Answer A is incorrect: 20% chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is tempting but incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago.  Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.

Answer B is incorrect: 26% chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.

Answer C is correct: 47% chose the correct answer, GREAT JOB.  “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” Per the 2026 ADA Standards of Care, bone health needs to be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.

Answer D is incorrect: 7% chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.

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!

Answer A is correct: 94% chose this answer, “It sounds like you are worried about a parasite infection. Tell me more about what you’ve read.” Great job. A is the best answer because it uses person-centered, nonjudgmental communication, as recommended by the ADA. It avoids dismissive language and explores misinformation respectfully. It preserves the therapeutic alliance.

More Info on Parasites and Diabetes

Since many of you mentioned that patients are asking about parasites causing diabetes – here is the scoop. This false rumor is based on a video from a scientist named Hulda Clark that has since been debunked. Clark falsely claimed that most diseases, including AIDS, Cancer and diabetes, were caused by different parasites and could be cured with an electric “zapper.”  Authorities took action against Clark’s “zapper” and other examples of her unproven treatments that she claimed could “cure all diseases” both before and after her death.  Read more here

John Buse, MD a professor at the University of North Carolina School of Medicine, said there is a long-standing theory that infection by certain viruses could trigger the body’s immune response that leads to type 1 diabetes, but that no link has been established between a parasitic infection and any type of diabetes. He also said there is no evidence that methanol (another proposed false claim) — a poison — would have any different effect on someone with diabetes than on a person without high blood sugar.

Answer B is incorrect: 3% chose this answer, “Yes. We will be treating that issue soon, but first we need to focus on your insulin doses.” Option B offers a false narrative saying that they are going to treat the parasitic infection then shifts focus to the blood glucose, without recognizing JR’s emotional distress.

Answer C is incorrect: 2% chose this answer, “I can see how you would be concerned, but here is no such thing as pancreatic parasites.” Option C does initially recognize the emotions but then ends with a dismissive tone, that may make JR feel defensive and unheard.

Answer D is incorrect: 1% chose this answer, “Sadly, prediabetes always progresses to diabetes when people are acutely ill, and you will probably be discharged on insulin therapy.” Option D completely ignores the emotional distress in addition to making assumptions that may not be true.

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!

Answer A is correct: 55.1% chose this answer, “When scheduling, JM requested an individual appointment” Answer A is correct; it does NOT justify individual DSMES. Although diabetes care should be patient-centered, patient preference alone does not meet Medicare criteria for individual DSMES. Medicare requires the referring provider document justification of barriers to group learning which can include clinical, educational, or psychosocial need.

Answer B is incorrect: 12.74% chose this answer, “The referral for DSMES stated JM has a language barrier” Answer B is incorrect and does justify individual DSMES. Language barriers can significantly limit participation in group DSMES. Medicare recognizes a referral with stated language and communication needs as valid justification for an individual visit.

Answer C is incorrect: 15.61% chose this answer, “A group DSMES class is not available within the next 3 months” Answer C is incorrect and does justify individual DSMES. Medicare will approve individual DSMES if no group class is available for two months or longer from the date on the referral.

Answer D is incorrect: 16.56% chose this answer, “JM was referred for training on starting insulin therapy” Answer D is incorrect and does justify individual DSMES. A referral for initiation of insulin therapy requires individualized instruction. This can include injection technique, dose adjustment, hypoglycemia prevention, and problem-solving. Medicare considers this
an appropriate reason for individual DSMES.

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!