If you are taking the CDCES or BC-ADM exam in 2023, these new lipid targets for high risk individuals and treatment interventions are important to know.
For all of us who serve people with diabetes, evidence from many trials demonstrated that these more intensive LDL cholesterol targets will save lives and decrease CV disease. By sharing this information with our colleagues and teams, we can be a part of improving outcomes and quality of life.
The following content summarizes the 2023 updated ADA guidelines as outlined in Standard 10 – Cardiovascular Disease and Risk Management.
The guidelines have remained the same for lower risk individuals with diabetes aged 40–75 years without atherosclerotic cardiovascular disease, “Start moderate-intensity statin therapy in addition to lifestyle therapy”. They also are the same for people with diabetes aged 20–39 years with additional atherosclerotic cardiovascular disease risk factors, “Based on individual assessment, initiate statin therapy in addition to lifestyle therapy.”
In the category of primary prevention for people with diabetes aged 40–75 at higher cardiovascular risk (LDL >100, HTN, Smoke, CKD, albuminuria, family hx ACSVD), the goals have been intensified.
Secondary Prevention goals have also been intensified.
For people of all ages with diabetes and atherosclerotic cardiovascular disease:
Target LDL cholesterol reduction of 50% or greater from baseline and an LDL cholesterol goal of <55 mg/dL.
Addition of ezetimibe or a PCSK9 inhibitor with proven benefit in this population is recommended if goal is not achieved on maximum tolerated statin therapy.
In 2022, the ADA Standards did not include specific LDL targets for people with diabetes. However, based on recent study results, the committee updated the 2023 guidelines to reflect the latest research findings. To learn more about the study findings, Standard 10 – Cardiovascular Disease and Risk Management.
Keeping track of medications for hypertension and cholesterol can seem daunting. We have put together a Lipid Medication Cheat Sheet along with summary information for each class that is important to know for certification exams and is very useful in clinical practice.
Together, we can improve the quality of life and outcomes for people living with diabetes. Getting LDL cholesterol levels to target is an important interventions to maintain health. Thank you for reading this article and advocating for the best evidence-based care.
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.
Objectives:
Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with prediabetes, diabetes and other related conditions.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
This bundle includes our CDCES Online Prep Bundle (featured above) plus the ADCES Review Guide – 5th Edition-Revised. The online bundle includes Level 1, Level 2, and Level 3 (Boot Camp), plus two bonus courses. The ADCES Review Guide offers over 480+ practice questions and is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam.
Enroll now | $499
This presentation will include 2023 updates from the ADA Standards of Care. This course offers critical content that will help with certification exam success. Coach Beverly will delve into Social Determinants of health, assessment strategies, and behavior change approaches.
She will explore the psychosocial issues that can discourage individuals from adopting healthier behaviors and provides strategies to identify and overcome these barriers. Life studies are used to apply theory to real-life situations. A great course for anyone in the field of diabetes education or for those looking for a new perspective on assessment and coping strategies.
Intended Audience: An important course for health care professionals working toward certification, that includes a comprehensive review of the components of population health and individual assessment.
Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.
All hours earned count toward your CDCES Accreditation Information
While the hard copies won’t be available until the new year, you can start reviewing the new standards now in our CDCES Coach App!
Here are some highlights of changes outlined by the ADA:
You can now pre-order a copy for yourself! We will ship it out to you once we receive them sometime in January/February 2023.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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.
Each year, I excitedly scan through the new ADA Standards of Care (SOC) to learn and incorporate best practices into my clinical practice and course content. Based on my initial review, here are some of the highlights I want to share with you right away, but there is a lot more info to come.
Screen for hyperglycemia starting at age 35
This year, I am happy to see that the screening age for prediabetes and diabetes has dropped by a decade, from 45 years of age to 35 years of age. This new guideline provides diabetes specialists with the opportunity to reach out to our colleagues and communities to spread the word that ALL people, regardless of weight, ethnicity and other risk factors, need to be tested for glucose dysregulation starting at age 35.
New Kidney Protection Guidelines
Since diabetes is the leading cause of kidney failure, I appreciate that the ADA has created a new standard dedicated to renal protection, called Chronic Kidney Disease and Risk Management (Standard 11).
Highlights of this standard include:
New Vaccination Information and Fatty Liver Treatment Recommendations
Standard 4 includes updated information on vaccinations.
In our clinic, we are encouraging all people to get the influenza vaccine in addition to the COVID vaccine series. Experts predict that severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and influenza viruses will both be active in the U.S. during the 2021–2022 season.
Most people don’t know that getting the Influenza vaccine decreases risk of death.
