From Dipsticks to GFR – How to Evaluate Kidney Function

The new ADA Standard on Chronic Kidney Disease and Risk Management outlines importance of measuring kidney function and the impact on our practice and quality of life for people living with diabetes.

I wanted a better understanding of these renal metrics since they are such an important indicator of risk, treatment and health outcomes.

Based on my review, we share four findings and take a closer look at renal function tests and their significance.

4 Kidney function findings that impact our practice:

  • Predicts CV Disease – albuminuria is associated with kidney disease and is a predictor of cardiovascular events, so it is important to measure and accurately evaluate urine protein and take action to prevent cardiovascular events.
  • SGLT2’s slow progression of chronic kidney disease and decrease risk of CV events. Therefore SGLT2 therapy is recommended for those with a GFR of 25 or greater with urinary albumin creatinine 300mg/g or more.
  • Frequency of measure depends on findings. People with diabetes need to have their Urinary Albumin Creatinine Ratio (UACR) measured yearly. However, if the UACR is 30mg/g or greater and their GFR is less than 60, kidney function should be tested twice a year.
  • Measure of success: If urine albumin severely increased, the goal is to provide an intervention and decrease albuminuria by 30%.

What is albuminuria?

Albuminuria is a general term that means there is significant protein in the urine. In the old days, we would order a 24 hour urine collection to determine the degree of albumin in the urine. We used the terms microalbuminuria to describe slightly elevated protein levels and macroalbuminuria to describe significant urine albumin. Since those terms are no longer used, how do we describe how much protein is in the urine? Now, we use Urinary Albumin Creatinine Ratio (UACR) to determine levels of urine protein and their significance.

What Exactly is Urinary Albumin Creatinine Ratio (UACR)?

Simply put, UACR is ratio of urine albumin to urine creatinine. The UACR is usually already calculated on the lab report, but using this lab example to the right, the albumin is 2.9 and the urine creatinine is 91. To determine the UACR, you would divide albumin by creatinine, 2.9 / 91 = 0.0318 in mg/mg. Then convert it to mg/g by moving the decimal point over three places, or 31.8 (32) in mg/g.

The reason this value is reported as a ratio as opposed to just urine albumin, is to account for the concentration and hydration status of the individual which improves accuracy.

UACR is an important measure of kidney health and the goal is to measure it yearly and if elevated, more frequently.

Any level of UACR 30mg/g or greater indicates kidney damage and requires prompt protective action by the health care team.

Action to protect the kidney include lifestyle interventions, blood pressure (ACE or ARB) and blood glucose management, along with use of SGLT-2 Inhibitors, GLP-1 RA’s and possibly finerenone.

Testing for UACR and Confirming Results

Testing for UACR is fairly easy. The ADA has approved using urine dipstick or a urine sample to calculate the UACR, However, according to the standards, two of three tests need to be positive to confirm diagnosis within a 3 to 6 month period before confirming diagnosis of moderate or severe albuminuria. Exercise within 24 h, infection, fever, congestive heart failure, marked hyperglycemia, menstruation, and marked hypertension may elevate UACR independently of kidney damage.

How to test for GFR

Another measure of kidney function is the Glomerular Filtration Rate. The result is derived from a complicated mathematical calculation, using the person’s creatinine and other data. For this reason, it’s often called an estimated GFR or eGFR. People with diabetes need their creatinine evaluated yearly to determine their GFR. Here is a link to an eGFR Calculator.

For people with diabetes, we start keeping a close eye on the GFR when levels start dropping below 60. As with UACR, heath care providers need to take preventive action to maintain kidney function and protect GFR through lifestyle and medications.

In conclusion, as diabetes specialists, being familiar with the results of these kidney health measures help us advocate on behalf of people with diabetes. Making sure our health care organizations are regularly measuring kidney function and taking action to protect these amazing filtering units can save lives and improve quality of life.


You are invited to join Coach Bev on February 3rd at 11:30 for an intensive 2-hour live webinar reviewing what Diabetes Specialists need to know about the updated standards.

Enroll in our Level 2 | ADA Standards of Care | 2.0 CEs

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.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

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.

2022 ADA Standards – New Updates and Findings

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.

Clinical Practice Updates

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:

  • The recommendation to start SLT2 Inhibitors if the GFR is 25 or greater and the urinary albumin is 300 or greater. An abundance of data has demonstrated that SGLT2’s protect renal function, delay progression of chronic kidney disease and decrease cardiovascular events. If clinically indicated, this class of medication can be used as a first line treatment for people with type 2 diabetes.
  • In addition, this standard recommends including the nonsteroidal mineralocorticoid receptor antagonist (finerenone) for treatment of diabetes kidney disease (see our Cheat Sheets for more info).

