guessed)

c. When adding a second agent, consider a medication proven to reduce cardiovascular mortality (61% guessed)

d. Avoid use of all injectables and oral meds that contribute to hypoglycemia (15% guessed)

Correct Answer:  c. When adding a second agent, consider a medication proven to reduce cardiovascular mortality

Rationale: 

Stepwise Approach to Pharmacologic Management of Type 2 Diabetes – 2018

Step 1

According to the ADA 2018 Standards, section 8, Metformin therapy should be started along with lifestyle Management at diagnosis of type 2 Diabetes (unless contraindicated).

Metformin is effective, safe, inexpensive and may reduce risk of CV events and death.

Step 2

If A1c target is not achieved after 3 months, consider metformin and any one of the six preferred treatment options based on drug specific effects and patient factors.

If A1c target is still not achieved after 3 months on metformin, and the patient has CV Disease, consider adding a second agent with evidence of cardiovascular risk reduction (based on drug specific effects and patient factors).

These include:

• SGLT-2 Inhibitors – empalgliflozin (Jardiance) and canagliflozin (Invokana)
• GLP-1 Receptor Agonist – liraglutide (Victoza)

Step 3

If A1c target is still not achieved after 3 months, combine metformin plus two other agents for a three-drug combination.

Step 4  

If A1c target is still not achieved after 3 months, add combination injectable therapy to the three-drug combination.

For all steps, consider including medications with evidence of CV risk reduction, based on drug specific effects and patient factors.

Medication Therapy Based on A1c

• If A1c is less than 9%, consider monotherapy
• If A1c is greater than or equal to 9% consider dual therapy
• If A1c is greater or equal to 10%, or if BG 300 or more, or pt is markedly symptomatic, consider insulin and injectable therapy.

Question of the Week & Rationale

Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDCES® Exam.

To sign up to receive the question of the week, download our free CDCES Coach App or join our Facebook Page.

This week’s Rationale: Question of the Week – December 5th – test your knowledge before seeing answer below!

What a perfect way to information share and bring new concepts to light. We appreciate our community of diabetes educators and the opportunity to keep learning together!

Question:

What best describes the elements of the CDC Diabetes Prevention Program?

a. Includes 16 weekly sessions followed by at least 6 monthly meetings.

b. Sessions must be taught by at least one licensed health care professional (RN, RD, PharmD etc.)

c. Pediatrics and adults with prediabetes can participate in the program.

d. A physician’s referral is required to participate in the Prevention Program.

Correct Answer:  Includes 16 weekly sessions followed by at least 6 monthly meetings.

Rationale: The CDC Approved Diabetes Prevention Program includes weekly meetings for the first 16 weeks within the first 6-month window and 6 monthly meetings in the last half of the year.

The sessions can be led by non-licensed life coaches such as community health workers, volunteers or educators who have completed a certified training for the Prevention Program.  Trained licensed personnel can also deliver the program.

Only overweight adults over the age of 18 can be admitted to the program and no physician’s referral is required.  This program is designed to be accessible for everyone.

For more information, please visit our Diabetes Prevention Program Resource Page.

Question of the Week Rationale

Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDCES® Exam. If you have not signed up to receive the question, you can today through our free CDCES Coach App or our Facebook Page.

Rationale:

We have had an overwhelmingly positive response to our “Question of the Week.” Thank you for participating!

Many of you have asked for the rationale behind the correct answer. We hear you and agree!

What a perfect way to information share and bring new concepts to light.  We appreciate our community of diabetes educators and the opportunity to keep learning together!

Question of the Week – November 14th – test your knowledge before seeing answer below!

Question:

Which of the following is true about prediabetes in the United States?

a. Only 40% of people with prediabetes know they have prediabetes

b. Medicare will provide payment for recognized Diabetes Prevention Programs starting in 2018.

c. Prediabetes can only be diagnosed with an A1c test

d. Prediabetes is not associated with any vascular complications

How did your answer compare?

Correct Answer: b. Medicare will provide payment for recognized Diabetes Prevention Programs starting in 2018

But why?

Rationale:

Currently, in the U.S., over 35% of people have prediabetes and only 7% know they are living with elevated blood glucose levels. Prediabetes is associated with increased risk of cardiovascular disease, heart attack and stroke.  Over a 3-year period, 30% of people with prediabetes will be diagnosed with diabetes. However, we know that Diabetes Prevention Programs works to protect beta cells and slow progression.

