Sharp increases in diabetes are being reported by the U.S. Centers for Disease Control and Prevention (CDC).

14% of adults living in the United States now have diabetes and only 10% are aware of it. 

This translates into 1 in 7 Americans living with diabetes. The CDC believes a number of factors are responsible for the sudden increase, including an aging population and an epidemic of obesity.  95% of diabetes cases are Type 2 and are tied to lifestyle factors, where as 5% are Type 1 and typically are diagnosed early in life and do not correlate with lifestyle choices.

• Surprisingly, many more men are now living with diabetes. The study revealed that 16% of men and 12% of women have diabetes.
• Diabetes is also more common within certain groups. 20% of Hispanics, 18% Blacks and 15% Asians and 12% whites are living with type 2 Diabetes, according to data collected via the U.S. National Health and Nutrition Examination Survey.

People who are overweight and obese are also more likely to develop diabetes, the researchers found. Only 6 percent of underweight or normal-weight adults had the disease, while 12 percent of overweight adults and 21 percent of obese adults did.

Although treatment for diabetes is available, said lead researcher Mark Eberhardt, an epidemiologist at CDC’s National Center for Health Statistics (NCHS). The public health goal should be taking steps to prevent the disease. “Sometimes prevention is the best treatment,” he said. 

As Diabetes Educators, we can take a leadership role in our communities by creating and supporting diabetes prevention programs and by providing amazing care to people living with diabetes.

Learn more about starting a Diabetes Prevention Program on our Prevention Resource Page.

To learn more, visit the CDC Website National Center for Health Statistics Site

To learn more: 30 Million Americans Now Have Diabetes – Health Day

Source: Prevalence of total, diagnosed, and undiagnosed diabetes among adults: United States, 2013–2016.
NCHS Data Brief, no 319. Mendola ND, Chen T-C, Gu Q, Eberhardt MS, Saydah S.  Hyattsville, MD:
National Center for Health Statistics. 2018.

Sleep is possibly the most overlooked aspect of successful weight loss. While there is a well known link between obesity and sleep, the actual role sleep plays in appetite regulation and glucose metabolism is often overlooked.

A recent study conducted by Uppsala University in Sweden found evidence that, “lack of sleep encourages the body to store more fat, altering the body’s metabolism.” The study demonstrated that even a small shift in an individual’s sleep schedule may have significant effects on metabolism leading to weight gain.

“Chronic sleep loss, social jet lag, and shift work—widespread in our modern 24/7 societies—are associated with an increased risk of numerous metabolic pathologies, including obesity, metabolic syndrome, and type 2 diabetes,” researchers explain in the new study. “Even minor weekly shifts in sleep timing, or as few as five consecutive nights of short sleep, have been associated with an increased risk of weight gain in healthy humans.”

In this study, fifteen volunteers were separated into two groups. One group received a normal night’s sleep and the other group had no sleep. Both groups gave samples of fat, muscle tissue, and blood. They were also asked to keep a food diary for the duration of the experiment. 

The most significant difference was in gene activity referred to as DNA methylation. This activity, “was linked to cells increasing their tendency to absorb lipids, boosting the body’s ability to store fats.” The participants who received no sleep also had a decreased ability to build or at least maintain muscle mass. Their bodies also experienced an increased state of inflammation and a higher risk for developing type 2 diabetes. 

To learn more: “Losing sleep can lead to more extra pounds”  ZME Science

 

What we say matters.

As educators, advocates, spouses, friends, and providers, our use of language can deeply affect the self-view of people living with diabetes everyday.

The language used in the health care setting is immensely important in determining the success of the interaction and long term relationships.

A judgemental and shaming approach can lead to an absence of engagement and self-management as well as “low satisfaction with care and poor clinical outcomes.” People are more likely to follow recommendations provided by a health care professional if they feel that they are in a supportive and non-judgmental environment. 