New data is revealing that the influenza vaccine doesn’t just lower the risk of getting the flu, it also lowers risk of all cause mortality and cardiovascular events and death. This simple annual intervention is recommended for all individuals with diabetes 6 months and older.
Fatty Liver Disease – Under detected and under treated
Over 50% of people with diabetes have non-alcoholic fatty liver liver disease (NAFLD) and the percentage is even higher for those with diabetes and a BMI of 30 or greater. Yet, there is no standardized diagnostic or treatment strategy. Experts in the field are trying to raise awareness while developing a consensus statement.
Diabetes specialist can take an active discovering fatty liver disease by looking for elevated liver enzymes, especially in those with elevated BMI and other risk factors. Even without an official diagnosis, if NAFLD is suspected, we can encourage healthy eating, weight and glycemic management plus interventions for hypertension and dyslipidemia.
In addition, some studies indicate that pioglitazone, vitamin E treatment, liraglutide, and semaglutide treatment of biopsy-proven non alcoholic steatohepatitis (NASH) improves liver histology, but effects on longer-term clinical outcomes are not known. Treatment with GLP-1s and SGLT-2s has also shown promise in preliminary studies. But more research is needed!
There is so much more to explore, please join Coach Beverly on February 3rd for our Annual Standards of Care Webinar and a comprehensive review!
Click below to download our CDCES Coach App to read the Standards today.
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2022 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.
Objectives:
Intended Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for their patients with diabetes and other related conditions.
Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.
All hours earned count toward your CDCES Accreditation Information
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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.
Written by Monique Jackson, MSN, CFNP, WHCNP, CDCES
A new study finds that hemoglobinopathies may distort A1C accuracy for people of African descent living with diabetes.
Hemoglobin variants don’t increase the risk for diabetes, but it can affect the results of A1C tests. African Americans Heterozygous for the common hemoglobin variant HbS may have, for any given level of mean glycemia, lower A1C by about 0.3% then those without the trait. Another genetic variant, X-linked glucose-6-phosphate dehydrogenase G202A, carried by 11% of African Americans, was associated with a decrease in A1C of about 0.8% in homozygous men and 0.7% in homozygous women compared with those without the variant (American Diabetes Association, Standards of Care in Diabetes-2021; 16).
Health care professionals often use A1C test results to guide decisions about diabetes care, such as changes to medication, meal plan, or physical activity routine to manage diabetes. In those with certain hemoglobin variants, A1C is not accurate for diagnosing and managing diabetes. Different tests that accurately reflect long term glucose levels are needed for early diagnosis and to provide needed medical management that prevents complications.
At my clinic, where I work as a Diabetes Nurse Specialist, an African American individual arrived with a high random glucose and mildly abnormal A1C. Reviewing their lab work, I noticed that the random blood glucose was 300 mg/dl and the A1C was at approximately 7.0%. When I converted the A1C to average blood glucose and compared with the elevated reading in the logs, the numbers did not match up. I realized that this individual had one of the hemoglobin variants (Sickle Cell anemia) HbS. I ended up starting them on Metformin for blood sugar, Atorvastatin because of the guidelines that everyone with Diabetes should be on a statin, Aspirin to prevent heart attack, and Lisinopril for blood pressure control.
Without this clinical finding that the elevated blood sugars were not reflected in the A1c, this individual might not have been started on diabetes treatment, because of the false low A1C.
A1C reflects glucose concentration from the past 2-3 months, but this relationship may differ between those with nutritional deficiencies, anemia, or genetic hemoglobinopathies, including the Sickle cell trait.
Since A1C measures the percentage of glycosylated hemoglobin, individuals who possess variants of hemoglobin can exhibit falsely low readings.
Fructosamine testing, which evaluates albumin glycosylation for the past 2-3 weeks, may be a better measure to help people with diabetes monitor and manage their blood glucose levels in cases where the A1C test cannot be used and/or a short-term monitoring window is desired.
It is important to consider the results of the A1C, fasting blood glucose, two-hour glucose tolerance test, random blood glucose, and or fructosamine when you are screening someone with diabetes who is diagnosed with a Hemoglobin variant.
A1C testing on two different occasions to diagnose diabetes for those with Hbs variants is not recommended, because it will yield false low results. To diagnose a person with diabetes and Hbs variants, the ADA recommends only plasma blood glucose criteria be used to diagnose diabetes.
More research is needed on the diagnoses of diabetes utilizing the A1C in populations with increased prevalence of Hbs variants. In addition, we need research aimed toward providing more accurate tests for the diagnosis and management of conditions associated with increased red blood cells turnover, such as sickle cell disease, hemoglobinopathy variants, pregnancy (second and third trimester).
We are so excited to introduce our newest DiabetesEd Specialist Blog Contributor, Monique Jackson, MSN, CFNP, WHNP, CDCES.
