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Rationale of the Week | Lifestyle Therapy for MASLD and MASH

For last week’s practice question, we quizzed participants on Lifestyle Therapy for MASLD and MASH. 83% 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

Lightbulb and text: Rationale of the Week

PJ has had type 2 diabetes for 8 years and is here for a follow-up visit. Labs indicate A1c at 7.2%, lipids at target, eGFR of 78 mL/min/1.73m², and urine albumin-to-creatinine ratio (UACR) of 65 mg/dL. Blood pressure at the office visit today was 142/86, which is consistent with home monitored values. PJ confirms taking medications, metformin and simvastatin. PJ inquires about recently completed lab work.

According to the ADA Standards of Care, what would be an appropriate next step in the diabetes care plan?

  1. No changes are needed because kidney function is within normal range.
  2. Initiate an ACE inhibitor or ARB to reduce progression the of diabetic kidney disease.
  3. Discontinue metformin due to the risk of kidney injury with reduced eGFR.
  4. Increase statin therapy to target albuminuria reduction.

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 A is incorrect: 6.35% chose this answer, “No changes are needed because kidney function is within normal range.” A is incorrect. Although eGFR indicates stage 2 kidney disease, the elevated UACR, ≥30 mg/g, confirms moderately increased risk and recommendation to treat. Additionally, PJ’s blood pressure is also above the target. Intervention is needed to protect kidney and cardiovascular health.

Answer B is correct: 83% chose this answer, “Initiate an ACE inhibitor or ARB to reduce progression the of diabetic kidney disease.” PJ has a mildly decreased eGFR, but UACR is elevated above 30 mg/g, indicating a recommendation to treat. Additionally, intervention is needed to optimize blood pressure. According to the ADA Standards of Care in Diabetes, individuals with diabetes, hypertension, and moderately increased albuminuria should be treated with an ACE inhibitor or angiotensin receptor blocker. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide 1 agonists (GLP1-RA), with demonstrated benefits, could also be considered to reduce CKD progression.

Answer C is incorrect: 5.25% chose this answer, “Discontinue metformin due to the risk of kidney injury with reduced eGFR.” Metformin is safe to continue unless eGFR falls below 30 30 mL/min/1.73m². PJ’s kidney function is adequate for continued use. However, consideration to add a change to SGLT2 or GLP1 with kidney benefit could also promote additional A1c reduction.

Answer D is incorrect: 5.52% chose this answer, “Increase statin therapy to target albuminuria reduction.” Statins are recommended for ASCVD prevention, but they do not reduce albuminuria. Lipids are within normal range, and albuminuria should be addressed with an ACE inhibitor/ARB or potentially a SGLT2 inhibitor or GLP-1 RA.

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!

Invite a colleague to our DiabetesEd Seminar in San Diego and get $75 off each registration.

Use code FriendDiscountSD during check out to save. 

Join us live in San Diego October 22nd – 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun!

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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 Treatment is FDA Approved for MASH?

Question of the Week Diabetes Education Services

MJ just discovered that in addition to their type 2 diabetes and a BMI of 31, they also have MASH. 

Based on this diagnosis, which FDA approved medication would help address their steatosis?

  1. Semaglutide (Ozempic)
  2. Empagliflozin (Jardiance)
  3. Tirzepatide (Mounjaro)
  4. Semaglutide (Wegovy)

Invite a colleague to our DiabetesEd Seminar in San Diego and get $75 off each registration.

Use code FriendDiscountSD during check to save. 

Join us live in San Diego October 22nd – 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

Earn 30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun!

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

October 2025 eNews

Happy October!💚

Greetings, wonderful healthcare colleagues!

With the onset of fall, it is the perfect time to curl up with a good book and read our monthly newsletter. Pull out your calendar and save the dates for our upcoming courses and free webinars.

First up, you are going to do a happy dance when you download our GLP-1/GIP Indications Cheat Sheet. With a glance, you will be able to quickly determine which incretin is the best match for the person sitting across from you, considering their glucose levels, weight goals, age, and other co-conditions. Shout out to Diana Issacs, PharmD, CDCES, for getting the ball rolling on this latest addition to our Cheat Sheet Library.

