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Rationale of the Week | FIB-4 of 2.83. What Action Required?

For last week’s practice question, we quizzed participants on FIB-4 of 2.83. 48.09% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

AR lives with type 2 diabetes, and their waistline is 41 inches. Since their ALT and AST levels are elevated, you know they are at risk for steatosis (MASH). You quickly calculate their Fibrosis-4 Index (FIB-4), by plugging in AR’s Age, AST, ALT, platelet count into the FIB-4 calculator. AR’s result is 2.83.

According to the ADA Standards, with a FIB-4 value of 2.83, which action is required?

  1. Start AR on pioglitazone and recheck FIB-4 in 3 months.
  2. Encourage AR to see a RDN and stop consumption of alcohol immediately.
  3. Suggest increased high intensity activity coupled with a GLP-1 to reduce body weight.
  4. Refer AR to liver specialist for further evaluation.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer A is incorrect: 18.4% chose this answer, “Start AR on pioglitazone and recheck FIB-4 in 3 months.” Although pioglitazone is a recommended treatment for steatosis, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer B is incorrect: 15.11% chose this answer, “Encourage AR to see a RDN and stop consumption of alcohol immediately.” Seeing a RDN is very important for AR to evaluate and customize an eating plan to address their steatosis and support quality of life. However, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer C is incorrect: 18.4% chose this answer, “Suggest increased high intensity activity coupled with a GLP-1 to reduce body weight.” Strength training and activity, coupled with a GLP-1 for GLP-1/GIP are important strategies to address steatosis. However, since AR’s FIB- is greater than 2.67, this indicates AR is at high risk for advanced fibrosis and a referral to a liver specialist is warranted.

Answer D is correct: 48.09% chose this answer, “Refer AR to liver specialist for further evaluation.” Great job! AR will require intensive intervention to decrease their risk of worsening steatosis, including MNT, targeted activities, and a referral to a liver specialist to determine the best treatment approach.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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Rationale of the Week | Which Treatment is FDA Approved for MASH?

For last week’s practice question, we quizzed participants on FDA approved treatment for MASH. 33.75% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

MJ just discovered that in addition to their type 2 diabetes and a BMI of 31, they also have MASH.

Based on this diagnosis, which FDA approved medication would help address their steatosis?

  1. Semaglutide (Ozempic)
  2. Empagliflozin (Jardiance)
  3. Tirzepatide (Mounjaro)
  4. Semaglutide (Wegovy)

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer A is incorrect: 24.19% chose this answer, “Semaglutide (Ozempic).” The diabetes approved version of semaglutide (Ozempic) does not yet have FDA approval as a medication that is used for treatment of MASH.

Answer B is incorrect: 18.77% chose this answer, “Empagliflozin (Jardiance).” Although empagliflozin will reduce blood glucose and can help with weight loss, it is not FDA approved for treatment of MASH.

Answer C is incorrect: 23.29% chose this answer, “Tirzepatide (Mounjaro).” Tirzepatide (Mounjaro) is approved for treatment of diabetes, helps with weight loss and is FDA approved for sleep apnea. However it is not FDA approved for treatment of MASH.

Answer D is correct: 33.75% chose this answer, “Semaglutide (Wegovy).” The weight loss approved version of semaglutide (Wegovy) has FDA approval as a medication that is used for treatment of MASH.

Please see our new “Indications for GLP-1/GIP” Cheat Sheet for a complete run down.  

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

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October 22nd – 23rd, 2025

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Rationale of the Week | Lifestyle Therapy for MASLD and MASH

For last week’s practice question, we quizzed participants on Lifestyle Therapy for MASLD and MASH. 83% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

PJ has had type 2 diabetes for 8 years and is here for a follow-up visit. Labs indicate A1c at 7.2%, lipids at target, eGFR of 78 mL/min/1.73m², and urine albumin-to-creatinine ratio (UACR) of 65 mg/dL. Blood pressure at the office visit today was 142/86, which is consistent with home monitored values. PJ confirms taking medications, metformin and simvastatin. PJ inquires about recently completed lab work.

According to the ADA Standards of Care, what would be an appropriate next step in the diabetes care plan?

  1. No changes are needed because kidney function is within normal range.
  2. Initiate an ACE inhibitor or ARB to reduce progression the of diabetic kidney disease.
  3. Discontinue metformin due to the risk of kidney injury with reduced eGFR.
  4. Increase statin therapy to target albuminuria reduction.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer A is incorrect: 6.35% chose this answer, “No changes are needed because kidney function is within normal range.” A is incorrect. Although eGFR indicates stage 2 kidney disease, the elevated UACR, ≥30 mg/g, confirms moderately increased risk and recommendation to treat. Additionally, PJ’s blood pressure is also above the target. Intervention is needed to protect kidney and cardiovascular health.