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!


Start reviewing the Standards Today with our CDCES Coach App!

Click below to download our CDCES Coach App to read the Standards today.


You are invited to join Coach Bev on February 3rd at 11:30 for an intensive 2-hour live webinar reviewing what Diabetes Specialists need to know about the updated standards.

Enroll in our Level 2 | ADA Standards of Care | 2.0 CEs

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:

  1. A review of changes and updates to the 2022 ADA Standards of Medical Care
  2. Identification of key elements of the position statement
  3. Discussion of how diabetes educators can apply this information in their clinical setting

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.

Enroll in our entire Level 2 – Standards of Care to join us for the below 2022 Live Webinar Updates. All courses air at 11:30 a.m. (PST)

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!

Sign up for DiabetesEd Blog Bytes

* indicates required


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.

A1c may not accurately Diagnose Diabetes in People of African Descent

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.  

African Americans at risk for falsely low A1cs due to Hemoglobin Variants

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. 

Mismatch between Glucose and A1c –  My Clinical Finding

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.    

Summary and Notes for the Future

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).  


Welcome, Monique Jackson, MSN, CFNP, WHCNP, CDCES, our new Blog Content Writer!

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!

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 Nerds Rejoice – ADA Standards 2021 are Here!

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!

There are some exciting changes in the 2021 Standards.

Based on my review of this playbook for Diabetes Specialists, here are some of the highlights:

  • There is a focused blending of science and person-centered care, with an intentional exploration of uncovering barriers and exploring social determinants of health.
  • A new powerful acronym was released. CRN – which stands for Cost-Related Medication Nonadherence. ADA is working to raise awareness of cost as a barrier to care and encourage care providers to address cost issues on a regular basis. Especially with the current economic crisis, finances are more of a barrier than ever.
  • More clarification about Latent Autoimmune Diabetes in Adults.
  • Immunization clarification. Finally, I completely understand the vaccine guidelines, which are more comprehensive and detailed than ever. Thank you, ADA.
  • Given the shaming associated with a diabetes diagnosis, a new section on “mindful self-compassion” is included in the Facilitating Behavior Change section.
  • The medication management section just keeps getting better. This year’s version is more straightforward while incorporating the newest research findings in an algorithm that is easy to follow.
  • OVER basalization made the headlines in the Pharmacologic Approaches to Hyperglycemia section.  Too much basal insulin is an issue that we encounter way too often. These guidelines help to clarify what is too much basal and offer possible solutions.
  • Older adult guidelines include updates on glucose goals and prevention of hypoglycemia.

Want more details on the 2021 Standards?

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


Join Coach Beverly on February 2, 2021, for her annual
Level 2 – Standards of Care Update!

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:

  • A review of changes and updates to the 2021 ADA Standards of Medical Care
  • Identification of key elements of the position statement
  • Discussion of how diabetes educators can apply this information in their clinical setting

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!

AccreditationDiabetes 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.

Women & Meds Management Webinars | Ready for Viewing

Watch for FREE or purchase to earn CEs!

Perfect for those planning to take CDCES or seeking an update.

Coach Beverly is updating her Level 2 Standards of Care Intensive Courses.

The Women with Diabetes webinar is completed revised for 2020, with a focus on detecting and managing gestational diabetes and diabetes in pregnancy.

Medication Management includes important 2020 updates. We include a critical review of existing medications and instructions on how to use the ADA or AACE Algorithms as a roadmap in clinical practice.

We hope you can join us! Coach Beverly


Women & Diabetes | Ready for Viewing

1.5 CEs | $29.00 or No CEsFree

Women with diabetes are confronted with a variety of issues that require special attention, education, and understanding. This online course reviews those special needs while focusing on Gestational Diabetes and Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, and prevention of complications during pregnancy.

Topics include:

  • Three issues that affect women with diabetes
  • The unique attributes of pre-existing diabetes in pregnancy and gestational diabetes
  • Diagnostic criteria and management goals for gestational diabetes
  • Prevention measures to keep mother and baby healthy

View FREE recorded webinar (no CEs).


Meds Management for Type 2 | Ready for Viewing

1.5 CE | $29.00 or No CEsFree

Have you heard a novel insulin formulation was FDA approved this week? What is all the news about metformin? How do we know which diabetes medication to start or add next?

Join Coach Beverly RN, MPH, CDCES, BC-ADM for an intensive live course that weeds out fact from fiction while detailing the latest diabetes medications and management algorithms.

During this live stream webinar, we will discuss diabetes medication benefits, considerations and critical information to share with people with diabetes and providers.