Speaking of Diana Isaacs, you won’t want to miss her at our DiabetesEd Course in San Diego in a few weeks. We have so much fun co-teaching at this conference and giving attendees our full attention! Invite a friend, save $75, and get ready for a wonderful experience and a comprehensive diabetes update.

Over 60% of people with diabetes are living with liver steatosis. Our nutrition expert, Christine Craig, reviews evidence-based lifestyle approaches that you can quickly apply in your clinical practice.

If you are looking for an easy-to-use insulin delivery device, check out this review article on CeQur Simplicity by our tech expert, Dr. Sarah Beattie. She explores the benefits and limitations of this straightforward bolus insulin delivery device.

A big welcome to our newest team member and customer service advocate, Astraea Ballinger. They bring a wealth of experience and positive energy to the team, and we are thrilled to introduce them.

Test your knowledge with our question and rationale of the week, and we hope to see you in San Diego!

With appreciation,

Coach Beverly, Bryanna, Astraea & Katarina

Save $75 – Invite a colleague to our DiabetesEd Seminar in San Diego.

Use code FriendDiscountSD during checkout to save!

Join us live in San Diego October 22nd - 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun!

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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 | Grandfather Avoiding Bolus Insulin

For last week’s practice question, we quizzed participants on insulin. 96% 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

Lightbulb and text: Rationale of the Week

R.S. is a 60-year-old with type 2 diabetes who was recently placed on insulin lispro at meals.  He has taken insulin glargine once a day for five years. Previously, non-insulin medications have been ineffective or not tolerated. He continues to have hyperglycemia despite the addition of insulin lispro.  During his diabetes education visit today, he shared that he has not been taking his mealtime insulin lispro because he does not want to inject it in front of his grandchildren, who live with him.  He feels overwhelmed by these additional injections but wants to get his blood glucose levels under better control so he can have the energy to play with his grandchildren and avoid losing his eyesight like his mother did.

As the diabetes care and education specialist, which of the following would be the most appropriate first step in addressing R.S.’s concerns? 

  1. Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.
  2. Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.
  3. Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.
  4. Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.

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 A is incorrect: 1% chose this answer, “Stress with R.S. the importance of never missing his meal time lispro to prevent diabetes-related complications.” R.S. is aware that his glycemic control is important, and he is already aware of the risk of diabetes-related complications. Counseling him on this would not help him be successful with his insulin management.  

Answer B is correct: 96% chose this answer, “Using open-ended questions, explore R.S.’s routine, stressors, and support systems to understand the barriers to his insulin use.” R.S. is struggling with barriers to successful insulin management.  A holistic approach would be to ask open-ended questions about his current routine, stressors, and support systems to gain a better understanding of these barriers. This information can lead to a personalized plan of care to help improve glycemic control. 

Answer C is incorrect: 2% chose this answer, “Recommend R.S. switch to another non-insulin medication to make his regimen easier for him to manage.” He has already attempted other non-insulin therapies, and these were either ineffective or not tolerated. Changing his regimen would not be successful at improving his glycemic control and quality of life.

Answer D is incorrect: 1% chose this answer, “Since it appears R.S. did not understand how to take his insulin lispro, write out step-by-step instructions on how to take the insulin.” R.S. appears to understand how to take his insulin lispro at meals. Writing out the instructions would not improve his situation. It is not a lack of knowledge, but the multiple barriers in his life that are keeping him from being able to implement this new medication regimen.  

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!

Invite a colleague to our DiabetesEd Seminar in San Diego and get $75 off each registration.

Use code FriendDiscountSD during check out to save. 

Join us live in San Diego October 22nd – 23rd, 2025 for our upcoming

DiabetesEd Training Seminar

30+ CEs with Expanded Accreditation!

Join our expert team for engaging, interactive sessions that bring the ADA Standards of Care to life—covering medications, behavior change, technology, and more. Ideal for CDCES or BC-ADM exam prep, this course also includes a 4-hour Virtual Medical Nutrition Therapy Toolkit and bonus content that also meets CDCES renewal requirements.

