Telemedicine in Rural Areas lead to A1c Improvements

COVID-19 has changed the landscape of how healthcare services are delivered in the U.S.

In our new “normal,” many healthcare professionals have begun to adopt telehealth/telemedicine services.

Is this new method leading to positive outcomes?

In a Veterans Health Administration program that combined Intensive telemonitoring, self-management and medication support, there were improved A1c levels within six months for those with diabetes residing in rural areas.

After 6 months of telehealth interventions, researchers of the Advanced Comprehensive Diabetes Care (ACDC), found a 1.36% reduction of HBA1c levels.

Specialists created custom-tailored intensive diabetes management interventions by using telehealth and electronic records systems.

Overall, the results from the ACDC programs across 7 VHA sites showed an overall improvement of “HbA1c, blood pressure, and diabetes self-care.”

People living in rural areas tend to have limited access to specialty care and diabetes management programs. By using telemedicine services we can create more opportunities for people living in rural areas to better manage their diabetes.

To read more, click here.


Meds Management for Type 2 |
Standards of Care Intensive 2020
Join us on June 25, 2020, at 11:30 am (PST) 
1.5 CE | $29.00 or No CEsFree

This advanced-level course is designed to help participants determine the best medication choice based on the patient’s unique characteristics. The content incorporates the management guidelines published by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) Algorithms. We will discuss the role of lifestyle changes and review the pros and cons of available diabetes medications using a patient-centered approach. In addition, we discuss medication algorithms in detail. Participants not familiar with the basics of diabetes medication may benefit from first enrolling in our “Meds for Type 2” and “Insulin 101 Course.”

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.

Does Video Gaming Affect Food Choices? | Tech Thursday

College-aged men who play video games consumed less healthy foods than their non-gaming peers, according to data presented at Nutrition 2020 Live Online.

“Video game usage has been studied extensively in children and adolescence, less in adults, and to our knowledge not at all in college students. Because college students are presented with a unique experience compared to other adults and children, it is important to understand how video game users in this specific population behave,” stated Dustin G. Moore, a graduate student at the University of New Hampshire, told Healio Primary care.

Male college students who were moderate or heavy video game players ate more saturated fat than those who did not play video games. While those who were moderate gamers consumed more salt than those who did not play video games, according to the data presented at Nutrition 2020 Live Online.

Heavy video game playing was also associated with consuming more discretionary calories when compared with those who don’t play. Men who were moderate and heavy video game users consumed fewer fruits and vegetables.

There appeared to be no significant differences in alcohol consumption, sugar, total dietary fat, and waist circumferences.

“This is a concerning finding because previous research has shown that lifestyle habits in early adulthood tend to continue later in life,” Jesse S. Morrell, PhD, principal lecturer for the nutrition program at the University of New Hampshire, said in an interview. “If these poor lifestyle habits continue, this population will be at higher risk for [above target weight] and chronic disease.”

It would be interesting to track video game time vs outdoor physical activity time in this same group, and comparing eating habits.

As diabetes specialist invested in the health of future generations, it is important to encourage physical activity and healthy eating in all age groups, but especially in the college-age group.

College is often the first time teens are living away from home, and making independent choices on food and meals.

To read more, click here.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


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.

Vitamin D, Diabetes, & COVID-19 | Tech Thursday

Interesting findings that explore the relationship between Vitamin D levels and COVID-19 outcomes are being released.

In an article by WedMD, there have been several international studies that evaluate Vitamin D levels in people infected with COVID-19.

None of these studies indicate definitively if higher levels of Vitamin D reduce the risk of contracting or becoming severely ill with COVID-19. Though, they’ve noticed that the “sickest” people with COVID-19 had low levels of Vitamin D.

Several studies conducted across different countries indicate that a healthy level of Vitamin D might strengthen our immune system and reduce our vulnerability to disease.

Vitamin D is so important for our bones, muscles, and a nutrient our immune systems need for optimal health. An adequate blood level of Vitamin D is between 20 nanograms/milliliter to 50 mg/ml. A simple but slightly costly blood test can measure one’s level of this vitamin.

People living with diabetes (type 1 & type 2) often have lower levels of Vitamin D. Vitamin D deficiency can manifest as fatigue, depression, muscle and bone pain, and decreased overall health.