Monique is a Board-Certified Family Nurse Practitioner licensed in the State of California and a member of the California Nurse Practitioner Association and a member of the American Association of Nurse Practitioners. Monique resides in Los Angeles, California. She enjoys gardening, sewing, reading, learning new things, fine dining in her spare time and spending time with her family.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]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.
2021 ADA Standards include important changes that you won’t want to miss!
Diabetes nerds across the United States are staying up way past their bedtime to read the latest standards in diabetes! You can now revel in the updated ADA Standards in our CDCES Coach App. Dig into the latest diabetes care recommendations, while waiting for your Standards Booklet in the mail.
Or you can join Coach Beverly for a virtual webinar that will walk you through these critical updates for your clinical practice and exam success. Join our ADA Standards Live Webinar on February 2nd at 11:30 am PST!
Based on my review of this playbook for Diabetes Specialists, here are some of the highlights:
Those are just some of the highlights, but there is so much more to discover. Please join Coach Beverly on February 2, 2021, at 11:30 am for her annual State of the Standards Live Webinar.
See complete Level 2 Standards of Care Webinar Schedule Here
This course is an essential review for anyone in the field of diabetes. This course summarizes the 2021 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for health care professionals involved in diabetes care and education.
Earn 2.0 CEs and get ready to lead the charge to implement best care practices for the New Year.
Topics Include:
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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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.
Diabetes Intensive with Dana Armstrong, RD, CDCES | Medical Nutrition Therapy + Meal Planning
Join Dana Armstrong, RD, CDCES, a trailblazer and thought leader, for a lively and intensive review of the latest in Medical Nutrition Therapy with immediate application to your clinical practice.
Dana combines the newest findings, her clinical experiences, plus the ADA Standards of Care into an action-packed presentation that will inform your practice while preparing for the certification exam.
Session 1 May 27 | Medical Nutrition Therapy Overview | Ready for Viewing!
Session 2 May 27| Meal Planning – How to Eat by the Numbers | Ready for Viewing!
$69 | Earn 4.0 CEs
Course Description: These two 2-hour courses review the latest national nutrition guidelines and provide strategies to translate this information to an individual living with diabetes.
Included is a discussion on different approaches to meal planning and the benefits and limitations of each. Dana will also review metabolic surgery, gastroparesis, and disordered eating.
She reviews nutrition approaches during pregnancy and for those living with chronic co-conditions. Dana also provides insights on how to support the transition to healthier eating using a “tasteful” approach.
Objectives:
Speaker Bio for Dana Armstrong, RD, CDCES
We are thrilled to welcome our guest speaker, Dana Armstrong, who will be joining our Virtual and Live Courses!
Dana received her degree in nutrition and dietetics from the University of California, Davis, and completed her internship in dietetics at the University of Nebraska Medical Center in Omaha. Dana is the Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic. She provides leadership for the Department of Diabetes Services and ensures coordination and integration of an effective system-wide Diabetes Center of Excellence across the organization for optimum patient care and collaboration of services. Having a child with diabetes, she combines her professional knowledge with personal experience and understanding.
These sessions are also included in our Virtual Conference.
Click here to enroll in the entire program.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
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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.
To be honest. the vaccination recommendations for diabetes have been shrouded in a veil of mystery for me, until this year.
Thankfully, the 2022 ADA Standards are wonderfully clear in describing the vaccination schedule and types for people living with diabetes. We created this simple chart that you are free to download and share with your colleagues and in your work setting.
Even though these vaccine recommendations are well established, I thought it would be interesting to find out what percentage of people actually get the complete compliment of recommended vaccinations.
According to the CDC data, among those with diagnosed diabetes, the vaccination coverage for influenza, pneumococcal, and shingles was lowest among lower income adults and varied by race and ethnicity. Hepatitis B vaccination coverage was lowest among poor adults, and it decreased with age.
As diabetes specialists, we can have a significant impact on encouraging people with diabetes to receive these important vaccinations. We can work within our health care systems to establish systems and surveillance to monitor vaccine participation. Partnering with community health workers and liaisons can create bridges to increase vaccination rates.
Vaccination Rates for People with Diabetes:
Given that most experts predict that severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and influenza viruses will both be active in the U.S. during the 2021–2022 season, getting the influenza vaccine is especially important.
Most people don’t know that getting the Influenza vaccine decreases risk of death.
New data is revealing that the influenza vaccine doesn’t just lower the risk of getting the flu, it also lowers risk of all cause mortality and cardiovascular events and death. This simple annual intervention is recommended for all individuals with diabetes 6 months and older.
See Table 4.5 in ADA Standard 4, 2022 for complete info
This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
[yikes-mailchimp form=”1″]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.