Program Objectives:

Upon completion of this activity, participants should be able to:

  • Describe the current ADA Standards for diagnosis, goals, and person-centered diabetes management across the lifespan. 
  • Demonstrate insulin pattern management and dosing strategies in clinical scenarios.
  • Implement timely screening and risk reduction strategies for microvascular and cardiovascular complications.  
  • Incorporate behavior change techniques and medical nutrition therapy to support people with diabetes self-management and lifestyle adjustment.  

Expert Faculty:

Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES

Smiling woman in white blazer and lavender blouse

Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Faculty Bios & Disclosures

Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun!

Program Faculty Disclosures:

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Faculy Bios & Disclosures:

Coach Beverly Thomassian RN, MPH, CDCES, BC-ADM – CEO of DiabetesEd Services

Disclosures: 

Beverly Thomassian has no financial disclosures

Bio:

Author, Nurse, Educator, Clinician, and Innovator, Beverly has specialized in diabetes management for over twenty years. As president and founder of Diabetes Education Services, Beverly is dedicated to providing compassionate and evidence based diabetes education and improving the lives of those with diabetes.

PicsArt_04 03 11Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCPCES 

Disclosures:

Dr. Diana Isaacs has the following relevant financial relationships:

  • Consultant, advisor, and speaker for Abbot Labratories, Dexcom, Medtronic, Insulet, Lilly, Cequr, Sanofi, and Undermyfork
  • Board member at Association for Diabetes Care and Education Specialists

Bio:

Diana Isaacs was awarded 2020 ADCES Diabetes Educator of the Year for her educational platform promoting the use of CGM for people with diabetes and other innovations.  She serves in leadership roles for several pharmacies and diabetes organizations. She has numerous diabetes publications and research projects with a focus on medications, CGM and diabetes technology.

For the past three year, Dr. Isaacs has served as a contributing author for the 2023 ADA Standards of Care.

As the Program Coordinator and clinical pharmacist specialist in the Cleveland Clinic Diabetes Center, Dr. Isaacs brings a wealth of clinical knowledge combined with extensive research and speaking experience to this program. 

Activity Start and End Date: 10/22/25 – 10/23/2025

Estimated time to complete the activity: 15 hours and 30 minutes

_____________________________________

Jointly provided by Partners for Advancing Clinical Education and Diabetes Education Services



Joint Accreditation Statement:

 In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and Diabetes Education Services. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education:

Partners designates this enduring material for a maximum of 15.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development:

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 15.50 contact hours.

Pharmacy Continuing Education:

Partners designates this continuing education activity for 15.50 contact hour(s) (1.550 CEUs) of the Accreditation Council for Pharmacy Education.
(Universal Activity Number – JA4008073-9999-25-206-L01-P)
Type of Activity: Application

For Pharmacists: Upon successfully completing the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Dietitian Continuing Education:

This program offers 15.50 CPEUs for dietitians.

Interprofessional Continuing Education:

This activity was planned by and for the healthcare team, and learners will receive 15.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

For additional information about the accreditation of this activity, please visit https://partnersed.com.

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.

Discovery of Insulin

On October 25th, 1923 the Nobel prize in physiology or medicine was awarded to Frederick Grant Banting and John James Richard MacLeod “for the discovery of insulin”. The discovery was made in 1921 i.e., only two years before, which makes the time period between the detection and this prize one of the shortest in the history of the Nobel Prize.

World Diabetes Day Celebrates Dr. Banting’s Birthday and the Discovery of Insulin

Dr. Banting was born on November 14, 1891.  That is why we celebrate World Diabetes Day on November 14th.

During a hot summer in 1921, Dr. Banting secured space to test out his theory in the University of Toronto. Along with his colleague, Charles Best, and a bare bones lab, they conducted dozens of experiments on dogs, which ultimately led to the discovery of insulin. 