Boosting Vitamin D Levels

Lifestyle changes can be used to treat low Vitamin D levels; eating healthy foods like eggs, mushrooms, fresh fish, and getting outside in sunlight, can increase our Vitamin D levels. As a supplement, Vitamin D3 or cholecalciferol is recommended at a dose of 400-1000 IU /day.

Vitamin D is made by the body when the skin is exposed to sunlight. Often people in the Northern Hemisphere with less sun exposure have lower levels of Vitamin D. Regular sun exposure can help increase Vitamin D levels, although supplementation seems to be more effective.

In addition, improving access to healthy foods needs to be a priority for all people, but especially vulnerable populations and those with diabetes.

For more information, read the WebMD article here. We also recommend you read Vitamin D and Type 1 Diabetes: What the Research Says & Higher vitamin D levels linked to lower risk for diabetes. Click here for NIH Vita D Info page.

Update

Healio has released more information on this topic that you can find on their recent article, “Researchers caution against ‘misinformation’ on vitamin D during COVID-19 pandemic.”

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


Please join us today, May 27th for our Virtual Course with Dana Armstrong, RD, CDCES, Medical Clinic Director of The Diabetes Center/Salinas Valley Medical Clinic.

Medical Nutrition Therapy + Meal Planning
Recorded and Ready for Viewing!
$69 | 4.0 CEs 

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.

Webinar Topics

Session 1 – Medical Nutrition Therapy Overview | Recorded & Ready for Viewing!

Session 2 – Meal Planning – How to Eat by the Numbers | Recorded & Ready for Viewing!

All presentations are recorded and available for on-demand viewing.

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.

Update for CMS Guidelines for CGM Coverage | Tech Thursday

Last week we posted a blog titled “CMS Updates For CGM Coverage,” which on the surface seemed like very exciting, impactful changes on CMS regulations for CGM coverage during the COVID-19 pandemic.

After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.

What do these changes actually mean?

To learn more we dove into the interim final rule with comment period (IFC) that was released by the Department of Health & Human Services – Centers for Medicare & Medicaid Services.

 In the March 31st COVID-19 IFC, we finalized on an interim basis that we will not enforce the clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump NCDs (Nation Coverage Determinations) and LCDs (Local Coverage Determinations) (including articles) allowing for more flexibility for practitioners to care for their patients. This enforcement discretion will only apply during the PHE for the COVID-19 pandemic. 

The language in the IFC is vague and ambiguous regarding what it means to have less stringent and “more flexible” requirements of obtaining a CGM in the time of the COVID-19 for people with diabetes. Though we have found a few highlights from the document based on feedback by our community on what is unclear.

The Highlights

  1. These changes are only applicable to those who are COVID-19 positive and living with diabetes.
  2. The type of diabetes one has is no longer relevant in coverage determinations.
  3. These guidelines do not automatically expand to Medicaid coverage. For more details on Medicaid coverage, contact your local state.

In this IFC, we are finalizing on an interim basis that we will not enforce the clinical indications for therapeutic continuous glucose monitors in LCDs. For example, we will not enforce the current clinical indications restricting the type of diabetes that a beneficiary must have or relating to the demonstrated need for frequent blood glucose testing in order to permit COVID-19 infected patients with diabetes to receive a Medicare-covered therapeutic continuous glucose monitor.  

Overall, there is still much to learn about these changes as they apply to real-life situations. This is an unprecedented time for all of us and there is a lot of unknowing. We hope as things develop to keep you informed.

To read the full IFC click here. For more information about Medicaid Guidelines, click here.

If you have any more information on these changes, please click here to visit our survey to update us.

Update from Michael Christian breaking down the CMS changes.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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.

Has Access to CGM Coverage Improved with CMS updates? We want to hear from you!

Yesterday, we shared our blog about the CMS Updates For CGM Coverage. These updates made us feel hopeful that people with diabetes would have fewer barriers and improved access to CGM devices.

After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.

What is your experience with accessing CGMs for people with diabetes?

We are hoping to open up a dialogue around this topic and hear from our community members about how these guidelines apply to real-life situations.

If you have information to share, please fill out our brief survey by clicking here.

We will send a follow-up post next week with updates.


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!

CMS Updates For CGM Coverage | Tech Thursday

Disclaimer: We always strive to give accurate information with our blogs. For this article, we discovered we need to dig deeper into this topic to make sure we got it absolutely right. If you have any information on this content, please click here to visit our survey to update us.