Researchers utilized the Open University library to assess the impact that negative verbiage had on goals and outcomes. 68 papers were reviewed that took a deeper look at, “communication elements of doctor-patient relationships, including stigma, empowerment, cultural competence, patient satisfaction, and clinical empathy.”  Negative verbiage included in these papers included words such as “uncontrolled,” “non-compliant” or “non-adherent.” It was found that these words often created a disconnect between the health care professional and the patient which led to little to no changes in health status. 

Thoughtful communication provides a sense of support and empathy and moves both provider and patient toward greater satisfaction and success.

Based on powerful research, there is growing movement within diabetes education and beyond, to rethink the words we use and the approaches we take when providing counsel to people with diabetes.

Let’s lift people up by choosing language that is non-judgmental and person centered.

Join our Mini-Webinar to learn more and take your communication to the next level!

What We Say Matters FREE Webinar
February 15, 11:30 to 12:00 PST

Topics covered include:

• Learn the old-fashioned diabetes phrases, words and approaches that can be left behind.
• Describe diabetes language that is respectful, inclusive, person-centered and imparts hope.
• Practice communicating about diabetes using phrases free from judgement with a focus on a strength-based approach.

 What We Say Matters Powerpoint Handout

This mini-webinar is free, and no CEs are provided, but there is lots of great info!

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FREE Diabetes & Language | Quiz

This four question quiz is inspired by the recent article, “The Use of Language and Diabetes Care” by Dickinson et al. What words we choose, our body gestures and the use of certain terms can have a tremendous impact on our interactions with people living with diabetes. This quiz highlights a few key areas where we may want to rethink our approach or feel reassured that we are on the right track.

To learn more about this topic,

Use of Language in Diabetes Care and Education – 2017 ADA & AADE 
Language is powerful and can have a strong impact on perceptions as well as behavior. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written words whether directed to people with diabetes, colleagues, or the general
public, as well as research questions related to language and diabetes. 

Appropriate language in clinical settings beneficial in diabetes care

 

 

Preparing for the CDCES Exam – Free Webinar! 

Providers often share nutrition recommendations with patients. In spite of best intentions, sometimes these recommendations may not match latest standards or reflect evidence based studies . A survey by the Nutrition and Lifestyle Working Group of the American College of Cardiology sought to understand just how much nutrition education physicians were actually receiving during medical school and throughout their careers.

The results of this survey concluded that while nearly 70% of physicians believed that nutrition education is vital in healing process, only 57% engaged in direct discussion with their patients. Almost 25% of physicians, “recall receiving no nutrition education in medical school” and 35% said their knowledge of nutrition, “often came from a single lecture.” In residency, a shocking 73% received no nutrition education whatsoever. With nutrition being a vital aspect of the healing process, it is hard to ensure you are receiving a complete treatment plan when physicians may not have the proper education to support their recommendations.  

For Diabetes Educators, this provides a wonderful opportunity to coach our referring providers on the latest nutrition guidelines. This can be accomplished by sending brief nutrition updates to providers, inviting guest speakers who have expertise on the latest nutrition guidelines and other strategies. Since we work in interdisciplinary teams, maintaining professional respect is an important aspect for long term collaboration and growth.

With the rise of CVD, Type 2 Diabetes, and other health conditions an intervention is required. “Improving education of physicians through more comprehensive nutrition training in medical schools and advanced postgraduate training is an essential step that can facilitate improvement.”

To learn more about the lack of nutrition education in our healthcare system, visit The Deficit of Nutrition Education of Physicians.

FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors 

The U.S. Food and Drug Administration (FDA) is warning that cases of a rare but serious infection of the genitals and area around the genitals have been reported with the class of type 2 diabetes medicines called (SGLT2) inhibitors. This serious rare infection, called necrotizing fasciitis of the perineum, is also referred to as Fournier’s gangrene.

Please let patient know about this new warning to be added to the prescribing information of all SGLT2 inhibitors.

Patients should seek medical attention immediately if they experience any symptoms of tenderness, redness, or swelling of the genitals or the area from the genitals back to the rectum, and have a fever above 100.4 F or a general feeling of being unwell. These symptoms can worsen quickly, so it is important to seek treatment right away.