Answer B is correct: 83% chose this answer, “Initiate an ACE inhibitor or ARB to reduce progression the of diabetic kidney disease.” PJ has a mildly decreased eGFR, but UACR is elevated above 30 mg/g, indicating a recommendation to treat. Additionally, intervention is needed to optimize blood pressure. According to the ADA Standards of Care in Diabetes, individuals with diabetes, hypertension, and moderately increased albuminuria should be treated with an ACE inhibitor or angiotensin receptor blocker. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 agonists (GLP1-RA), with demonstrated benefits, could also be considered to reduce CKD progression.

Answer C is incorrect: 5.25% chose this answer, “Discontinue metformin due to the risk of kidney injury with reduced eGFR.” Metformin is safe to continue unless eGFR falls below 30 30 mL/min/1.73m². PJ’s kidney function is adequate for continued use. However, consideration to add a change to SGLT2 or GLP1 with kidney benefit could also promote additional A1c reduction.

Answer D is incorrect: 5.52% chose this answer, “Increase statin therapy to target albuminuria reduction.” Statins are recommended for ASCVD prevention, but they do not reduce albuminuria. Lipids are within normal range, and albuminuria should be addressed with an ACE inhibitor/ARB or potentially a SGLT2 inhibitor or GLP-1 RA.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Invite a colleague to our DiabetesEd Seminar in San Diego and get $75 off each registration.

Use code FriendDiscountSD during check out to save. 

Join us live in San Diego October 22nd – 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Rationale of the Week | Grandfather Avoiding Bolus Insulin

For last week’s practice question, we quizzed participants on insulin. 96% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

R.S. is a 60-year-old with type 2 diabetes who was recently placed on insulin lispro at meals.  He has taken insulin glargine once a day for five years. Previously, non-insulin medications have been ineffective or not tolerated. He continues to have hyperglycemia despite the addition of insulin lispro.  During his diabetes education visit today, he shared that he has not been taking his mealtime insulin lispro because he does not want to inject it in front of his grandchildren, who live with him.  He feels overwhelmed by these additional injections but wants to get his blood glucose levels under better control so he can have the energy to play with his grandchildren and avoid losing his eyesight like his mother did.

As the diabetes care and education specialist, which of the following would be the most appropriate first step in addressing R.S.’s concerns? 

  1. Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.
  2. Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.
  3. Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.
  4. Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer A is incorrect: 1% chose this answer, “Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.” R.S. is aware that his glycemic control is important, and he is already aware of the risk of diabetes-related complications. Counseling him on this would not help him be successful with his insulin management.  

Answer B is correct: 96% chose this answer, “Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.” R.S. is struggling with barriers to successful insulin management.  A holistic approach would be to ask open-ended questions about his current routine, stressors, and support systems to gain a better understanding of these barriers. This information can lead to a personalized plan of care to help improve glycemic control. 

Answer C is incorrect: 2% chose this answer, “Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.” He has already attempted other non-insulin therapies, and these were either ineffective or not tolerated. Changing his regimen would not be successful at improving his glycemic control and quality of life.

Answer D is incorrect: 1% chose this answer, “Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.” R.S. appears to understand how to take his insulin lispro at meals. Writing out the instructions would not improve his situation. It is not a lack of knowledge, but the multiple barriers in his life that are keeping him from being able to implement this new medication regimen.  

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Invite a colleague to our DiabetesEd Seminar in San Diego and get $75 off each registration.

Use code FriendDiscountSD during check out to save. 

Join us live in San Diego October 22nd – 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Rationale of the Week | How does Mifepristone Work?

For last week’s practice question, we quizzed participants on How does Mifepristone work to treat hypercortisolism? 48.73% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it by clicking here.

Lightbulb and text: Rationale of the Week

A 54-year-old with type 2 diabetes and hypertension is diagnosed with hypercortisolism. Despite lifestyle interventions and maximum doses of metformin, GLP-1 RA, and an SGLT2 inhibitor, her A1C remains 9.2%. They are started on mifepristone.

Which of the following best explains how mifepristone improves glycemic control in this setting?