We have positive news to share for people with diabetes who are on insulin and would like to use a CGM (Continuous Glucose Monitor)!

The Center for Medicare and Medicaid Services (CMS) is relaxing some of their stringent requirements for obtaining a CGM during the COVID-19 pandemic.

“CMS will not enforce certain clinical criteria in local coverage determinations that limit access to therapeutic continuous glucose monitors for beneficiaries with diabetes. As a result, clinicians will have greater flexibility to allow more of their diabetic patients to monitor their glucose and adjust insulin doses at home.”

CMS just announced they would not enforce certain clinical criteria for obtaining a CGM, insulin pump, or associated supplies during the pandemic. For example, in-clinic provider visits, certain lab tests like a C-peptide or antibody testing, and demonstrations of SMBG would not be mandatory.

This is huge for people with diabetes!

It would limit visits to hospitals, clinics, and labs and help reduce exposure to the coronavirus at these public facilities.

Since CGM’s and insulin pumps have the ability to transmit the collected data to a provider for a telehealth consult, providers can now use that data to review during telehealth visits. This can strengthen the relationship during COVID by allowing for data-driven insulin adjustments.

This is a win-win situation and we can hope that private insurance companies will follow the lead of CMS for the benefit of people with diabetes who use insulin.

To learn more read diaTribe’s article and visit CMS.gov.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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.

May Newsletter | Insulin Savings, Telehealth Updates, and Salivary Glucose Testing

Click here to read our entire May Newsletter

As a Diabetes Nurse Specialist in a local clinic, I am providing telehealth once a week. During these visits, I am checking in with people about their food and medications.

Do you have enough food and insulin to last? Most of them answer, “yes, for now”. 

Many of them may run out of insulin and supplies in the near future, some as a result of the costs that make essential medications in-affordable. If this is the case, what can we offer them?

We are excited to thank our guest contributor and Diabetes Educator of the Year, Dr. Diana Isaacs, who has provided us with helpful information and a multitude of resources for people in need of low-cost insulin.

In light of the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS), has expanded opportunities to provide remote care to people with diabetes. We have highlighted some recent updates and provided links to helpful resources for your billing team.

Lastly, we are looking towards the future with salivary glucose testing and insights into a past Question of the Week.

I am grateful to be a part of this amazing community of diabetes specialists. Thank you for your care, concern and advocacy.

Be well! Coach Beverly

Click here to read our entire May Newsletter


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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.

Saliva-Based Glucose Testing | Tech Thursday

Courtesy of iQ Group Global’s website.

“Scientists have been in search of a more cost-effective, non-invasive, and accurate diabetes monitoring alternative to blood sugar testing.”

Is there a better way to check blood glucose than uncomfortable fingersticks?

For people with diabetes who use self-management of blood glucose (SMBG) to monitor diabetes progress, fingersticks can wear on one’s fingertips, emotional well-being, and bank account.

Even continuous glucose monitors (CGMs) that provide around-the-clock glucose information and reduce the need for fingersticks, help with finger fatigue. But for many, they are not an affordable option.

Is there another option to check one’s glucose that is less painful and accurate?

The answer could be saliva-based glucose readings.

“Lab tests of the saliva process have shown promising results with an accuracy rate of 95.2%. The research has been published in the journal PLOS ONE,” wrote Dr. Kamal Kant Kohli for Medical Dialogues.

Courtesy of iQ Group Global’s website.

Currently, companies like iQ Group Global and GBS inc. are developing Saliva Glucose Biosensors. This biosensor is a small strip that once matched with someone’s saliva offers an immediate glucose check and sends the results to an app on one’s phone.

Once these new systems are approved, it will be a game-changer.

Though saliva-based glucose testing has not yet hit the markets, for the millions of people that continue to perform finger sticks, we hope that saliva glucose testing will be available soon.

To read more, click here or visit iQ Group Global and GBS Inc websites.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

  1. Describe critical teaching content before starting insulin pump therapy.
  2. Describe appropriate candidates for insulin pump therapy.
  3. Discuss strategies to determine and fine-tune insulin pump basal rates.
  4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
  5. State important safety measures to prevent hyperglycemic crises.
  6. List inpatient considerations for insulin pump therapy and CGMs.
  7. Discuss features of available professional and personal CGMs and insulin pumps.
  8. Describe CV risk factors associated with diabetes and future event prediction.
  9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.


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.