Health care professionals should assess patients for Fournier’s gangrene if they present with the symptoms described above. If suspected, start treatment immediately with broad-spectrum antibiotics and surgical debridement if necessary. Discontinue the SGLT2 inhibitor, closely monitor blood glucose levels, and provide appropriate alternative therapy for glycemic control.

Fournier’s gangrene is an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels of the perineum. The bacteria usually get into the body through a cut or break in the skin, where they quickly spread and destroy the tissue they infect. Having diabetes is a risk factor for developing Fournier’s gangrene; however, this condition is still rare among diabetic patients. Overall published literature about the occurrence of Fournier’s gangrene for men and women is very limited. Publications report that Fournier’s gangrene occurs in 1.6 out of 100,000 males annually in the U.S., and most frequently occurs in males 50-79 years (3.3 out of 100,000).^1-3 In our case series, however, we observed events in both women and men.

In the five years from March 2013 to May 2018, we identified 12 cases of Fournier’s gangrene in patients taking an SGLT2 inhibitor. This number includes only reports submitted to FDA* and found in the medical literature,^4-6 so there may be additional cases about which we are unaware. In 2017, an estimated 1.7 million patients received a dispensed prescription for an SGLT2 inhibitor from U.S. outpatient retail pharmacies.⁷ Although most cases of Fournier’s gangrene have previously been reported in men, our 12 cases included 7 men and 5 women. Fournier’s gangrene developed within several months of the patients starting an SGLT2 inhibitor and the drug was stopped in most cases. All 12 patients were hospitalized and required surgery. Some patients required multiple disfiguring surgeries, some developed complications, and one patient died. In comparison, only six cases of Fournier’s gangrene (all in men) were identified in review of other antidiabetic drug classes over a period of more than 30 years.

To help FDA track safety issues with medicines, we urge patients and health care professionals to report side effects involving SGLT2 inhibitors or other medicines to the FDA MedWatch program, using the information in the “Contact FDA” box.

For more information, please see the FDA Warning Post

Download our Diabetes Medication Pocket Cards

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More time needed to provide diabetes education – Support Medicare Expansion Bill

3 things you can do today On August 22, Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) introduced the Expanding Access to Diabetes Self-Management Training (DSMT) Act (S. 3366) in the U.S. Senate. This is the Senate companion to legislation introduced in the U.S. House of Representatives on May 10 by Representatives Tom Reed (R-NY) and Diana DeGette (D-CO). AADE worked in collaboration with the Diabetes Advocacy Alliance and our Senate champions to introduce this important piece of legislation.  Now that legislation has been introduced in the House and the Senate, we need the help of all diabetes educators to build support for these bills on Capitol Hill.  Send a letter to your legislator Call or Tweet your members of Congress urging them to support this important legislation by becoming a cosponsor.  Share this post with your friends and colleagues   Why is this bill important? As diabetes educators, we know that self-management can be a path to a better quality of life. However, barriers within the Medicare benefit keep some of our most vulnerable citizens from accessing DSMT. The Expanding Access to DSMT Act (H.R. 5768 and S. 3366) will reduce barriers and improve Medicare beneficiary access to DSMT services in the following ways: Allows the initial 10 hours of DSMT during the first year to remain available until fully utilized. If there’s a determination of medical necessity, then an additional 6 hours of training/ education may be added. Allows 6 hours of DSMT in subsequent years, up from 2 hours.  Removes the restriction related to coverage of DSMT and Medical Nutrition Therapy (MNT) services furnished on the same day. Excludes DSMT services from Part B cost-sharing and deductible requirements. Permits physicians and qualified non-physician practitioners who are not directly involved in managing an individual’s diabetes to refer them for DSMT services. An example would be a specialist treating a comorbidity like gangrene or vision loss, or an emergency room doctor. Revises the Medicare Benefit Policy Manual to allow DSMT services to be furnished in a community-based location.] Establishes a 2-year demonstration of virtual DSMT, potentially paving the way for future Medicare coverage of virtual DSMT services.

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