Question of the Week | Bone Fracture Prevention Based on 2024 ADA Standards
Since people with diabetes are at increased risk of fractures, the 2024 Standards have an increased focus on preventing bone fractures.
Which of the following is an accurate statement regarding diabetes and bone fractures?
- Annual bone scans are recommended starting at age 40 to determine fracture risk category.
- Individuals taking insulin or sulfonylureas are at higher risk of bone fractures.
- Most people with diabetes benefit from a vitamin D supplement.
- Refer individuals starting at age 65 for an assessment of fall risk.
Click Here to Test your Knowledge
Learn more about Bone Fracture Prevention and ADA Standards
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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 our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Coach Beverly Connects – Airs April 23rd
Join us again for Coach Beverly Connects!
Airs April 23rd @ 11:30 am PST on Facebook Live
This session will be a 30-minute Q&A on diabetes-related topics with Coach Beverly.
Health care professionals from all over the country, send us questions about diabetes care and management. Coach Beverly wants to meet with you all directly, to connect, discuss, and share.
Please send in your questions ahead of time.
Your question may be selected!
Topics of discussion include
- strategies to succeed at certification exams,
- lifestyle recommendations,
- medication clarification,
- overcoming barriers to providing care,
- communication strategies
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Sign up for DiabetesEd Blog Bytes
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Untangling Weight Stigma in Medical Appointments
Besides being a diabetes educator and advocate for person-centered care, I am also a patient who has to navigate our healthcare system. I have regular appointments with my team of healthcare providers to address several chronic health issues I have acquired over the past decade. Like many of us, I have a difficult relationship with my weight and a long history of entangling my self-worth with the numbers on the scale. As a chunky kid, I never reached an “ideal body weight” until my twenties. Later, I fought hard to keep my BMI under 25, thinking that would increase my feelings of worth. I later realized this was a myth.
Since weighing myself caused such emotional turmoil, starting in my 30s, I refused to check my weight for the next twenty years (except during my pregnancies).
However, since I had a stroke eight years ago, and soon after that, I was diagnosed with Hashimoto’s thyroiditis, I decided to start weighing myself again. Then menopause hit.
My weight increased despite taking thyroid medication and maintaining an active lifestyle.
My weight distress re-emerged and reared its ugly head.
I knew I wanted to address my internalized weight stigma, and I devised several effective changes.
For example, when at the provider’s office, I would provide a “stated weight.” I would kindly let the medical assistant (MA) know there is no need to weigh me on your clinic scale.
As a knowledgeable healthcare professional in the current era, I know I can gently refuse to be weighed, and this does not mean I am ‘non-compliant”, difficult, or demanding. I am simply stating my needs.
I felt liberated and was no longer fearful of going to my doctor visits. This approach has been successful for the past six months, and l felt incredibly empowered.
Sadly, this sense of empowerment crumbled at my last provider visit. Here is how it all went down.
They called my name for my appointment, and MA greeted me with a warm smile and asked me to “please stand on the scale.” The scale is in the center of a busy office, where everyone can easily observe the measurement.
I smile back at him and say, “No, thank you. I am happy to share my stated weight.”
Confused, he looked at me and said, “No, you need to get on the scale.”
Still smiling, I pleasantly said, “No, I’m happy to give you my stated weight.”
The MA was bewildered by my continued refusal and unsure what to do next. We stood at the scale in an uncomfortable silence.
A provider who overheard the conversation came out of their office and walked over. The provider had two choices: to support my autonomy or to go with the status quo. It takes courage to buck the system, and my courage as a patient wasn’t enough.
Like many of us, they repeated the instructions and stated, “Just get on the scale and turn your back so you don’t have to see the number.”
In a last desperate attempt to lower the number on the scale, I toss off my shoes, let out a big sigh, and stand on the scale with my back to the readout.
“I am being bullied into getting weighed.”
Tears of anger and humiliation rolled down my cheeks.
Despite my privilege as a medical professional, my simple, repeated requests not to be weighed were ignored.
I started thinking about all the people living with diabetes who struggle with internalized weight stigma and how this intersects with diabetes stigma. Understanding intersectional stigma is hard, and change takes time, even for well-meaning healthcare professionals.
I reached out to Megrette Fletcher, M.Ed., R.D., CDCES, owner of Inclusive Diabetes Care, a continuing education company that created the Inclusion Pyramid, to help me make sense of this uncomfortable interaction with my healthcare team.
