Nobel 2024 – Implications for T1D and Celiac Disease
by Christine Craig, MS, RD, CDCES
Type 1 diabetes and celiac disease share a fascinating connection rooted in their autoimmune nature and shared genetic background.
In T1D, autoantibodies attack the insulin-producing beta cells of the pancreas, leading to insulin deficiency. In celiac disease, ingesting gluten triggers an immune response that damages the epithelial villi of the small intestine. Recent studies suggest that approximately 6% of individuals with T1D also have celiac disease, far higher than the prevalence of celiac disease in the general population, which is around 1%.
Shared Genetic Background
T1D and celiac disease have a shared genetic background, with 95% of individuals with type 1 and 99% of individuals with celiac having the presence of HLA class II genes as DQ2 and DQ8.1 While the presence of these DQ and other alleles increases the risk of developing T1D by 30–50%, most individuals with these genetic predispositions will never progress to develop either condition, this highlights the need for deeper insights into the factors predict that disease onset and progression.
Nobel Prize Awarded
In October 2024, the Nobel Prize in Physiology or Medicine was awarded to Victor Ambros and Gary Ruvkun for discovering microRNA and its role in post-transcriptional gene regulation.2 As we recall, messenger RNA is created by copying a gene sequence from DNA, carrying this genetic code to the ribosomes for protein synthesis- microRNAs up or down-regulate and “fine-tune” gene expression.2 MicroRNAs could be utilized to track what genes are expressed and in which cells. They could potentially be used as a tool for early detection and biomarkers of disease progression.
In T1D genetic risk combined with a triggering event leads to expression of autoantibodies. BreakthoughT1, previously JDRF,3 funded additional research on microRNA due to the potential to increase early prediction of T1D autoimmunity, provide additional biomarkers of Stage 1 and Stage 2 T1D progression, and for its potential to modulate the immune system by slowing down or ceasing autoimmune response. In celiac disease, tissue transglutaminase (TGA) and anti-endomysium autoantibody concentrations are used to screen individuals at risk of celiac disease, however these autoantibodies are often elevated when villous atrophy is already present. An article by Tan and colleagues4 reviewed 53 microRNAs as potential biomarkers of celiac disease, some were found more than a year before tissue transglutaminase (TGA) positivity, and some became normalized with initiation of a gluten-free diet.
microRNA enable earlier detection?
microRNA has the potential for early detection before the onset of intestinal damage. In both celiac disease and T1D, we currently use autoantibodies as predictors of disease development, but it is the biopsy of the villi4 or glucose levels that truly diagnose the stage of the disease. microRNAs may enable earlier detection of disease progression before significant damage occurs, revolutionizing current diagnostic and monitoring approaches.
AI to Develop Proteins to Treat Disease?
Another 2024 Nobel Prize awarded in Chemistry, also has implications for T1D and celiac research. David Baker, Demis Hassabis, and John Jumper received their prize for using artificial intelligence (AI) to develop computational protein design and predict protein structure.2 Their research led to the development of a new way to create proteins that have the potential to treat disease, make vaccines, and, important to T1D, develop new glucose-responsive insulins. These glucose-responsive insulins are currently in clinical trials and can activate in response to glucose needs after injection.5 In addition, their research led to the development of TAK-062, an investigational treatment aimed at improving gluten tolerance in individuals with celiac disease.6 TAK-062 holds promise as a therapeutic option to ease the burden of a strict gluten-free diet, which is currently the only treatment for celiac disease.
New Scientific Developments to Provide Future Benefits
Science continues to pave the way for new targeted therapies, and the 2024 Nobel Prizes highlight the breakthroughs which can benefit individuals with autoimmune conditions such as T1D and celiac diseases. The discoveries in protein design and microRNA regulation show promise for additional tools for prediction, early detection, and targeted therapies. Until then, nutrition therapy, diabetes education and a comprehensive team-based care approach remain the cornerstone of managing these complex conditions. If you’re interested in learning more check out all of the Nobel Prize winners here.