Dr. Banting and Charles Best began their experiments ligating the pancreases of dogs, thinking this would prevent destruction by the digestive pancreatic juices, and then isolating the extract from the islet cells. They then processed the extract from the islet cells and injected this extract they called “insulin” into diabetic dogs.  According to an audio Interview with Dr. Best, by July 1921, they had 75 positive examples of insulin lowering blood glucose levels in dogs. 

In February 1922, doctor Frederick Banting and biochemist John Macleod published their paper on the successful use of a alcohol based pancreatic extract for normalizing blood glucose levels in a human patient.

Here are some photos of the first insulin bottles produced by the University of Toronto and Eli Lilly.

Soon, word of their discovery got out and the race was on to produce enough insulin to treat the flood of type 1 patients arriving in Toronto to receive this miracle injection.

First Children to Receive Insulin

The first patient to receive insulin was a ‘welfare’ case at Toronto General Hospital – no clinical trial structure to say the least. People from Canada/US flooded into Toronto to receive treatment. Banting struggled with the lack of accessibility of insulin – volume needed and issues of purification.

The earliest patients were “selected”, some youths from Canada/US, some soldiers with diabetes (probably because of Banting’s service in the First World War) and then later some select private patients. During this time they were working hard to increase the volume and continue to improve the purification process. Insulin was available for testing in US, namely through Dr. Elliot Joslin in the late summer 1922.

Dr. Banting – Fun and Interesting Facts

 

    • Sold insulin patent for $1

    • Was wounded during the First World War and received the Military Cross

    • Youngest Nobel Laureate in Medicine

    • First Canadian on the cover of Time Magazine

    • Among the last Canadians to receive a knighthood and have the title Sir Frederick Banting

    • One of only two “non-Americans” to have a Second World War Liberty Ship named after him (USS Frederick Banting)

    • Has as a crater on the Moon named after him (between Apollo 15 & 17 landing sites).

Takes a Team

While Best played a critical and important role, credit must also go to Professor Macleod, from the University of Toronto, who provided the lab space, showed Dr. Banting how to operate on dogs, provided his student Best and suggested they switch from a saline to alcohol to purify the ‘extract’.  Dr. Macleod also secured the support of JB Collip, the 4th man on the team and the fist person to purify insulin for human use. Best is also known for pushing Banting to return to the research during a particular dark period of failure.

Want to Learn More About the Dr. Banting and the Discovery of Insulin?

Historical Insulin Powerpoint Slides – here is a collection of some of my favorite powerpoint slides, depicting the discovery of insulin.

 Visit Banting House Facebook Page

Canadian Broadcast that highlights the first patient, Ted Ryder, the first patient to receive insulin from Dr. Banting. Some great historic video footage of Dr. Banting shaking hands with the young man..

The Quest – 1958  This short film is a re-enactment of the critical year in Dr. Frederick Banting’s life when he discovered insulin for the treatment of diabetes at the University of Toronto. It depicts the odds against which he and his assistant, Charles Best, worked; the scepticism of other doctors and the final victory that gave thousands of diabetics hope for a healthier life.

Historical Insulin Powerpoint Slides – here is a collection of some of my favorite powerpoint slides, depicting the discovery of insulin.

Banting Historical Site Facebook Page

The Flame – Banting House Historical Site Newsletter

Banting House Blog full of interesting facts

Grant Maltman – Banting House Curator and Historian

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10 Steps to Survive the Holidays

Staying Centered During the Holidays: Support for People with Diabetes

The holiday season can bring joy—but also stress, disrupted routines, late nights, and rich meals that may affect blood glucose levels and emotional well-being. For people with diabetes, this time of year can stir feelings of self-doubt and distress, especially if glucose levels veer outside their usual target range.

To help you and your community feel more grounded, we’ve created two helpful resources:

🎁 Holiday Survival Guide
This handout offers 10 practical strategies to stay balanced and navigate holiday gatherings with confidence. Even trying just one or two of the suggestions can make a big difference.

💡 Reframe & Reset: Coping with Diabetes Distress
This companion sheet provides tools to recognize, reframe, and release feelings of shame, guilt, or overwhelm that can surface during the holidays—and beyond.