  1. It decreases cortisol synthesis in the adrenal cortex, lowering circulating cortisol levels.
  2. It reduces ACTH release from the pituitary, leading to decreased adrenal stimulation.
  3. It blocks glucocorticoid receptors, preventing cortisol from exerting metabolic effects.
  4. It directly enhances insulin secretion and sensitivity, independent of cortisol pathways.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 25.14% chose this answer, “It decreases cortisol synthesis in the adrenal cortex, lowering circulating cortisol levels.” As tempting as this answer is, mifepristone does not inhibit cortisol synthesis.

Answer 2 is incorrect. 15.21% of you chose this answer, “It reduces ACTH release from the pituitary, leading to decreased adrenal stimulation.This medication does not directly reduce ACTH release from the pituatary.

Answer 3 is correct. About 48.73% of respondents chose this, “It blocks glucocorticoid receptors, preventing cortisol from exerting metabolic effects.” Mifepristone is a glucocorticoid receptor antagonist. By competitively binding to glucocorticoid receptors, it prevents cortisol from exerting downstream effects, including increased hepatic gluconeogenesis, peripheral insulin resistance, and lipolysis. This mechanism is particularly useful in people with hypercortisolism and concurrent type 2 diabetes, as it improves insulin sensitivity and lowers blood glucose without lowering circulating cortisol levels.

Finally, Answer 4 is incorrect. 10.99% chose this answer, “It directly enhances insulin secretion and sensitivity, independent of cortisol pathways.” This medication does not act directly on pancreatic β-cells or insulin receptors.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Invite a colleague to our DiabetesEd Seminar in San Diego and get $75 off each registration.

Use code FriendDiscountSD during check out to save. 

Join us live in San Diego October 22nd – 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Rationale of the Week | Time Restricted Eating – Best Approach

For last week’s practice question, we quizzed participants on Time Restricted Eating- Best Approach. 86% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

MJ is a 56-year-old with type 2 diabetes (A1C 7.3%), HTN, and dyslipidemia. Current medications include metformin 1,000 mg twice daily, lisinopril, and atorvastatin. Activity includes walking 20–30 minutes most evenings. At their most recent visit, MJ is inquiring about using at 16:8 time-restricted eating plan and plans eating from 11 a.m. to 7 p.m. and will include coffee/unsweetened beverages outside that window. MJ checks their blood glucose once daily and there is no reported history of severe hypoglycemia.

What response would you provide MJ regarding the safety and effectiveness of an intermittent fasting, time-restrictive eating plan?

  1. Individuals with type 2 diabetes should include regular meals throughout the day to support stabilize blood sugars and prevent hypoglycemia.
  2. Review with MJ his motivations for the time-restricted eating plan and assess plan for dietary intake within the eating window.
  3. Encourage a time-restricted eating plan, evidence indicates it is more effective than calorie reduction alone for weight loss and A1c reduction.
  4. Recommend starting Incretin therapy, such as Ozempic or Mounjaro, to ensure effectiveness of time-restricted eating plan.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 9% chose this answer, “Individuals with type 2 diabetes should include regular meals throughout the day to support stabilize blood sugars and prevent hypoglycemia.” Random control trials have indicated that time-restricted eating is a safe and practical dietary approach for individuals with type 1 and type 2 diabetes. While assessment and prevention of hypoglycemia is a priority, MJ’s current medication regimen is of low risk. Even with higher risk medications, such as insulin or sulfonylureas modifications of medication, timing or dose can be made to support safety.

Answer 2 is correct. 86% of you chose this answer, “Review with MJ his motivations for the time-restricted eating plan and assess plan for dietary intake within the eating window.” Great Job! Time-restricted eating can be a safe and effective strategy for MJ. Reviewing motivation and current eating patterns may improve the ability to apply balanced meals within the eating window.

Answer 3 is incorrect. About 3% of respondents chose this, “Encourage a time-restricted eating plan, evidence indicates it is more effective than calorie reduction alone for weight loss and A1c reduction.” While time restricted eating may be a practical strategy, it has not been shown to be superior to continuous energy restricted dietary intake for weight loss and A1c outcomes.

Finally, Answer 4 is incorrect. About 2% chose this answer, “Recommend starting Incretin therapy, such as Ozempic or Mounjaro, to ensure effectiveness of time-restricted eating plan.” While we may consider addition of an incretin therapy to support A1c, weight and cardiovascular risk reduction, time-restricted eating does not require the addition of these medications to be effective.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Live in San Diego
DiabetesEd Training Seminar

Join us live October 22nd – 23rd, 2025!

30+ CEs with Expanded Accreditation!

More than a course, an experience.