This simple model illustrates the often-invisible need for belonging, ease, feeling seen and heard, and nonjudgment are not met, and this creates invisible barriers to sustainable self-care.
My personal experience of being weighed is just one example of how othering and stigma can be experienced in medicine. As diabetes care and education specialists, we can role model weight inclusivity and make sure that each individual we serve, feels seen, heard and respected. We know that many people with diabetes in larger bodies may skip their medical appointments due to fear of being weighed or judged by healthcare professionals.
As you can see in the Inclusive Care pyramid below, we all have Basic Needs for Inclusion to actualize wholesome self-care. In the Barriers to Diabetes Self-Care Pyramid, feelings of othering, lack of ease, judgment and not feeling heard or seen can lead to no-shows and act as a barrier to receiving health care. When we focus on weight as a primary health indicator, we are missing opportunities to make meaningful connections with individuals and discover other contributing factors to their disease.
Weight stigma in medical appointments is a significant issue that can have detrimental effects on the individuals’ physical and mental health. It refers to the negative attitudes, beliefs, and stereotypes healthcare providers may hold towards individuals with extra weight. This stigma can manifest in various ways during medical appointments, including biased treatment, assumptions about the person’s lifestyle or health behaviors, and even neglect of legitimate health concerns unrelated to weight.
My goal in sharing my personal experience with all of you is not only to raise awareness of this often-overlooked barrier to care but a call to take action in our places of work.
Action Steps to Untangle Weight Stigma in Medical Appointments:
Awareness and Education: participate in training programs to help care providers recognize and address weight bias. A great resource is Inclusive Diabetes Care.
Language Matters: Use neutral and respectful language when discussing weight-related issues.
Focus on Health, Not Weight: Shift the focus of medical appointments from weight to overall health and well-being.
Individualized Care: Recognize the individual and understand their story around weight.
Create Supportive Environments: Design healthcare settings that are inclusive and welcoming to individuals of all sizes.
Advocate for Systemic Change: Addressing weight stigma requires systemic change within the healthcare system and society as a whole. Healthcare providers can advocate for policies that promote health equity, combat weight bias in research and media, and support initiatives that address social determinants of health.
By implementing these strategies, healthcare providers can help untangle weight stigma in medical appointments and create a more supportive and inclusive environment for all patients, regardless of their size.
We invite you to share your comments and experiences.
Have you experienced weight stigma and would like to share your story? Have you taken actions in your work setting to promote body positivity?
Please feel free to share anonymously on this google doc so we can continue this conversation.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. 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 our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best treatment for Hospital and Heart failure?
For last week’s practice question, we quizzed participants on the best treatment for hospitals & heart failure. 73% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR has newly discovered type 2 diabetes and is admitted to the hospital with heart failure. Their A1C is 7.9% with negative ketones and a GFR greater than 90 mg/g.
According to the 2024 ADA Standards of Care, which of the following is a recommended intervention during JR’s hospital stay?
Answer Choices:
- Assess for immune mediated diabetes markers, starting with GAD.
- Utilize a mild insulin sliding scale to minimize risk of worsening heart failure.
- Initiate a SGLT-2 during hospitalization and continue upon discharge.
- Encourage a sleep study evaluation to determine if JR also has sleep apnea.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 7.54% chose this answer. “Assess for immune mediated diabetes markers, starting with GAD.” Given that JR’s A1C is 7.9% and their ketones are negative, it seems unlikely they might have undiscovered immune mediated diabetes. The most pressing issue in addition to their diabetes is addressing the CHF.
Answer 2 is incorrect. 15.57% of you chose this answer. “Utilize a mild insulin sliding scale to minimize risk of worsening heart failure.” Based on the ADA Standards of care, insulin sliding scale as the only treatment approach is not recommended. In addition, insulin therapy doesn’t aggravate heart failure.
Answer 3 is correct. About 72.75% of respondents chose this. “Initiate a SGLT-2 during hospitalization and continue upon discharge.” YES, this is the best answer. Given that JR has diabetes and heart failure, using a SGLT-2 will lower their blood sugar plus provide a “glucoretic” effect, which will promote diuresis.
Finally, Answer 4 is incorrect. 4.14% chose this answer. “Encourage a sleep study evaluation to determine if JR also has sleep apnea.” From the information provided, there is no indication that JR is experiencing sleep apnea. The most pressing issues are the CHF and new diabetes diagnosis.