These printable Cheat Sheets are designed for easy sharing with your friends, clients, and colleagues. Feel free to distribute widely—they’re full of tips to promote self-compassion, support balanced choices, and bring more ease to the season.

1. Be a sleep warrior – People living in the United States are chronically underslept. Not getting enough sleep is associated with increased hunger, higher blood sugars, poor concentration, frequent illness, and impaired problem-solving. Make sure to give yourself the gift of at least 7 hours of sleep a night. This sleep will help you make the best choices for your health and will protect against illness and fatigue. You got this.

Goal:  Get at least 7 hours of sleep a night. You deserve it.

2. Keep active – Holidays can put our exercise plans to the test, but we have a few ideas for you. Take an after-meal stroll instead of plopping on the couch.   After meal walks lower post-meal blood sugars and increases energy by getting muscles activated. Just 10 minutes of walking after meals can make a big difference.  You can even put music on and have a small dance session, anything to get your body moving.

Goal:  Work toward 30 minutes of activity a day. 

3. Don’t forget the Fiber – With all the snacks and tempting foods, whole healthy foods may take a back seat. Enjoy the abundance of seasonal vegetables, fruits, nuts, and grains that are fiber-rich and that decrease inflammation.  Examples include; yams, squash, mandarin oranges, almonds, pistachios, quinoa, kale, brown rice, warm oatmeal, salads, and broth-based soups.

Goal:  Strive to eat at least 25gms of fiber a day.

4. Enjoy the ultimate beverage – H20. Water is the perfect way to keep hydrated, replenished, and keeps appetite in check. Add a splash of flavor with a jigger of fruit juice or fresh cucumbers, lime slices, or a sprig of rosemary.  Be creative. Sparkling waters come in a vast variety of flavors, are calorie-free, and contain no artificial sweeteners.

Goal:  Keep hydrated by enjoying plenty of water.

5. Keep an eye on alcohol – While it’s true that red wine offers a beneficial anti-inflammatory compound called resveratrol, drinking too much alcohol can lead to unintended outcomes.  Studies show that we make poorer food choices if alcohol is on board. This can offer special challenges in party settings, where temptations are abundant. A drink of alcohol contains about 100 calories and mixed drinks have even more. In addition, alcohol can lead to low blood sugars, especially for those taking insulin or sulfonylureas.

Goal:  Limit alcohol to one drink a day for women, two drinks a day for men.

6. You are already sweet enough – Holidays and sugar go hand in hand. If possible, try and eat less than 6 teaspoons of added sugar (does not include natural sugars found in fruit and milk). This goal may not be realistic on all days, but aim for success most of the time.  Excess sugar intake can cause inflammation and buildup of fat in the liver. One strategy is to limit sugar intake during the day and save your 6 teaspoons for that special dessert or parties.  When looking at labels, it is helpful to know that 1 teaspoon equals 4 gms of sugar.

Goal: Limit sugar to 6 teaspoons a day.

7. Your teeth need extra special attention – Taking care of our teeth and gums improves health. Gum inflammation is associated with blood vessel inflammation. Swollen gums can also lead to an increase in blood sugars. During the holidays, find time for regular oral hygiene. Your mouth (and dental team) will thank you.

Goal: Brush teeth at twice daily and floss at least once daily.

8. Keep connected to friends and family who love you just the way you are! – As enjoyable as holidays can be, reuniting with family can also cause stress and stir-up emotions. Feeling out of sorts can lead to stress eating and decrease self-care.  If possible, reach out to a trusted friend to share your feelings or keep a holiday journal. Consider bringing a favorite book along during your travels that you find inspiring and comforting.  Give yourself permission to steal away for some quiet time.

Goal: Self-care is important during the holidays.

9. Enjoy an Oxygen Cocktail – Studies show that when humans venture into natural outdoor settings, heart rate and blood pressure improve. Take a moment to appreciate the feeling of the air on your skin, take a deep breath of fresh air, try to find nests in leafless trees, listen to the animal sounds and bird songs and just enjoy that moment.

Goal: Step into nature daily.

