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In diabetes care, what is the reported percentage
of patients who have missed or not returned for follow-up care due to feelings of shame, blame, or judgment?
Answer A is incorrect: 8.39% chose this answer, “10%.” This answer underestimates the problem. Research indicates that approximately 40% of patients with diabetes may miss or avoid follow-up appointments because they experience feelings of shame, blame or judgment related to their condition or care. This highlights the importance of delivering diabetes care with stigma-free, supportive communication approaches as a means to improve engagement and outcomes
Answer B is incorrect: 17.10% chose this answer, “25%.” This answer underestimates the problem. Research indicates that approximately 40% of patients with diabetes may miss or avoid follow-up appointments because they experience feelings of shame, blame or judgment related to their condition or care. This highlights the importance of delivering diabetes care with stigma-free, supportive communication approaches as a means to improve engagement and outcomes.
Answer C is correct: 66.77% chose the correct answer, GREAT JOB. “40%.” Per the 2026 ADA Standards of Care, bone health needs to be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.
Answer D is incorrect: 7.74% chose this answer, “60%.” This answer overestimates the problem. Research indicates that approximately 40% of patients with diabetes may miss or avoid follow-up appointments because they experience feelings of shame, blame or judgment related to their condition or care. This highlights the importance of delivering diabetes care with stigma-free, supportive communication approaches as a means to improve engagement and outcomes.
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!
All hours earned count toward your CDCES Accreditation Information
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.
Did you know that in ancient times, diabetes was identified by the sweet taste of a person’s urine?
Thankfully, science has come a long way from this ancient practice! The introduction of fingerstick blood glucose meters in the 1970s and continuous glucose monitors (CGMs) in the early 2000’s marked significant advancements in blood glucose monitoring. With more than 800 million people worldwide living with diabetes, interest in pain-free glucose testing is growing.1
Although current CGMs and fingerstick methods still require skin penetration, needle-free alternatives are being promoted, prompting many questions. Let’s discuss how healthcare professionals can address these products using evidence-based information.
Noninvasive (NI) glucose monitoring is a method of measuring blood glucose that does not involve breaking the skin. NI glucose monitoring technology under development includes: 2
FDA approval is granted for glucose monitoring devices used for either medical or lifestyle management. FDA approval for medical management is based on sufficient evidence of safety and accuracy for people living with diabetes. FDA approval ensures adequate evidence to guide treatment decisions, such as insulin dosing. FDA approval for lifestyle use applies to individuals who do not use the device for the medical management of diabetes and who are not on insulin therapy.
Currently, no NI glucose monitoring devices have received FDA approval for medical management of diabetes. In 2024, the FDA issued a safety announcement that NI glucose devices could pose a possible threat to those with diabetes, as the FDA has not approved them.3 Numerous companies are currently in the research process to advance NI glucose monitoring devices toward FDA approval.
When considering noninvasive glucose monitoring, it’s essential to understand how these devices fit into everyday diabetes care. Despite the lack of FDA approval, clients can purchase NI glucose monitoring devices without a prescription. Clients may be using these before the healthcare provider is ever aware.
Individuals living with diabetes should be aware that many factors, including hydration status, skin characteristics, temperature, and movement, can affect NI glucose device readings. These devices may be better suited for detecting general trends but are not approved for making real-time treatment decisions. As diabetes healthcare professionals, we can provide guidance on the use of FDA-approved devices to verify readings and inform treatment decisions. Arming our clients with this information can help avoid frustration and unsafe treatment decisions.
Diabetes healthcare providers often approach noninvasive (NI) glucose monitoring with cautious optimism. While the appeal of “no more pokes” is understandable, clients may be influenced by strong marketing claims. As providers, our role is to meet clients where they are to start the conversation.
As with any other FDA-approved diabetes technology, not every device is the right fit for everyone. Ask clients about their diabetes goals, barriers, and assess their digital literacy. Address what clients are seeing on social media and online ads, and how these NI devices compare to current FDA-approved blood glucose monitoring technology.
Here are some helpful tips that can further the conversation:
As technology advances, we hope to see accurate and safe NI glucose monitoring options for those living with diabetes. Until then, we can partner with our clients to provide education and clinical insights on the latest trends in diabetes technology.
References:
Get exam-ready with confidence.
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Full accreditation details are available on the registration page
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level up their clinical knowledge and skills.
This evidence-based study bundle is a comprehensive BC-ADM Boot Camp designed for advanced-level healthcare professionals preparing for the Board Certified in Advanced Diabetes Management (BC-ADM) exam and will also provide you with state-of-the-art information to level up your clinical practice.
Join national experts including Dr. Diana Isaacs (Cleveland Clinic), Beverly Thomassian (30+ years of experience), and Christine Craig for high-impact, virtual learning—no travel required.