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Rationale of the Week | Clinical Clues to Hypercortisolism

For last week’s practice question, we quizzed participants on clinical clues to hypercortisolism. 53% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

AJ is a 52-year-old with type 2 diabetes presents with worsening hyperglycemia despite taking three diabetes medications.  AJ says, “No matter what I do, I can’t seem to get my blood sugars down”.

Which of the following clusters of physical findings would increase your suspicion that AJ is struggling with hypercortisolism?

  1. Dorsocervical fat pad, wide purple striae and bruising.
  2. Peripheral muscle hypertrophy, thick hair growth, and flushed skin.
  3. Weight loss, skin hyperpigmentation, and generalized muscle wasting.
  4. Pallor, brittle nails, and spoon-shaped fingernails.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is correct. 53.62% chose this answer, “Dorsocervical fat pad, wide purple striae and bruising.”  YES, GREAT JOB!  These are classic physical features of hypercortisolism. Dorsocervical fat pad, wide purple striae and easy bruising along with proximal muscle weakness, and poor wound healing, should prompt evaluation for hypercortisolism in people with elevated glucose and hypertension, despite being on several medications for blood glucose and blood pressure.

Answer 2 is incorrect. 20.47% of you chose this answer, “Peripheral muscle hypertrophy, thick hair growth, and flushed skin.” These features are not characteristic of hypercortisolism; thick hair growth and muscle hypertrophy point to other conditions.

Answer 3 is incorrect. 16.34% of respondents chose this, “Weight loss, skin hyperpigmentation, and generalized muscle wasting.” These features are more consistent with Addison’s disease (adrenal insufficiency) or chronic illness, not hypercortisolism.

Finally, Answer 4 is incorrect.9.58% chose this answer, “Pallor, brittle nails, and spoon-shaped fingernails.” These findings are typically seen in iron-deficiency anemia, not hypercortisolism.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

More than a course, an experience.

Live in San Diego
DiabetesEd Training Seminar

Join us live October 22nd – 23rd, 2025!

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Rationale of the Week | Diabetes Distraction in the Clinic

For last week’s practice question, we quizzed participants on Diabetes Distraction in the Clinic. 97% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Lightbulb and text: Rationale of the Week

In the clinic today, you are seeing L.K., a 28-year-old with type 1 diabetes who was diagnosed at the age of 10. She was referred by the healthcare team for carb counting education and to discuss insulin pump options. During the session, L.K. appears preoccupied with her phone, avoids eye contact, and appears disinterested. When you ask what L.K.’s goals are for today’s session, she reports, “No matter how hard I try, no one is ever happy with my readings. Going on a pump isn’t going to change that”.

As a diabetes care and education specialist, what would you do?

  1. Point out to L.K. that she appears distracted and ask her if she wants to reschedule the appointment.
  2. Educate L.K. on diabetes-related complications related to chronic hyperglycemia.
  3. Continue the education session as planned, but make sure to provide handouts she can use later.
  4. Pause the session to explore L.K.’s feelings and beliefs about her diabetes care and previous experiences.

Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 1% chose this answer, “Point out to L.K. that she appears distracted and ask her if she wants to reschedule the appointment.” L.K. verbalized her frustration with her diabetes and the healthcare system. As the diabetes healthcare provider, you are poised not only to provide information, but also to build a trusting relationship using person-centered approach. Stopping the session and rescheduling might derail collaboration and forward movement.

Answer 2 is incorrect. 1% of you chose this answer, “Educate L.K. on diabetes-related complications related to chronic hyperglycemia.” Although educating clients about the potential health outcomes of chronic hyperglycemia is essential, it does not constitute a person-centered approach in this situation. L.K. has made it clear that she is frustrated with her diabetes and healthcare experience.

Answer 3 is incorrect. About 1% of respondents chose this, “Continue the education session as planned, but make sure to provide handouts she can use later.” Continuing the education session with L.K. after she has verbalized her frustration is not a person-centered approach to care. She will not be engaged and an active participant in her care if she does not feel heard and validated.

Finally, Answer 4 is correct. 97% chose this answer, “Pause the session to explore L.K.’s feelings and beliefs about her diabetes care and previous experiences.” Every client has both positive and negative experiences in their diabetes journey that will influence their diabetes self-management and health outcomes. The statement she made in the diabetes education session must be addressed and discussed to build trust and understand her specific concerns. This approach is person-centered, leading to a shared decision-making approach to her personal diabetes goals.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Live in San Diego
DiabetesEd Training Seminar

Join us live October 22nd – 23rd, 2025!

30+ CEs with Expanded Accreditation!

More than a course, an experience.

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

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

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

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