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!
Want to learn more about this question?
Enroll in our ADA Standards of Care Update
Airs live today, February 1st, 2024, at 11:30 am PT
Objectives:
- A review of changes & updates to the annual ADA Standards of Medical Care in Diabetes.
- Identification of key elements of the position statement.
- 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 professionals, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
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 our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | Best Intervention to address Elevated LDL?
MK is 67 years old and is concerned about cardiovascular disease risk and diabetes. Their last lab result showed an A1C of 6.8%, HDL of 38 and LDL of 132. MK started reading food labels and is concerned about their total fat intake each day and wants to make diet changes to reduce CVD risk.
According to the 2024 ADA Standards of Care, which evidence-based statement is most accurate when counseling MK about their fat intake?
- There is no one optimal percentage of calories from fat for people with diabetes.
- Try to limit saturated fat to less to 7% of calories each day.
- We suggest including 1 gram per day of Omega-3 supplement for prevention of cardiovascular events.
- The best approach is to reduce total fat to less than 30% of total calories per day.
Click Here to Test your Knowledge
Want to learn more about nutrition and the ADA Standards?
Level 3 | DiabetesEd Certification Boot Camp
with Coach Beverly, RN, MPH, CDCES &
Christine Craig, MS, RDN, CDCES
Airs live on February 13th – March 19th, 2024, at 11:30 am PT
Class Topics & Webinar Dates:
- February 13, 2024 – Boot Camp 1: Diabetes | Not Just Hyperglycemia | 1.75 CEs
- February 15, 2024 – Boot Camp 2: Standards of Care & Cardiovascular Goals | 1.8 CEs
- February 20, 2024 – Boot Camp 3: Meds for Type 2 | What you need to know | 1.75 CEs
- February 22, 2024 – Boot Camp 4: Insulin Therapy | From Basal/Bolus to Pattern Management | 1.75 CEs
- February 27, 2024 – Boot Camp 5: Insulin Intensive & Risk Reduction | Monitoring, Sick Days, Lower Extremities | 1.75 CEs
- February 29, 2024 – Boot Camp 6: Medical Nutrition Therapy | 1.75 CEs
- March 12, 2024 – Boot Camp 7: Microvascular Complications & Exercise | Screen, Prevent, Treat | 1.75 CEs
- March 14, 2024 – Boot Camp 8: Coping & Behavior Change | 1.75 CEs
- March 19, 2024 – Boot Camp 9: Test-Taking Coach Session (48 Questions) | No CE
Intended Audience: 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.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructors: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
Christine Craig, MS, RD, CDCES, winner of the 2023 Impact on Diabetes Award, is a leader in the field of nutrition, technology, and diabetes care. Her years of expertise combined with her person-centered approach and work ethic, make her a perfect speaker for this nutrition and activity focused content.
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 our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Upcoming webinars | ADA Standards of Care CE Course, 2024 Boot Camp Series
Be a part of our diabetes community while learning about the latest in diabetes care. Plus, Coach Beverly provides an interactive question and answer session at the end of each live webinar.
ADA Standards of Care CE Course
Airs live on February 1, 2024, at 11:30 am PT
Topics:
- A review of changes & updates to the annual ADA Standards of Medical Care in Diabetes.
- Identification of key elements of the position statement.
- Discussion of how diabetes educators can apply this information in their clinical setting.
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
Join us for our upcoming 2024 Boot Camp Series
Airs live February 13th – March 19th, 2024, at 11:30 am PT
Class Topics & Webinar Dates:
- February 13, 2024 – Boot Camp 1: Diabetes | Not Just Hyperglycemia | 1.75 CEs
- February 15, 2024 – Boot Camp 2: Standards of Care & Cardiovascular Goals | 1.8 CEs
- February 20, 2024 – Boot Camp 3: Meds for Type 2 | What you need to know | 1.75 CEs
- February 22, 2024 – Boot Camp 4: Insulin Therapy | From Basal/Bolus to Pattern Management | 1.75 CEs
- February 27, 2024 – Boot Camp 5: Insulin Intensive & Risk Reduction | Monitoring, Sick Days, Lower Extremities | 1.75 CEs
- February 29, 2024 – Boot Camp 6: Medical Nutrition Therapy | 1.75 CEs
- March 12, 2024 – Boot Camp 7: Microvascular Complications & Exercise | Screen, Prevent, Treat | 1.75 CEs
- March 14, 2024 – Boot Camp 8: Coping & Behavior Change | 1.75 CEs
- March 19, 2024 – Boot Camp 9: Test-Taking Coach Session (48 Questions) | No CE
Intended Audience: 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.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
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 our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Upcoming webinars | Hypoglycemia, Sick Days, and Monitoring & ADA Standards of Care CE Course
Be a part of our diabetes community while learning about the latest in diabetes care. Plus, Coach Beverly provides an interactive question and answer session at the end of each live webinar.