References
- Flores Monar GV, et al. Association Between Type 1 Diabetes Mellitus and Celiac Disease: Autoimmune Disorders with a Shared Genetic Background. Cureus. 2022 Mar 7;14(3):e22912.
- Nobel Prize Committee. (2024). Press Release: Retrieved from www.nobelprize.org
- Breakthrough T1D and the Nobel Prizes: Connected!. Downloaded on November 17th, 2024.
- Tan IL, et al. Circulating miRNAs as Potential Biomarkers for Celiac Disease Development. Front Immunol. 2021 Dec 7;12:734763.
- Yun Liu, Shiqi Wang, Zejun Wang, Jicheng Yu, Jinqiang Wang, John B. Buse, Zhen Gu; Recent Progress in Glucose-Responsive Insulin. 20 August 2024; 73 (9): 1377–1388.
- The 2024 Nobel Prize in Chemistry goes to a leading celiac researcher. Downloaded on November 18, 2024.
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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.
How Healthcare Professionals Can Earn CDCES Certification Hours
Becoming a Certified Diabetes Care and Education Specialist (CDCES) is an incredible achievement that not only demonstrates your expertise but also reflects your unwavering commitment to improving the lives of individuals with diabetes.
Whether you’re already on this path or just considering it, the fact that you are exploring the certification process shows your dedication to expanding your knowledge and enhancing the care you provide to individual with diabetes. Achieving this certification allows you to make an even greater impact in the field of diabetes care and education, empowering those with diabetes to live healthier, more fulfilling lives.
If you are just getting started, you may be wondering what counts toward the 1000 hours of Diabetes Self Management (DSME) Experience.
Below is an excerpt from the CBDCE Exam Handbook regarding what hours count towards this 1000-hour DSME requirement:
- Assessment: The participant’s DCE needs are identified. This process is led by the participant with the assessment and support of the educator.
- Education and Care Plan: The participant’s individualized education and care plan is developed. The plan reflects the participant’s self-management goals and current evidence and practice guidelines and includes criteria for evaluating outcomes.
- Interventions: The specialist delivers intervention options to assist the participant in meeting self-management goals.
- Ongoing Support: The specialist provides options for ongoing support and resources. The support option(s) is selected by the participant to best meet their self-management goals.
- Participant Progress: The specialist will monitor and communicate whether the participant is achieving their self-management goals and other outcome(s) to evaluate the effectiveness of interventions. Additional assessments are based on the participant’s needs across the lifespan.
- Documentation: The specialist documents the assessment, education plan, intervention, and outcomes in the participant’s health record.
- Services Development/Administration: Development and administrative activities performed as part of DSMES services.
How Do I Track My Hours?
Tracking your activities and hours consistently is key, and these varied approaches can help you meet the requirements while making a positive impact in the community.
To log your hours we created the Diabetes Management Hours Tracker. The column “Remaining Hours Needed” is a formula that is tied to “Hours Completed” so be sure to only put numbers in the hour’s column so the formula automatically deducts those hours to get the remaining hours you need.
Work Experience Hours: How To Gain Hands-On Experience
Meeting the 1,000-hour requirement for the Certified Diabetes Care and Education Specialist (CDCES) exam is achievable with a variety of approaches. The hours needed can include volunteer or paid hours. Below are some practical ways to accumulate hours if you are not able to accrue enough hours in your current work environment.
- Volunteer in Community Health Programs or Diabetes Camps
-
- Offer your expertise to local diabetes prevention or management programs, such as YMCA’s Diabetes Prevention Program, Diabetes Camps, or similar initiatives.
- Shadow a Diabetes Education Specialist in your Community
-
- Search for already existing diabetes programs in your community and volunteer to help with their diabetes program. This might even evolve into a paid position in the future.
- Join ADCES Local Networking Diabetes Groups
-
- Networking with diabetes educators in your area can lead to opportunities to gain hours and possible future employment.
- Join Diabetes Support Groups
-
- Facilitate or assist with support groups in person or online to provide guidance and share educational resources.