Coach Beverly will highlight the key elements of the latest Medication Guidelines by AACE and ADA. We will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and discuss new medications.

Topics include:

  • Overview of classes and actions of diabetes medications
  • Medication updates and new recommendations
  • Using the ADA/AACE algorithms to improve diabetes care and outcomes

Watch FREE Recorded Webinar (No CEs)


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!


AccreditationDiabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

June Newsletter | Strategies to Provide Inclusive Care

Diabetes and Inclusivity – Strategies for Change

Click here to view our June Newsletter

Our community has faced many challenges in 2020. As a result of the pandemic, some health professionals have lost their positions or had jobs furloughed. We have shifted from in-person visits to telehealth. For those working on the front line, there is a real fear of being infected by COVID-19.

In our neighborhoods, we are witnessing many of our community members demanding a repair of social injustices. There is a recognition that worse health outcomes with COVID-19 and diabetes are often the result of longstanding social inequities in marginalized communities.

As diabetes advocates, we owe ourselves the time to reflect on how these inequities came to be and how we can contribute to their repair.

Certainly, as a community dedicated to health, we can stand up and acknowledge, address, and advocate to improve health equity for each person.

In this newsletter, we explore strategies to provide more inclusive diabetes care. From reflecting on the language we choose to how we set up and deliver our health care services. Let’s step back and take a new view from a different lens and see how we can be more welcoming to all people, but especially to those from marginalized communities.

We also celebrate the 2021 Medicare Cap on the monthly cost of insulin and share a warning on some brands of metformin. Lastly, we dive deep into two of our Questions of the Week and provide rationales.

Please consider joining Coach Beverly for her ADA Standard Intensive Live Stream Webinar Series (below). We invite you to join us for free as our guest. We want to make sure that everyone has access to this critical information.

Coach Beverly

Click here to view our June Newsletter


Upcoming Live Streaming Webinar
Airs June 23, 2020 from 11:30 am to 12:30 pm (PST)

Our Level 2 Standards of Care Intensive Series is designed to engage students in deciphering and exploring the ADA Standards of Care from top to bottom. This straight forward program will provide you with information you can use in your clinical setting and also provides critical content for the diabetes educator exam.

Mastery of this content is critical to ensure certification exam success and to improve clinical outcomes.

Register for FREE live stream webinar (no CEs)


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!


AccreditationDiabetes 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.

Medical Nutrition Therapy + Meal Planning | Virtual Course with Dana Armstrong | 4.0 CEs

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.

Virtual MNT Course Dates:

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

Purchase Course

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:

  1. Prioritize person-centered nutrition issues based on assessment and clinic data.
  2. Explore national guidelines for medical nutrition therapy and how to individualize interventions from a person-centered perspective.
  3. Describe the impact of micro and macronutrients on health.
  4. List different meal planning approaches and the pros and cons of each.
  5. Describe how to help people with diabetes to read labels and be thoughtful consumers.
  6. State how to customize nutritional approaches in people living with complications of diabetes.

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!


AccreditationDiabetes 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.

Important Immunization Update for People with Diabetes

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.

What percent of People with Diabetes Get Vaccinated?

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:

  • Influenza vaccine, about 60% of people with diabetes get their annual shot.
  • Pneumonia vaccine only 53% of people with diabetes have recieved this vaccine.
  • Hepatitis Vaccine Series: Only 33.2% of people with diabetes have received their Hepatitis Vaccines as of 2018.
  • Herpes Zoster Series: Only 27.2% adults 60 and older with diabetes had ever received their Herpes Zoster vaccine.
  • HPV Vaccine: About 59% of people in the U.S. have completed their HPV vaccine series.

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


DiabetesEd Boot Camp | Level 3

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.

  • February 8, 2022 – Class 1 – Diabetes – Not Just Hyperglycemia
  • February 10, 2022 – Class 2 – Standards of Care & Cardiovascular Goals
  • February 15, 2022 – Class 3 – Insulin Therapy – From Basal/Bolus to Pattern Management
  • February 17, 2022 – Class 4 – Insulin Intensive – Monitoring, Sick Days, Lower Extremities
  • February 22, 2022 – Class 5 – Meds for Type 2 – What you need to know
  • February 24, 2022 – Class 6 – Exercise and Medical Nutrition Therapy
  • March 1, 2022 –  Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
  • March 3, 2022 – Class 8 – Coping and Behavior Change 1.5 CEs
  • March 8, 2022 – Class 9 – Test-Taking Coach Session (48 Questions) No CE

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.

Diabetes Blog Bytes

Sign up now to receive the latest Blog Bytes in your inbox.

Upcoming Courses & Events

View Full Calendar