✔ Learn from National Experts — Anywhere
Get the same expert-level instruction you’d receive in person, delivered live to your home or office.
✔ Interactive & Flexible
Walk away with tools you can apply immediately in clinical practice or while preparing for CDCES or BC-ADM exams. From insulin dosing protocols to behavior change strategies that work in the real world—this content bridges theory and practice.
Betty, a 60-year-old female, is receiving pembrolizumab, an immune checkpoint inhibitor, as treatment for melanoma. She is worried about the potential adverse effects. She is very concerned about the risk of developing diabetes. Her recent lab work shows normal fasting blood glucose and hemoglobin A1c.
Get exam-ready with confidence.
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Full accreditation details are available on the registration page
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level up their clinical knowledge and skills.
This evidence-based study bundle is a comprehensive BC-ADM Boot Camp designed for advanced-level healthcare professionals preparing for the Board Certified in Advanced Diabetes Management (BC-ADM) exam and will also provide you with state-of-the-art information to level up your clinical practice.
Join national experts including Dr. Diana Isaacs (Cleveland Clinic), Beverly Thomassian (30+ years of experience), and Christine Craig for high-impact, virtual learning—no travel required.
✔ Learn from National Experts — Anywhere
Get the same expert-level instruction you’d receive in person, delivered live to your home or office.
✔ Interactive & Flexible
Walk away with tools you can apply immediately in clinical practice or while preparing for CDCES or BC-ADM exams. From insulin dosing protocols to behavior change strategies that work in the real world—this content bridges theory and practice.
For last week’s practice question, we quizzed participants on who needs to have a bone density evaluation according to the 2026 ADA Standards. 47% 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:
According to the 2026 ADA Standards of Care, what individuals should be recommended to have a bone density evaluation using dual-energy X-ray absorptiometry to evaluate for bone loss?
Answer A is incorrect: 20% chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is tempting but incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago. Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.
Answer B is incorrect: 26% chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.
Answer C is correct: 47% chose the correct answer, GREAT JOB. “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” Per the 2026 ADA Standards of Care, bone health needs to be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.
Answer D is incorrect: 7% chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Get exam-ready with confidence.
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Full accreditation details are available on the registration page
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level up their clinical knowledge and skills.
This evidence-based study bundle is a comprehensive BC-ADM Boot Camp designed for advanced-level healthcare professionals preparing for the Board Certified in Advanced Diabetes Management (BC-ADM) exam and will also provide you with state-of-the-art information to level up your clinical practice.
Join national experts including Dr. Diana Isaacs (Cleveland Clinic), Beverly Thomassian (30+ years of experience), and Christine Craig for high-impact, virtual learning—no travel required.
✔ Learn from National Experts — Anywhere
Get the same expert-level instruction you’d receive in person, delivered live to your home or office.
✔ Interactive & Flexible
Walk away with tools you can apply immediately in clinical practice or while preparing for CDCES or BC-ADM exams. From insulin dosing protocols to behavior change strategies that work in the real world—this content bridges theory and practice.
Test your knowledge.
In diabetes care, what is the reported percentage
of patients who have missed or not returned for follow-up care due to feelings of shame, blame, or judgment?
All hours earned count toward your CDCES Accreditation Information
Q: What do you see as the most common misconceptions healthcare professionals have about people who don’t engage effectively with diabetes self-management behaviors?
A: The most common misconceptions are that people who don’t engage with diabetes management are unmotivated, not scared enough, and don’t care about their health.
We asked our favorite diabetes psychologist, Susan Guzman, PhD, to share her insights on how to engage most effectively when providing care to people with diabetes. Keep reading for more expert insights.
Q: How do these misconceptions lead to further problems for people with diabetes and further frustrations for the HCPs?
A: Not understanding the actual barriers to effective engagement leads to responses that don’t help. If you think someone is unmotivated, you might encourage someone to try harder or offer advice that doesn’t meet the person’s needs. If you think someone isn’t taking action because they must not be scared enough, you might try to warn them of all the terrible complications that could happen if they don’t make changes. If you believe someone doesn’t engage with diabetes self-management because they don’t care about their health, you may stop suggesting changes thinking they won’t do it anyway.
Because these are misconceptions, these corresponding tactics are ineffective, often leading people to feel more disengaged and misunderstood, immobilized with fear and hopelessness. In turn, HCPs too can end up feeling more frustrated and hopeless about helping patients reach treatment targets.
Q: What are some of the actual reasons people may not engage with diabetes self-management?