- Offer Educational Workshops or Webinars
-
- Create and present workshops for people with diabetes or even train other healthcare professionals about aspects of diabetes management.
- Collaborate with Pharmacies
-
- Partner with local pharmacies to provide diabetes education to people picking up diabetes-related medications or supplies.
- Participate in Health Screenings or Free Health Clinics
-
- Assist with diabetes screenings, provide educational coaching at health fairs, or sign up to provide diabetes coaching at your local free clinic.
- Support Long-Term Care Facilities
-
- Offer diabetes-related education to staff and residents in long-term care or assisted living facilities.
- Write or Develop Educational Content
-
- If you’re skilled in writing, contribute to diabetes educational materials for local papers and websites. You can count the time spent on research and content development towards your hours.
- Join our Facebook Certification Exam Study Group
- This group is great for networking, connecting with colleagues and sharing study tips.
Conclusion: You’ve Got This!
The road to becoming or renewing your CDCES certification may feel like a big task, but remember—you’re not alone in this journey. You’re part of a supportive community of healthcare professionals dedicated to improving diabetes care. By earning the required hours through work experience, and volunteer opportunities, you’ll build the skills and knowledge needed to pass the exam and make a lasting impact in the field of diabetes care.
You’ve already made the commitment to be the best diabetes care provider you can be. Keep going—you’re doing amazing things, and we’re here to support you along the way. If you need guidance or resources to get started, check out DiabetesEd.net for accredited courses, webinars, and study materials designed to help you succeed! We are excited to welcome you to this diabetes education community and hope you find this information helpful!
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Recent Blog Bytes
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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.
Diabetes Mentorship Program Kicks-Off in Northern Cal
Dignity Health Mercy Medical Center Redding Steps Up with a Diabetes Mentorship Program!
We are thrilled to announce the launch of the Diabetes Mentorship Program at Mercy Medical Center in Redding, designed to support and guide the next generation of diabetes educators. This unique opportunity is tailored for eight motivated mentees who are eager to gain hands-on experience in diabetes care, all while learning from Janelle Revnak, MS, RDN, CDCES, an experienced diabetes care and education specialist, with 10 years practicing as an RDN and 5 years as a CDCES. Janelle is passionate about sharing her expertise with the next generation of diabetes professionals. Her extensive background in both outpatient and inpatient diabetes education will ensure that mentees receive comprehensive training and valuable insights into the world of diabetes care.
Over the course of the program, mentees will attend monthly educational sessions led by Janelle, coupled with didactic learning sessions and job shadowing, providing an immersive experience in the inpatient setting. As part of our mentoring partnership, the trainees will also have access to our Diabetes Boot Camp series. Janelle decided to start this program after realizing that the need for diabetes education in her rural community was larger than what one person could realistically deliver. She reached out and identified colleagues in her hospital who were interested upping their diabetes knowledge and improving care.
“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” – Mother Teresa
Increasing Demand for Diabetes Care and Education Specialists
As the number of people living with diabetes continues to rise, the demand for skilled diabetes educators is paramount. According to the latest CDC Data, the prevalence of diabetes has increased dramatically over the past decade, with more than 37 million Americans now living with diabetes—an increase of nearly 30% over the past 10 years. This growing population needs more than just medical care; they require specialized education and support to effectively manage their condition. Current diabetes care and education specialists (DCES) are uniquely positioned to assist in equipping future professionals with the knowledge and experience needed to meet the needs of this expanding patient population.
The mentorship program will be held once a month and is designed to create a balanced approach to learning. Mentees will dive deep into didactic topics, such as advanced diabetes management, behavior change strategies, and innovative approaches to diabetes care. In addition to classroom-style learning, they will have the opportunity to job-shadow Janelle, gaining firsthand experience in how diabetes education is applied in real-world inpatient clinical settings. This combination of theory and practice ensures mentees are well-equipped to make an impact in the field.