10.   Take inventory of things that you are grateful for – Find a moment each day to reflect on a few things that brought you joy or good feelings. Maybe it was your cousin who lent you her favorite sweater.  Or an Aunt who gave you the best hug.  Special moments with a best friend or an after-dinner walk enjoying the fall leaves.  These small moments of connection and beauty are one of the most treasured gifts of the holiday season that linger in our hearts and memory long after we say our goodbyes.

Goal: Take note of special moments.

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Gestational Diabetes: Diabetes Care in the Fourth Trimester

The fourth trimester is the time from delivery through the first 12 weeks
postpartum. During this phase, attention often shifts to the newborn; however, for women who have had gestational diabetes mellitus (GDM), this time can set the stage for long-term health and well-being. Although only about 10% of women are affected by GDM, their risk of developing type 2 diabetes increases tenfold ¹. Despite this heightened risk, studies ²,³ have indicated that postpartum follow-up remains suboptimal. Comprehensive postpartum care planning should start before delivery and include a multidisciplinary approach that supports physical and psychological health.

Individuals with GDM usually transition off diabetes medications in the postpartum period ¹; however, it is important to ensure appropriate medication care plans are in place based on the individual’s need. As prior existing pre-diabetes or diabetes may be found in up to one-third ² of individuals during this stage, both the American Diabetes Association and ACOG recommend oral glucose tolerance testing (OGTT) using pre-pregnancy criteria at 4-12 weeks 3 after delivery. OGTT is recommended instead of A1c testing, within the first 12 weeks postpartum, because of changes in blood volume, blood loss during delivery, and the rapid glycemic variations after birth.

However, we know barriers follow-up care and screenings exist. One health system’s retrospective study ¹ showed that while most women receive care from an OB-GYN after delivery, only 29% completed the recommended blood glucose screening. Among those
with abnormal results, just 11% were prescribed glucose-lowering medications, and 21% received a referral for diabetes risk reduction. This study is not unique ¹,²  in its findings, and it highlights the need for proactive outreach and post-delivery care.

Ongoing and additional screenings are recommended due to increased cardiometabolic health risks. If postpartum OGTT results are found normal, repeat pre-diabetes and diabetes screening is recommended at least every 1-3 years. ¹ Home blood pressure monitoring is recommended for individuals with history of hypertension. Checking a lipid panel within the first year postpartum for assessment of ASCVD risk, however lipid levels may take up to 3 months to return to pre-pregnancy levels and should not be performed before 6 weeks postpartum due to pregnancy-related changes in lipid metabolism. Routine screening for post-partum depression is also recommended, given the higher prevalence of depression symptoms during and post-GDM, impacting self-care and metabolic outcomes.

In addition to early screening, intervention strategies require a multidisciplinary approach focusing on recovery, prevention, and empowerment. Coordination between OB-GYN, primary care, diabetes care teams, and pediatric groups ensures continuity of care. Education on lifestyle and behavioral health management should be delivered with empathy and flexibility, recognizing the competing demands of new motherhood. A Diabetes Prevention Program subgroup analysis of women who received lifestyle
interventions 10 years after GDM found a 50% decreased incidence of development of diabetes, and a more recent meta-analysis 5 found lifestyle interventions reduced the incidence of diabetes by 24%. Interventions with a registered dietitian can support lactation, restore nutrient balance, and promote cardiometabolic risk reduction.

Encouraging a gradual return to physical activity, beginning with gentle movement and progressing to regular moderate exercise, is associated with improved insulin sensitivity, diabetes risk reduction, and enhanced mood. Incorporating lactation consultants into postpartum care supports ACOG recommendations for exclusive breastfeeding the first 6 months of life and continued up to 2 years of age with solid foods transition. Though challenges such as delayed milk production and reduced supply may occur 6 due to the history of insulin resistance, breastfeeding offers many health benefits and significantly lowers the risk of developing type 2 diabetes for both mother and child. 4 Finally, establishing a clear transition plan to primary care that promotes annual visits, family planning, and ongoing lifestyle support may enhance long-term health maintenance.