A: There are many common barriers that can result in someone seeing that needed changes as not worth the effort required or seem unachievable. When you begin to see the “good reasons” for people feeling disengaged from diabetes care, you can start to spot solutions that better fit the problem. For example, someone might actually feel doomed (scary complications and early death are unavoidable) and are hopeless that their efforts will have a positive impact. Instead of a scary lecture, this person could really benefit from some “evidence-based hope”, learning that there is good evidence that with targeted effort as a team to reach target, it is possible to have a long and healthy life with diabetes.
Q: Are there quick ways to identify these common barriers to effective diabetes management and brief interventions to help?
A: Yes! There are simple evidence-based ways to identify common behavioral obstacles and address them in routine clinical care. In our one-day workshop, “Engaging the Disengaged: Innovative Strategies for Behavior Change in Diabetes” we will help participants gain confidence in using these tools, having more productive conversations and collaborating with patients in generating more engaging and effective treatment plans.
Q: Are there any upcoming trainings available to explore these techniques and strategies?
A: Yes! Dr. William Polonsky and myself are facilitating a 6-hour conference in San Diego designed to bring these concepts life. This course isn’t a lecture — it’s an immersive, skills-building experience. Using a collaborative, person-centered approach, participants will practice real communication strategies that enhance motivation, build patient confidence, and make self-management feel doable. From diabetes distress to action planning to long-term adherence, every skill you gain is immediately applicable in your practice.
Sign-up today, since we are limiting enrollment to 50 people!
Dr. Susan Guzman is a clinical psychologist specializing in diabetes. In 2003, Dr. Guzman co-founded the Behavioral Diabetes Institute (BDI), the first non-profit organization devoted to the emotional and behavioral aspects of living with diabetes.
At BDI, she serves as the Director of Clinical Education, developing and leading programs for people with diabetes and healthcare professionals. She has helped develop and facilitate diabetes distress group interventions for two NIH-funded research studies for adults with type 1 diabetes.
Dr. Guzman is passionate about helping to change the conversations in diabetes away from shame, blame, and judgment to those based on facts, empathy, and engagement. She has been part of a joint ADA/ADCES effort to address problematic language and messages in diabetes.
Dr. William H. Polonsky, PhD, CDCES
In addition to being the Co-Founder of the Behavioral Diabetes Institute, Dr. Polonsky is Associate Clinical Professor in Medicine at the University of California San Diego.
A licensed clinical psychologist, certified diabetes care and educational specialist (CDCES), and highly-cited research scientist with more than 150 peer-reviewed publications in the field of behavioral diabetes.
His most recent research projects have focused on quality of life in diabetes, diabetes-related distress, hypoglycemic fear, glucose monitoring behavior and attitudes in people living with diabetes, group-based behavior change programs, the influence of continuous glucose monitoring on quality of life, and the development of new methods for enhancing diabetes education. In addition, he continues to maintain a small clinical practice where he works with his patients to help alleviate the stresses, strains and aggravations of living with diabetes.
Of note, he has authored several books for the lay audience (e.g., Diabetes Burnout: What to Do When You Can’t Take it Anymore) and co-edited several others for health care professionals (e.g., A CORE Curriculum for Diabetes Education).
For last week’s practice question, we quizzed participants on JR wanting treatment for pancreatic parasites, and what would be the best response. We share the scoop on pancreatic parasites below. 94.8% 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
JR is hospitalized with influenza. They have a history of prediabetes but now have persistent glucose readings between 220–260 mg/dL and are started on basal-bolus insulin.
JR is upset and states: “I’ve been reading that pancreatic parasites can cause of diabetes. No one is treating my infection.”
What is the BEST response?
Answer A is correct: 94% chose this answer, “It sounds like you are worried about a parasite infection. Tell me more about what you’ve read.” Great job. A is the best answer because it uses person-centered, nonjudgmental communication, as recommended by the ADA. It avoids dismissive language and explores misinformation respectfully. It preserves the therapeutic alliance.
Since many of you mentioned that patients are asking about parasites causing diabetes – here is the scoop. This false rumor is based on a video from a scientist named Hulda Clark that has since been debunked. Clark falsely claimed that most diseases, including AIDS, Cancer and diabetes, were caused by different parasites and could be cured with an electric “zapper.” Authorities took action against Clark’s “zapper” and other examples of her unproven treatments that she claimed could “cure all diseases” both before and after her death. Read more here
John Buse, MD a professor at the University of North Carolina School of Medicine, said there is a long-standing theory that infection by certain viruses could trigger the body’s immune response that leads to type 1 diabetes, but that no link has been established between a parasitic infection and any type of diabetes. He also said there is no evidence that methanol (another proposed false claim) — a poison — would have any different effect on someone with diabetes than on a person without high blood sugar.
Answer B is incorrect: 3% chose this answer, “Yes. We will be treating that issue soon, but first we need to focus on your insulin doses.” Option B offers a false narrative saying that they are going to treat the parasitic infection then shifts focus to the blood glucose, without recognizing JR’s emotional distress.