Participants will also have the chance to engage with a wide range of diabetes-related cases during their job shadowing. From inpatient diabetes clinical management to individualized patient education, they will develop a well-rounded understanding of the crucial role diabetes educators play in improving care outcomes while helping individuals feel emotionally supported through this challenging disease. This hands-on approach allows for active learning and real-time feedback, which is vital for shaping confident and competent DCES.
The mentorship program is not just about learning—it’s about making connections, fostering growth and building a community of passionate diabetes care professionals. We are excited to offer this incredible opportunity to those who are committed to advancing their skills and knowledge in diabetes education. Together, we can make a real difference in the lives of those living with diabetes. In the spirit of Mother Teresa, it is not one person alone that can impact the growing population affected by diabetes, but working together, we can achieve meaningful change.
If you have questions, you can reach Janelle at [email protected].
Are you Interested in Starting a Mentorship Program?
As part of our Bridge Program, Coach Beverly wants to support YOUR efforts to mentor a new generation of Diabetes Care and Education Specialists. If you are a mentor, we are offering significant discounts off of our Diabetes Boot Camp or Virtual 3 Day Program for groups of mentees who are practicing in underserved regions of our country. Please email us for more information at [email protected]
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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!
Recent Blog Bytes
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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.
Common New Year Questions for CDCES Prep
“What Year ADA Standards Should I Study?”
Given my seven-time experience taking the CDCES exam, I can say with complete conviction that being familiar with the American Diabetes Association (ADA) Standards of Care is one of the most important and essential strategies to prepare for exam success. More importantly, this evidence-based guidebook is crucial for providing the best clinical and person-centered care, with close attention to the Social Determinants of Health.
Taking CDCES in January or February 2025?
If you are taking the exam in January or February 2025 and you have already read the 2024 ADA Standards cover-to-cover, you are all set. It takes at least a year for the exam writers to include new questions culled from the ADA Standards. Having said that, if there are any critical new guidelines that impact clinical care, education, or treatment of diabetes, that content can be included in the exam that same year. From my review of the 2025 Standards, there are no critical new clinical guidelines that need immediate adoption into practice. One important caveat to consider: if you are relying on last year’s standards, make sure to read through the Summary of Revisions section included in the Standard of Care, so that you that latest information under your belt.
Taking the Exam in 2025 Sometime?
On the other hand, if you are taking the exam in 2025 and haven’t reviewed the ADA Standards in the past, I recommend a thorough review of the most recent ADA Standards. You can access the ADA Standards on our CDCES Coach App and the ADA Website at www.diabetes.org.
Short on Time?
In case of emergency, there is a shorter version of the ADA Standards called the Abridged version for Primary Care Providers that highlights critical clinical content. The abridged version is usually released in February by the ADA. It can also be used as a quick review after you have read the document in full. Again, after successfully passing the exam seven times, my advice is to be familiar with the ADA Standards of Care in its entirety.
Study Strategies from Coach Beverly
- Plan on reading one Standard a week, highlighting key content areas – you CAN do it!
- Review the most challenging Standards several times to allow the content to sink in.
- Provide a short in-service on an aspect of a Standard you found particularly difficult.
- Join our Level 2 – ADA Standards 2025 Update and Online Series, where Coach Beverly breaks down the critical content to help you focus your limited study time.
- Create old-fashioned flashcards and quiz yourself while walking.
- Join our FREE Prep for CDCES Certification Webinars.
“What Counts Toward My 1000 Hours and How Can I Accumulate Hours?”
If you are trying to accumulate practice hours, you may be wondering what counts toward the 1000 hours of Diabetes Self Management (DSME) Experience.
Below is an excerpt from the CBDCE Exam Handbook regarding what hours count towards this 1000-hour DSME requirement:
- Assessment: The participant’s DCE needs are identified. This process is led by the participant with the assessment and support of the educator.
- Education and Care Plan: The participant’s individualized education and care plan is developed. The plan reflects the participant’s self-management goals and current evidence and practice guidelines and includes criteria for evaluating outcomes.
- Interventions: The specialist delivers intervention options to assist the participant in meeting self-management goals.