Join us for our upcoming Hypoglycemia, Sick Days, and Monitoring class
Airs live on January 30th, 2024, at 11:30 am PT
Topics:
- Discuss risk & prevention of hypoglycemia.
- Strategies to get the most out of blood glucose monitoring & technology.
- Review sick day management, from hospital to home.
- Describe behavior change road blocks & work arounds.
This session reviews cause & strategies to prevent hypoglycemia are discussed. Includes a review of blood glucose monitoring considerations & teaching topics, with a focus on sick day management. Includes discussion of inpatient glucose management guidelines & goals.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
ADA Standards of Care CE Course
Airs live on February 1, 2024, at 11:30 am PT
Topics:
- A review of changes & updates to the annual ADA Standards of Medical Care in Diabetes.
- Identification of key elements of the position statement.
- Discussion of how diabetes educators can apply this information in their clinical setting.
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
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 our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best action to determine if JR “really” has diabetes based on ADA Standards.
For last week’s practice question, we quizzed participants on determining if someone has diabetes based on ADA Standards. 49% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: JR is 47 years old and who just got lab results from their annual physical. Their fasting plasma glucose result was 129 mg/dL. The provider is worried that JR might have diabetes and sent them to back to the lab to check their A1C, which came back 6.4%.
According to the 2024 ADA Standards, to most accurately assess if JR has diabetes, which of the following follow-up actions is recommended?
Answer Choices:
- Recheck the A1C in 3 months.
- Order a meter for JR, so they can check fasting and post-prandial glucose for one month.
- Evaluate JR for immune mediated diabetes antibodies.
- Recheck the fasting blood glucose.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 22.36% chose this answer. Recheck the A1C in 3 months. According to ADA Standard 2 on Diagnosis and Classification of Diabetes, “if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels.” Since JR’s fasting BG test result meets the diagnostic threshold of equal to or greater than 126 mg/dL, we would need to repeat the fasting test, to see if the second lab would confirm diagnosis. We would also consider factors (hemoglobinopathies, lab issues) that might be affecting the accuracy of the A1C result.
Answer 2 is incorrect. 15.76% of you chose this answer. Order a meter for JR, so they can check fasting and post-prandial glucose for one month. Since home glucose meters have limited accuracy, they are not recommended for diagnosis of diabetes. In addition “if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels.” Since JR’s fasting BG test result meets the diagnostic threshold of equal to or greater than 126 mg/dL, we would need to repeat the fasting test, to see if the second lab would confirm diagnosis. We would also consider factors (hemoglobinopathies, lab issues) that might be affecting the accuracy of the A1C result.
Answer 3 is incorrect. About 12.55% of respondents chose this. Evaluate JR for immune mediated diabetes antibodies. In this case study, JR does not present with risk factors or symptoms of immune mediated type 1 diabetes or LADA. However, since their fasting blood sugar meets the diagnostic threshold for diabetes, we need to redraw JR’s fasting blood glucose, to confirm (or dispute) diagnosis.
Finally, Answer 4 is correct. 49.33% chose this answer. Recheck the fasting blood glucose. YES – GREAT JOB, According to ADA Standard 2 on Diagnosis and Classification of Diabetes, “if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels.” Since JR’s fasting BG test result meets the diagnostic threshold of equal to or greater than 126 mg/dL, we would need to repeat the fasting test, to see if the second lab would confirm diagnosis. We would also consider factors (hemoglobinopathies, lab issues) that might be affecting the accuracy of the A1C result.
On the other hand, if an individual has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with careful consideration of factors that may affect measured A1C or glucose levels. The diagnosis is made based on the confirmatory screening test. For example, if an individual meets the diabetes criterion of A1C (two results ?6.5% [?48 mmol/mol]) but not FPG (<126 mg/dL [<7.0 mmol/L]), that person should nevertheless be considered to have diabetes.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!
Want to Learn More About this Question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at info@diabetesed.net with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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