Flexible care delivery models that meet women where they are in this stage of life may further help overcome barriers and reduce disparities in postpartum follow-up.

The fourth trimester represents a pivotal opportunity to ensure postpartum care and support to engage lifelong health. This time often shifts focus to the newborn, but for women with a history of GDM, this period is not only about recovery but also prevention of type 2 diabetes, cardiovascular disease, and future pregnancy complications. The diabetes care team can support postpartum screenings, nutrition, lifestyle interventions, and transition of care that close postpartum care gaps. Proactively outreaching and engaging during this critical phase can connect individuals to resources and long-term chronic disease prevention.

References: 

  1. American Diabetes Association Professional Practice Committee; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S306–S320. https://doi.org/10.2337/dc25-S015
  2. Thomas D, Benson G, Gan A, et al. Fourth Trimester: Assessing Women’s Health Equity and Long-Term Cardiovascular Outcomes in a Large Midwestern Health System in 2021. Circulation: Cardiovascular Quality and Outcomes. 2023;17(1) https://doi.org/10.1161/CIRCOUTCOMES.123.010157
  3. D’Amico R, Dalmacy D, Akinduro JA, et al. Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes. JAMA Netw Open. 2023;6(2):e2254765.
  4. Parikh NI, Gonzalez JM, Anderson CAM, Judd SE, Rexrode KM, Hlatky MA, Gunderson EP, Stuart JJ, Vaidya D; on behalf of the American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and the Stroke Council. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart
    Association. Circulation. 2021;143:e902–e916.
  5. Bracco, P.A., Reichelt, A.J., Alves, L.F. et al. Lifestyle intervention to prevent type 2 diabetes after a pregnancy complicated by gestational diabetes mellitus: a systematic review and meta-analysis update. Diabetol Metab Syndr. 2025;17(66)
    https://doi.org/10.1186/s13098-025-01606-x
  6. Geddes DT, Gridneva Z, Perrella SL. Breastfeeding after gestational diabetes mellitus: maternal, milk and infant outcomes. Curr Opin Clin Nutr Metab Care. 2025 May 1;28(3):257-262.

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Diabetes Tech and Distress

The world of diabetes technology is advancing at a record pace. There is no doubt that technology intends to make life with diabetes a bit easier. In the United States, over 50% of adults living with diabetes have experienced some level of diabetes distress.¹ The impact of diabetes technology on mental well-being is complicated. Diabetes technology, including insulin pumps, continuous glucose monitors (CGMs), and connected insulin pens, can either lessen or aggravate diabetes distress.

Understanding Diabetes Distress

The American Diabetes Association (ADA) defines diabetes distress as “significant negative psychological reactions related to emotional burdens and worries specific to an individual’s experience in having to manage a demanding chronic condition such as diabetes.”.²  Diabetes distress is a natural reaction to the daily burden of managing diabetes. Signs of diabetes distress can include avoiding blood glucose monitoring, omitting medications, and struggling to achieve personal hemoglobin A1c targets.

The ADA recommends screening for diabetes distress at least annually. More frequent screening is recommended if clients are not meeting treatment goals, develop diabetes-related complications, and during times of life transitions.²

Validated screening tools for diabetes distress include:

  • Problem Areas in Diabetes (PAID) Scale
  • Diabetes Distress Scale (DDS-17)
  • Type 1 Diabetes Distress Scale (T1-DDS)
  • The Type 2-Diabetes Distress Assessment System (T2-DDAS)

Can Technology Improved Diabetes Distress?

Let’s explore how diabetes technology can have a positive impact on diabetes distress.

CGMs: With current CGMs, fewer fingerstick readings are needed to make treatment decisions. CGMs provide information on blood glucose trends and impending hyperglycemia or hypoglycemia, creating more peace of mind. 

Record Keeping: Various forms of diabetes technology can log blood glucose values, insulin doses, site changes, and total daily doses of insulin.  This eliminates the need for clients to worry about detailed record-keeping. 