- Ongoing Support: The specialist provides options for ongoing support and resources. The support option(s) is selected by the participant to best meet their self-management goals.
- Participant Progress: The specialist will monitor and communicate whether the participant is achieving their self-management goals and other outcome(s) to evaluate the effectiveness of interventions. Additional assessments are based on the participant’s needs across the lifespan.
- Documentation: The specialist documents the assessment, education plan, intervention, and outcomes in the participant’s health record.
- Services Development/Administration: Development and administrative activities performed as part of DSMES services.
Is There a Tracker to Document My Hours?
To help you keep track of your hours, we created the Diabetes Management Hours Tracker. The column “Remaining Hours Needed” is a formula that is tied to “Hours Completed” so be sure to only put numbers in the hour’s column so the formula automatically deducts those hours to get the remaining hours you need. Make sure you let your supervisor know you are tracking your hours, since they will need to attest and verify DSME hours completed.
Tracking your activities and hours consistently is key and this Hours Tracker excel sheet can help you tally your hours, while working toward your goal of becoming a CDCES.
Work Experience Hours: How To Gain Hands-On Experience
Meeting the 1,000-hour requirement for the Certified Diabetes Care and Education Specialist (CDCES) exam is achievable with a variety of approaches. The hours needed can include volunteer or paid hours. Below are some practical ways to accumulate hours if you are not able to accrue enough hours in your current work environment.
- Volunteer in Community Health Programs or Diabetes Camps
-
- Offer your expertise to local diabetes prevention or management programs, such as YMCA’s Diabetes Prevention Program, Diabetes Camps, or similar initiatives.
- Shadow a Diabetes Education Specialist in your Community
-
- Search for already existing diabetes programs in your community and volunteer to help with their diabetes program. This might even evolve into a paid position in the future.
- Join ADCES Local Networking Diabetes Groups
-
- Networking with diabetes educators in your area can lead to opportunities to gain hours and possible future employment.
- Join Diabetes Support Groups
-
- Facilitate or assist with support groups in person or online to provide guidance and share educational resources.
- Offer Educational Workshops or Webinars
-
- Create and present workshops for people with diabetes or even train other healthcare professionals about aspects of diabetes management.
- Collaborate with Pharmacies
-
- Partner with local pharmacies to provide diabetes education to people picking up diabetes-related medications or supplies.
- Participate in Health Screenings or Free Health Clinics
-
- Assist with diabetes screenings, provide educational coaching at health fairs, or sign up to provide diabetes coaching at your local free clinic.
- Support Long-Term Care Facilities
-
- Offer diabetes-related education to staff and residents in long-term care or assisted living facilities.
- Write or Develop Educational Content
-
- If you’re skilled in writing, contribute to diabetes educational materials for local papers and websites. You can count the time spent on research and content development towards your hours.
- Join our Facebook Certification Exam Study Group
- This group is great for networking, connecting with colleagues and sharing study tips.
Resources to help Prepare for CDCES Exam
- Join our annual ADA Standards of Care | 2.0 CEs Update on January 30, 2025!
- CDCES Coach App – Which includes the ADA Standards of Care, quizzes and lot so of FREE info.
- Level 2 | Standards of Care Intensive | 20+ CEs –
- Prep for CDCES Exam Resource Page
Are you Interested in Starting a Mentorship Program?
As part of our Bridge Program, Coach Beverly wants to support YOUR efforts to mentor a new generation of Diabetes Care and Education Specialists. If you are a mentor, we are offering significant discounts off of our Diabetes Boot Camp or Virtual 3 Day Program for groups of mentees who are practicing in underserved regions of our country. Please email us for more information at [email protected]
The 2025 ADA Standards of Care are here!!
Join us Jan. 30th @ 11:30 am PST!!
This webinar provides a comprehensive breakdown of the ADA Standards of Care, focusing on essential content for clinical practice and exam success.
This webinar is designed for healthcare professionals aiming to deepen their understanding of the ADA Standards for improved practice or preparing for the BC-ADM or CDCES certification exams.
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!