Medicare will start funding CDC based recognized Diabetes Prevention Programs starting in April 2018. You can start a Diabetes Prevention Program in your community.  Let’s be a part of slowing down the epidemic of diabetes.

Learn more on our Prevention Resource Page.

Question of the Week Rationale

Our “Question of the Week” is created weekly by Coach Beverly to cover a variety of Diabetes related topics. The questions are designed to keep you current and prepare you for the CDCES® Exam. If you have not signed up to receive the question, you can today through our free CDCES Coach App or our Facebook Page.

Rationale:

We have had an overwhelmingly positive response to our “Question of the Week.” Thank you for participating!

Many of you have asked for the rationale behind the correct answer. We hear you and agree!

What a perfect way to information share and bring new concepts to light.  We appreciate our community of diabetes educators and the opportunity to keep learning together!

Question of the Week – October 31st – test your knowledge before seeing answer below!

Question:

How do humans establish the majority of their gut microbiome?

a. Through the foods they eat before the age of 10

b. By a combination of birth method, foods and environment

c. Mostly through genetics and stress levels

d. By exposure to animals and foreign bodies

How did your answer compare?

Correct Answer:  b. By a combination of birth method, foods and environment

But why? 

Rationale

The human microbiome is established by the about the age of three through the following:

Birth method – babies born vaginally are exposed to healthy lactobacillus as they travel through the birth canal. Babies born via C-Section are exposed to the skin bacteria from the person delivering the baby (usually staphylococcus).

Breast fed– breast milk contain a myriad of healthy bacteria and food (oligosaccharides) to feed the bacteria and support intestinal microbial diversity.

Environment – this includes exposure to animals, other children, foods (fresh or packaged), time spent indoors and outdoors, antibiotic use and more.

This infographic is an excellent summary on strategies to promote a healthy microbiome to our future generations. It is based early research by Dr. Maria Gloria Dominguez-Bello, an associate professor in the Human Microbiome Program at the NYU School of Medicine. She is testing a fast and easy work-around called the “gauze-in-the-vagina technique” for women that need C-section delivery.

Be reassured that it is never too late to improve the health of your microbial friends.

Want to learn more? Join our free webinar below:

Join our FREE New Horizons – Getting to the Gut Webinar

November 6th, 2017 at 11:30 a.m. PST

Want more questions like this? Really test your knowledge and prepare with our CDCES Exam Prep Bundle!

Enjoy additional free questions! Download our CDCES Coach App to receive our Question of the Week on your mobile device every week!

New Sugar Question – September 1st, 2017

These questions are created weekly by Coach Beverly to cover a variety of Diabetes related topics. However, this week is special as we are trying to raise awareness on the sugar consumption in our communities.

Click here to take sugar question #4

Sugar Question #3

Sugar Question #2

Sugar Question #1

This week we will be doing a daily “question of the week” related to added sugar to support our newest campaign to increase sugar awareness in our communities.

Don’t forget to join our “The Joy of Six – Sugar Pledge” by clicking the link following your answer submission.

The Joy of Six – Sugar Pledge

To enjoy up to six teaspoons of added sugar and increase sugar awareness in our communities.

We have created this pledge campaign to raise awareness on the health risks of added sugar and more so, the benefits of enjoying less.

By eating less added sugar starting today, we will not suffer from any nutritional deficiency. 
On the contrary, we will get healthier.

Join Our Pledge

New Sugar Question – August 30th, 2017

These questions are created weekly by Coach Beverly to cover a variety of Diabetes related topics. However, this week is special as we are trying to raise awareness on the sugar consumption in our communities.

Click here to take the question of the week >>

This week we will be doing a daily “question of the week” related to added sugar to support our newest campaign to increase sugar awareness in our communities.

Don’t forget to join our “The Joy of Six – Sugar Pledge” by clicking the link following your answer submission.

The Joy of Six – Sugar Pledge

To enjoy up to six teaspoons of added sugar and increase sugar awareness in our communities.

We have created this pledge campaign to raise awareness on the health risks of added sugar and more so, the benefits of enjoying less.

By eating less added sugar starting today, we will not suffer from any nutritional deficiency. 
On the contrary, we will get healthier.

Join Our Pledge