Answer C is incorrect: 2% chose this answer, “I can see how you would be concerned, but here is no such thing as pancreatic parasites.” Option C does initially recognize the emotions but then ends with a dismissive tone, that may make JR feel defensive and unheard.
Answer D is incorrect: 1% chose this answer, “Sadly, prediabetes always progresses to diabetes when people are acutely ill, and you will probably be discharged on insulin therapy.” Option D completely ignores the emotional distress in addition to making assumptions that may not be true.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Get exam-ready with confidence.
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Full accreditation details are available on the registration page
Our CDCES Boot Camp Online Prep Bundle is a comprehensive, high-impact program built specifically for healthcare professionals preparing for the Certified Diabetes Care and Education Specialist (CDCES) exam who want to level up their clinical knowledge and skills.
This evidence-based study bundle is a comprehensive BC-ADM Boot Camp designed for advanced-level healthcare professionals preparing for the Board Certified in Advanced Diabetes Management (BC-ADM) exam and will also provide you with state-of-the-art information to level up your clinical practice.
Join national experts including Dr. Diana Isaacs (Cleveland Clinic), Beverly Thomassian (30+ years of experience), and Christine Craig for high-impact, virtual learning—no travel required.
✔ Learn from National Experts — Anywhere
Get the same expert-level instruction you’d receive in person, delivered live to your home or office.
✔ Interactive & Flexible
Walk away with tools you can apply immediately in clinical practice or while preparing for CDCES or BC-ADM exams. From insulin dosing protocols to behavior change strategies that work in the real world—this content bridges theory and practice.
Have you ever left a medical appointment thinking, “I wish I had asked that question,” or “I wish someone really understood what this feels like”?
Managing type 2 diabetes is not just about numbers. It is about decisions. Emotions. Responsibilities. Fatigue. Food. Family. And sometimes feeling like you are carrying all of it alone.
That is why Coach Beverly and DiabetesSisters are proud to launch a new chapter in diabetes support on the West Coast!
Coach Beverly has been a nurse for 40 years and a diabetes specialist for 30. For two decades, she led a hospital-based diabetes support group that became a trusted space for women to gather, learn, and feel understood.
Now, she is bringing that experience to a new West Coast Type 2 Diabetes Support Group with DiabetesSisters.
What drew her to diabetes care was not only the science but the opportunity to make a difference in how women experience living with this condition.
She noticed that many conversations focused on what was not working. Very few recognized the daily effort required to manage a condition no one asked for.
She believes women deserve more than instruction. They deserve encouragement.
As she often reminds participants:
You are already doing more than you think.
This new diabetes support program on the West Coast is built around something simple and powerful: connection.
When women gather in Coach Beverly’s group, they talk about the realities of living with type 2 diabetes, including:
One woman shares something she has never said out loud. Another nods in recognition. And just like that, isolation begins to soften.
Peer support has been shown to strengthen confidence and encourage meaningful behavior change. Our 2024 survey data show that 90 percent of participants felt confident making behavioral changes, and 88 percent felt confident taking steps to support their diabetes management.
But beyond the numbers, there is something deeply human about being seen.
As one participant shared: “I feel so much more connected and less alone in my diabetes journey through the monthly meetings. DiabetesSisters is an amazing resource and community.”
That is the experience this new West Coast program is creating.
Because this is a new program on the West Coast, you have the opportunity to join from the very beginning.
At your first session, you can expect:
At the end of each meeting, you may choose one small, realistic commitment to focus on before the next session. Not a complete life overhaul. Just one doable step.
This is not about perfection. It is about progress. It is about living well while managing diabetes.
If you are a healthcare professional, this new diabetes support program on the West Coast offers an additional layer of care for women living with diabetes.
Diabetes management does not end in the exam room. Women benefit from structured peer support that addresses emotional health, daily decision-making, and lived experience.
Coach Beverly’s group complements clinical care and reinforces self-management behaviors. We welcome referrals for women living with type 2 diabetes who may benefit from additional support.
If you are living with type 2 diabetes and wondering whether this new group is for you, Coach Beverly has a simple invitation:
Come once.
And there is a seat waiting for you.
Join national experts including Dr. Diana Isaacs (Cleveland Clinic), Beverly Thomassian (30+ years of experience), and Christine Craig for high-impact, virtual learning—no travel required.
✔ Learn from National Experts — Anywhere
Get the same expert-level instruction you’d receive in person, delivered live to your home or office.
✔ Interactive & Flexible
Walk away with tools you can apply immediately in clinical practice or while preparing for CDCES or BC-ADM exams. From insulin dosing protocols to behavior change strategies that work in the real world—this content bridges theory & practice.