Recent Blog Bytes
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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 | Which precaution when starting tirzepitide according to 2025 ADA Standards?
TZ is a 32-year-old female with type 2 diabetes and an A1C of 8.3% who takes metformin 1000mg twice daily and is on oral contraception. TZ is going to start tirzepitide 2.5mg weekly to help with weight loss and blood glucose management. According to the 2025 ADA Standards, what precaution would we recommend to TZ along with the initiation of tirzepitide?
According to the 2025 ADA Standards, what precaution would we recommend to TZ along with the initiation of tirzepitide?
- Reduce the metformin by 50% to prevent side effects and maintain B12 levels.
- Assess TZ’s risk of acidosis before initiating dual therapies.
- Provide a glucagon emergency kit in case of severe hypoglycemia.
- Suggest using a second form of contraception for at least 4 weeks.
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Level 1 Diabetes Fundamentals
This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.
All hours earned count toward your CDCES Accreditation Information
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!
Recent Blog Bytes
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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 Meds to Treat MASH – 2025 Standards
For last week’s practice question, we quizzed participants on best meds to treat MASH. 64% 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: In the 2025 ADA Standards, they have updated the term Non-Alcoholic Steatohepatitis (NASH) to Metabolic Associated Steatohepatitis (MASH). They also recommend pharmacologic agents along with lifestyle interventions to treat people with diabetes and MASH.
Which of the following are the recommended diabetes medications to treat MASH?
Answer Choices:
- Vitamin E and SGLT-2
- Pioglitazone and/or GLP-1 RA / GIP
- Fish oil supplements and statin
- Metformin and/or bolus insulin therapy
Getting to the Best Answer
Answer 1 is incorrect. 14.93% chose this answer. “Vitamin E and SGLT-2.” While SGLT-2’s will help lower glucose levels and may result in some weight loss, the ADA does not recognize it as a treatment for steatosis. As far as Vitamin E, according to the ADA 2025 Standards, “it may be beneficial for the treatment of MASH in people without diabetes. However, in people with type 2 diabetes, vitamin E monotherapy was found to be ineffective in a small RCT, and it did not seem to enhance pioglitazone’s efficacy when used in combination, as reported in an earlier trial in this population.
Answer 2 is correct. 63.81% of you chose this answer. “Pioglitazone and/or GLP-1 RA / GIP.” GREAT JOB, this is the best answer. According to the ADA Standards In adults with type 2 diabetes with biopsy-proven MASH or those at high risk for liver fibrosis (based on noninvasive tests), pioglitazone, a GLP-1 RA, or a dual GIP and GLP-1 RA is preferred for glycemic management because of potential beneficial effects on MASH.
Answer 3 is incorrect. About 12.69% of respondents chose this. “Fish oil supplements and statin.” Part of this answer is correct. Based on the 2025 ADA Standards, “Statin therapy is safe in adults with type 2 diabetes and compensated cirrhosis from MASLD and should be initiated or continued for cardiovascular risk reduction as clinically indicated. In people with decompensated cirrhosis, statin therapy should be used with caution, and close monitoring is needed, given limited safety and efficacy data. However, the ADA does not recommend fish oil supplements to treat MASH.
Finally, Answer 4 is incorrect. 8.58% chose this answer. “Metformin and/or bolus insulin therapy.” Although metformin therapy and insulin are effective at addressing insulin resistance and lower glucose levels, they are not first line recommended agents to treat MASH.
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?
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Test Taking Practice Exam Toolkit
Jan. 13th @ 11:30am PST
You are invited to join Coach Beverly for this FREE Webinar. And, if you want to have access to an additional 220+ sample practice online questions, you can purchase the complete Test Taking Toolkit.
For many of us, taking the certification exam is a nerve-wracking process
During this webinar, Coach Beverly will help you transform your nervousness into focused energy that will help you succeed. She will provide test-taking tips based on her experience taking the certification exam six times.
All hours earned count toward your CDCES Accreditation Information
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!
Recent Blog Bytes
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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 | What do the NEW 2025 ADA Standards Say?