Automated Insulin Delivery: Automated insulin pumps can decrease decision fatigue by making automated adjustments to both basal and correction insulin doses. This approach to insulin delivery can also benefit individuals with an active lifestyle. Utilizing wearable insulin delivery devices and algorithms can reduce the mental burden of diabetes self-management.

Connectivity: Remote data sharing supports communication with parents, caregivers, and friends to create a diabetes support team. Connectivity with healthcare providers enhances communication with the care team, allowing adjustments to treatment plans between clinic visits. 

Empowerment: The data trends can empower individuals living with diabetes to take control and gain confidence in making and evaluating medication and lifestyle adjustments in response to changes in glycemic control. 

Can Technology Worsen Diabetes Distress?

As diabetes care and education specialists (DCES), we must also understand how diabetes technology can negatively impact diabetes distress.

❌ Information Overload: Diabetes technology generates an enormous amount of data.  This can cause distress by constantly feeling the need to monitor glucose trends and numbers throughout the day and night, leading to feelings of anxiety and overwhelm.

Alarms: Alarms on diabetes technology are rooted in safety, but for those living with these devices, this can lead to diabetes distress.  Alarms can disrupt sleep or bring unwanted attention from others in public. Erroneous alarms for hyperglycemia or hypoglycemia can cause stress, frustration, and alarm fatigue.

Perfectionism: Diabetes technology provides a continuous insight into glycemic control, which for some can create a need for perfection. Some clients feel like they fail when they don’t reach their time-in-range goal each day. 

Physical Impact: Wearable devices not only carry a psychological burden but can also cause physical distress. Skin irritation and allergic reactions to adhesives cause physical pain and embarrassment. Those who wish to keep diabetes private, wearing a CGM, insulin pump, or other wearable device that puts diabetes on display, causing distress.

Technical issues: Losing connectivity with CGMs or an AID system can cause frustration and make it challenging to achieve optimal glycemic control.  Insurance coverage, prior authorizations, out-of-pocket costs, and access to supplies for diabetes technology can all contribute to or worsen diabetes distress.

How Can Diabetes Care and Education Specialists Help?

We can’t overlook diabetes distress. The 7A’s model is a useful tool for the DCES:

  1. Aware: Be aware of diabetes distress.
  2. Ask: Ask about diabetes distress. 
  3. Assess: Use a validated screening tool for assessment.
  4. Advise: Explain diabetes distress.
  5. Assist: Develop an action plan.
  6. Assign: If you are not equipped to help, assign the client to another healthcare professional. 
  7. Arrange: Set up follow-up as needed. 3

Here are some other actionable tips you can use to help those with diabetes distress:

  • Refer clients to local or virtual diabetes support groups.
  • Discuss with clients that diabetes distress is common and not a character flaw or failure
  • Collaborate with clients to choose the best technology based on their technology readiness, skill level, and comfort level. 
  • Set realistic goals for time-in-range and other data metrics.
  • Educate clients on how to troubleshoot their devices regarding alarms or connectivity issues. 
  • Support a healthy relationship with diabetes tech.

References

    1. Alexander, D.S., Saelee, R., Betsy Rodriguez, B., Koyama, A. K., Cheng, Y. J., Tang, S., Rutkowski, R. E., & Bullard, K. M. (2025). Diabetes distress among US adults with diagnosed diabetes, 2021. Preventing Chronic Disease: Public Health Research, Practice, and Policy, 22(E07), 1-7. https://www.cdc.gov/pcd/issues/20)25/24_0287.htm#:~:text=Among%20US%20adults%20with%20diabetes%2C%20an%20estimated%201.6%20million%20(6.6,income%20compared%20with%20their%20counterparts.

    2. American Diabetes Association Professional Practice Committee. (2025). Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes—2025. Diabetes Care, 48(Supplement_1): S86–S127. https://diabetesjournals.org/care/article/48/Supplement_1/S86/157563/5-Facilitating-Positive-Health-Behaviors-and-Well?searchresult=1
    3. American Diabetes Association. (n.d.). Professional development: Behavioral health toolkit. https://professional.diabetes.org/professional-development/behavioral-mental-health/behavioral-health-toolkit

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