For last week’s practice question, we quizzed participants on 2025 ADA Standards & hyperglycemic crises. 43% 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: What do the NEW 2025 ADA Standards Say?
According to the Newly Published 2025 Standards of Care, which of the following statements reflect the latest guidelines to treat hyperglycemic crises?
Answer Choices:
- Administer low dose basal insulin analog in addition to intravenous insulin infusion to improve glucose management.
- If serum pH is below 7.4, administer IV bicarb, along with a glucose infusion to resolve severe acidosis.
- To differentiate between DKA and HHS, the most important lab indicators are the anion gap and glucose levels.
- Lactated Ringers is now the preferred intravenous solution for fluid resuscitation.
Getting to the Best Answer
Answer 1 is correct. 43.04% chose this answer. “Administer low dose basal insulin analog in addition to intravenous insulin infusion to improve glucose management.” YES, great job, this is the best answer. According to ADA Standard 16 on Hospital Care, “Studies have reported that the administration of a low dose of basal insulin analog in addition to intravenous insulin infusion may prevent rebound hyperglycemia without increased risk of hypoglycemia.”
Answer 2 is incorrect. 19.59% of you chose this answer. “If serum pH is below 7.4, administer IV bicarb, along with a glucose infusion to resolve severe acidosis.” Since this pH is in the normal range, this person is not in ketoacidosis. According to ADA Standard 16 on Hospital Care, “Several studies have shown that the use of bicarbonate in people with DKA made no difference in the resolution of acidosis or time to discharge, and its use is generally not recommended.”
Answer 3 is incorrect. About 20.10% of respondents chose this. “To differentiate between DKA and HHS, the most important lab indicators are the anion gap and glucose levels.” According to the 2024 Consensus Statement, to differentiate between the two conditions, the most decisive lab indicators are beta hydroxybutyrate or urine ketones to verify insulin deficiency along with pH levels to verify acidosis and osmolality to determine hydration status in HHS.
Finally, Answer 4 is incorrect. 17.27% chose this answer. “Lactated Ringers is now the preferred intravenous solution for fluid resuscitation.” According to the 2024 Consensus Statement, Normal saline or Ringer’s lactate are both accepted IV rehydration solutions.
You are invited to register for our Hyperglycemic Crises – New criteria and treatment guidelines for DKA, Euglycemic DKA and HHS | 1.25 CE – Recorded and Ready for Viewing.
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!
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ADA Standards of Care
Level 2 | Standards of Care Intensive
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) Standard of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.
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.
Learning Outcome: Participants will identify updates and articulate recommendations from the 2024 ADA Standards of Care that can be applied to their practice.
Target Audience: This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, 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. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
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- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
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- Rationale of the Week | Diabetes & Malnutrition Risk
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- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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Question of the Week | Best Meds to Treat MASH – 2025 Standards
In the 2025 ADA Standards, they have updated the term Non-Alcoholic Steatohepatitis (NASH) to Metabolic Associated Steatohepatitis (MASH). They also recommend pharmacologic agents along with lifestyle interventions to treat people with diabetes and MASH.
Which of the following are the recommended diabetes medications to treat MASH?
- Vitamin E and SGLT-2
- Pioglitazone and/or GLP-1 RA / GIP
- Fish oil supplements and statin
- Metformin and/or bolus insulin therapy
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Level 2 | Meds Management Update for Type 2 Diabetes
Join us live on December 17, 2024, at 11:30 am PST for our Level 2 | Meds Management Update for Type 2 Diabetes
Title: Level 2 | Meds Management Update for Type 2 Diabetes | 1.5 CEs
This course is included in: Level 2 – Standards of Care. Purchase this course individually for $29 or enroll in the entire bundle and save 45% (discount already applied). Don’t worry if you can’t make it live, your registration gives you access to the recorded version for a full year.
Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses for 1 year after your purchase date. Each online course includes a: video presentation, podcast, practice test, and additional resources.
All hours earned count toward your CDCES Accreditation Information
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!
Recent Blog Bytes
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
- Question of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
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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